Today the membership rolls of health-maintenance organizations (HMOs) top 67 million–more than of all people insured. But as the managed-care industry grows, so do patients’ complaints: A 1996 Consumer Reports investigation revealed that 10 percent of readers feel their HMO has discouraged them from seeking certain treatments, and 18 percent have gone outside their plan to get the care they need.

Consumers don’t have to take this medicine lying down. If you’re considering or already belong to an HMO:

Know the plan. “Read everything you can about the HMO’s scope of coverage and referrals and reimbursement policies,” says Liza Greenberg, medical affairs director of the American Association of Health Plans. Familiarize yourself with the membership booklet and the rules for services such as obstetric and gynecological care, emergency treatment and preventive care.

Ask about point-of-service (POS) plans. Some HMOs and employers , offer this insurance option, which lets patients seek care outside the network for an additional out-of-pocket fee.

Work the doctor-patient relationship. Talk frankly with your primary-care physician about your health concerns, says Trudy Lieberman, a senior investigative editor for Consumer Reports. Ask, for example, if she’ll refer you to specialists if necessary. Jointly develop strategies to make the system work for you.

Be a squeaky wheel. If you’re refused a referral or reimbursement, first try to negotiate through the HMO’s formal grievance process, suggests Lieberman. Then contact your state insurance commissioner s office to complain. Keep records of receipts, correspondence and phone calls, and ask your benefits administrator for help.

Always put your health first. Don’t hesitate to get the care you want and need. Some HMOs will reimburse as much as 80 percent of out-of-network costs.

For more managed-care strategies, read The HMO Health Care Companion by Alan Raymond (HarperCollins, $10).

Q I left my physically abusive husband of 11 years. He wants us to get back together and is seeking himself and for us, but I’m afraid to take any chances. What should I do?

A Do not allow your husband to coerce you in any way, and always maintain self-protective behavior. If you fear reconciliation, encourage him to seek help on his own, and ask his personal counselor to advise you of any progress. Only indepth therapy can determine whether your husband has learned how to control his violent outbursts.