Carve-Outs

These are entire areas of medical care that the HMO pays another insurer to manage. The most common is mental health care.

It allows an organization with more understanding of a disease to manage it. Unfortunately, some things fall into the cracks and neither part of your plan wants to pay for it - like testing the psychological effects of a neurological disease, for instance.

It's probably no accident that this strategy is used most often for mental health. Most people are loath to consider the possibility they may need such care themselves, and they don't question the quality of care their plan provides until they need it.

 

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©2000 Eileen K. Carpenter, MD