Now this has become a legal issue with the State of California, can this stand with not covering Viagra? It might appear the jury is going to be out on this one for a while and there are other drugs that come in to play with HMO coverage.
What is and what is not covered is becoming a big issue today and how far do you need to drive to a facility within network. HMOs are also having their own internal management struggles in various areas. If there were enough in network locations it would not be an issue, but as recent contracts have broken down, changed, etc. figuring out what your HMO does and does not cover can be challenging and again the focus has been shifted to money first, healthcare second. BD
Who would have guessed that a little baby-blue tablet designed to restore potency to the impotent would pack such a wallop? In June, Kaiser Permanente, the giant HMO with the imperial name, announced that it had decided not to cover the cost of the $10 erection pill for its 9 million members. Just three weeks later, the little pill had become a symbol of one of the nation’s hottest political issues: what HMOs do and don’t pay for….Rather than increase premiums to cover the added costs, Kaiser decided to let its members pay for the potency pill out of their own pocket.
Viagra’s role in the debate was heightened last week when the federal agency that administers Medicaid told the states that they were required to cover Viagra for the indigent and infirm “when medical necessity dictates,” and some of the states–much like tightfisted HMOs–dug in their heels and refused to pay.
Getting really sick is what worries most Americans…. Pressured by rising medical costs on one side and employers’ refusal to pay higher premiums on the other, a number of managed-care firms began running into trouble. Case in point: Kaiser Permanente, which posted a $270 million loss last year. This was on the heels of a sudden $291 million loss at Oxford Health Plans of Norwalk, Conn., which CEO Stephen Wiggins blamed on the collapse of his overtaxed computer billing system. Wiggins was forced to resign, but that wasn’t the end of his troubles. Last week the New York State attorney general’s office confirmed to TIME that it was investigating Wiggins for possible insider trading.
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