Approved for All Ages
Dr. Linda Peeno is a devoted physician and homemaker who is just re-entering the workforce after spending several years in her Kentucky home raising her children and stepson while her husband Doug, an OB/GYN physician, built his practice.
Linda, apprehensive but eager to succeed, is overwhelmed at her good fortune when she is offered a high-paying position as a medical care reviewer at a major HMO. This HMO acts as a go-between among doctors, employers and patients, emphasizing the need to stop doctors from "scoping for dollars" and ordering unnecessary tests and surgical procedures for patients just to pad their insurance claims. Linda, who is highly ethical, agrees that this unscrupulous behavior should not be tolerated. She is confident in her ability to make tough decisions and deny medical services that are unwarranted. However, she soon realizes that her employers expect her to reject virtually every claim she can, even for medically necessary procedures. Unable to accept the HMO's policies and practices, she resigns from her position, despite her husband's objections.
She accepts another similar position at a managed-care facility that claims to put the needs of patients first. However, she soon learns that the emphasis is again on dollars saved over patients' health needs. She talks with an attorney whose beliefs and ethics are the same as hers. After one particularly unacceptable decision by her employers, she resigns from her job and teams with the attorney, and together they devote their time and energies to correcting these practices.