Your options for medical care will depend on where you live. The kind of care specific to HIV infection is likely to be better in a big city: most big cities offer many options for treatment of HIV infection. Smaller cities and rural areas are likely to offer fewer options, and the physicians in these areas are likely to be less familiar with HIV infection. This is because most of the people who became infected in the early stages of this epidemic lived primarily in large cities like New York, San Francisco, Los Angeles, Miami, and Washington, D.C.; disproportionately fewer people living in smaller cities and rural areas were infected. As a result, physicians who trained or who practice in small cities or rural areas often lack experience in treating HIV infection.     As a consequence, when people with HIV infection who live in small cities and rural areas want medical treatment or periodic consultation about medical treatment, they often travel to the nearest physician or clinic specializing in HIV infection.     The options for medical care may also be substantially fewer for people who belong to HMOs, for people receiving Medicaid, and for people who have limited financial resources and no health insurance. HMOs and city health clinics offer medical services that vary in quality, some very good and some not so good. Some HMOs do not allow patients to see physicians other than those physicians who participate in the HMO, or do so only on a case-by-case basis. People enrolled in those HMOs therefore have no choice in what specialists they see. HMOs can also limit the hospitals people may be admitted to.     The process of selecting among medical options begins with finding out what your finances allow. This disease is expensive, and HMOs, insurance plans, and Medicaid will each pay for some things and not for others. In addition, HMOs, insurance plans, and Medicaid all differ in what they will and will not pay for. Many insurance plans especially restrict the outpatient services they cover. Medicaid covers a broad range of services but reimburses physicians at so low a rate that most physicians refuse to accept patients paying through Medicaid. Many employers offer a choice between joining an HMO or being reimbursed by the insurance company, and you may be able to switch back and forth as your needs dictate. In any case, you need to know your options. You can begin by finding out what your HMO, insurance company, or government medical assistance will allow, and then discussing these issues candidly with your physician or with a social worker.

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