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The Horror of HMOs

HMO HealthcareThis article was written anonymously. Please do not write to Dr. Grohol about the content of this article unless you’d like to either add on to it with your own personal experiences about your difficulty in receiving adequate mental health treatment from your managed care entity or HMO, or you’d like to respond to it in some other way.


If I’m rushed into surgery today because my appendix is about to rupture, my HMO will pay 100 percent for surgical services and hospital- covered expenses.

When – in my case, not if – I experience another major depressive episode, the HMO will pay 50 percent up to no more than $1,000 per year for psychiatric or psychotherapeutic care, or any combination of both. At local rates, that works out to about one appointment with someone per month or so, with me laying out about $1,400 of my own when you add in co-payments for visits and prescriptions.

The HMO recognizes that a ruptured appendix can lead to peritonitis, which can lead to death. So what does it think that acute unipolar depression leads to? A bad hair day?

In truth I should be elated that my employer’s HMO is so beneficent. The previous provider, if it can be called that, made no provision at all for mental health care.

Why this discrepancy? It’s purely a matter of probabilities and money. The HMO knows I won’t have my appendix removed more than once. On the other hand, I could be faking this depression thing, though only heaven knows why. And, after all, you really can’t measure or quantify depression, can you? No test or x-ray can confirm that I’m tickety-boo and all better again.

In effect, the HMO is saying I’d best not sink very far or for very long. In a 1995 book titled The Beast, Pulitzer Prize nominee Tracy Thompson frets that her 10 days of essential in-patient treatment for depression at a Washington hospital cost her employer’s insurance carrier $20,000. By comparison, my HMO will pay 50 percent for no more than 10 days per year – with a lifetime maximum of $10,000. I don’t need a CPA to tell me to dread ever finding myself at the precipice that Thompson did.

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While Congress rants about controlling Medicare costs and the Clinton White House mewls over universal health insurance, those of us with mental illnesses (the very population that experiences one hell of a hard time merely facing the day with something approaching competency) are at the mercy of the HMO bean-counters. They wouldn’t argue if I were a coronary patient or a diabetic, but because I’m a unipolar, I’m treated like something on the sidewalk they wished they hadn’t stepped in. Why didn’t I think of this before? I know what I can do: complain to my employer about unequal treatment at the hands of the HMO. Of course, the employer can’t change this without paying bigger premiums, and that prospect carries no joy at all. And then there’s the minor matter of telling the employer that I’m mentally ill, so much so that a psychiatrist recently wrote to the local federal court stating that under no circumstances was I to be called up for jury duty. That revelation would do wonders to anyone’s career, don’t you think?

How am I doing? After four years of all this, I’m keepin’ on. I take my medication on schedule, I fight my natural tendency to isolate when there’s an episode, and I do the work that the therapist says I need to do. Some days are diamonds; some days are stones.

Truth to tell, I’m rather proud that I’ve climbed so far out of the pit, considering that I’m dealing with an HMO whose actions say it knows I could easily snap out of this depression crap if only I really wanted to. To all this I suggest that the penurious, callow bastards ought to wake up just one morning inside my head, or the heads of my countless brothers and sisters who are Walkers In Darkness. Let them wonder why they’re weeping convulsively at 4 a.m. for no apparent reason. Let them experience just a few routine hours of any one of our lives, and then let them decide what they’re willing to pay to escape.

In fact, let them roast in hell. All of us have done so. Now it’s their turn.

The Horror of HMOs

This article has been updated from the original version, which was originally published here on November 16, 1995.

Psych Central Staff

Psych Central Staff writers are vetted, professional authors and science journalists. All work written under this moniker is editorially and scientifically reviewed by Psych Central.

APA Reference
Psych Central. (2019). The Horror of HMOs. Psych Central. Retrieved on August 4, 2020, from
Scientifically Reviewed
Last updated: 15 May 2019 (Originally: 16 Nov 2014)
Last reviewed: By a member of our scientific advisory board on 15 May 2019
Published on Psych All rights reserved.