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SCHUMER'S STOP IN CHEEKTOWAGA ADDS TO GRIPES ABOUT HMOS

Everywhere he goes in the state, says Sen. Charles E. Schumer, D-N.Y., he is bombarded with complaints about health maintenance organizations.

He got yet another earful when he showed up Tuesday at St. Joseph Hospital in Cheektowaga to talk up a patients' bill of rights now before the Senate.

Max Berman of Buffalo said his wife, who has lymphoma, needs two weekly shots of a drug that boosts her energy level. But instead of letting her self-inject the medicine, her HMO makes her go to the doctor's office, which is far more expensive, he said.

Berman said he is waging his own war with the insurer over how his cellulitis should be treated.

"Who are they to dictate how we should live, what we should do with our lives?" he asked.

Jennifer Coleman of Buffalo complained about "the gross disparity" between the way HMOs cover mental illness -- few do -- and other conditions.

Adding to the litany were Nancy Miller of Cheektowaga, whose husband, Thomas, died in 1997, after his insurer repeatedly refused to let him receive a bone marrow transplant for a disease called AL amyloidosis, and Janet Stanek of East Aurora, who was forced to pay $1,000 a month to lease a heart monitor for her 2-year-old son, Bailey, who has sleep apnea, after her HMO declined to cover the cost.

Schumer said the Senate patient rights bill he supports, sponsored by Sens. John McCain, R-Ariz. and Edward M. Kennedy, D-Mass., would put medical decisions back in the hands of physicians, "rather than an accountant in Denver who has no medical training."

The rising chorus against HMOs, which are subject to more complaints in New York State than any other industry according to a study Schumer released Sunday, underscores the need for reform, he said.

The McCain-Kennedy bill would:

Establish independent panels to review HMO decisions denying or limiting care.

Allow families to sue when an HMO decision to withhold care results in injury or death.

Guarantee access to specialists, even if the physician is not an HMO member.

Ensure access to emergency room care whenever the HMO member needs it.

Let a woman choose an OB/GYN specialist as her primary care physician.

Require HMOs to cover the cost of potentially life-saving experimental treatments.

Prohibit HMOs from "gagging" member doctors who want to discuss all treatment options with their patients.

Schumer said a bipartisan coalition pushing the McCain-Kennedy bill is "on the edge of victory" despite President Bush's threat to veto it.

However, the bill would not require HMOs to cover mental illness, Schumer told Ms. Coleman.

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