More than 50 million Americans have enrolled in HMOs, and 50 million more are expected to sign up by the year 2000. For a flat monthly fee the HMOs cover all necessary care and decide which care is necessary and who delivers it. Most provide good service at a decent price, but employers who pay premiums are demanding more cost-cutting. In some regions, HMOs have already squeezed pay for doctors and hospitals about all they can, and are tightening rules for patients. As competitive pressures spawn "horror stories," journalists may find themselves called upon to investigate.

Here are some typical scenarios that reporters will be called upon to sort out:

* A young mother needs a tricky operation for a rare tumor. The HMO surgeon has done it only once or twice. The patient wants a surgeon with more experience, but the plan says no.

* A woman who wants to visit her parents fifty miles away during her eighth month of pregnancy finds her HMO will not permit her to do so. If she goes anyway and labor begins, the hospital bills won't be covered.

* A man is struck by chest pains as he's dressing for work. His wife calls paramedics, who take him to the emergency room. When it turns out not to be a heart attack, the HMO won't pay.

Reporters should head first for the nearest medical school library to look up The Managed Health Care Handbook by Peter R. Kongstvedt, HMO Magazine, and the health policy reports by John K. Iglehart in The New England Journal of Medicine, July 7 and October 27, 1994. (Anything written before 1993 is obsolete.) Also, the Group Health Association of America offers a wealth of information on the HMO industry and individual companies. Their media contact is Don White (202 778-3274).

Here are some other useful resources:

* Forms that show profits and other financial information from publicly traded HMOs are available from the Securities and Exchange Commission. Proxy statements or annual reports often show executive salaries. Nonprofit HMOs must make available to the public a great deal of financial information at their offices. Ask for IRS Forms 1023/24 and 990.

* In many states, the insurance department has public records on HMOs that enable you to figure out what percent of the premium dollar is being spent on health care and how much is going to administrative salaries, marketing, and profits.

* Also ask the insurance department for the plan's complaint ratio. That is the number of complaints, divided by enrollment. You may have to do the computing yourself.

* State and local agencies that contract with HMOs for care of government employees or Medicaid patients should have figures on "disenrollment," how many members resigned from the plan. By comparing that number to the enrollment, you can get a good measure of dissatisfaction.

* Check court files, but don't be unduly impressed if a plan has never been sued. Federal law and court opinions shield HMOs from lawsuits in most cases.

* Call the National Committee for Quality Assurance in Washington to find out the plan's accreditation status and whether any HEDIS measurements are available for your region (HEDIS, short for Health Plan-Employer Data and Information Set, is a core set of performance measures).

If you're looking into a specific type of HMO complaint, try the state agency charged with investigating them -- usually the Department of Insurance, but sometimes Health or Corporations. Some states, including Florida, Washington, and Texas, allow reporters access to the files or provide names of people who have had specific types of HMO trouble. However, many states won't give reporters access. If that's the case in your state, try:

* Files in a state that permits access and in which the HMO does business, especially its headquarters.

* Health care rights organizations, if there are any in your state. If not, try activist groups such as Families USA or Consumers Union.

* Your own newspaper or TV station's consumer complaint office (often called Action Line). Many calls and letters come in there, and only a few of them ever get on the air or in print. If a certain HMO is causing trouble, the trend may show up there.

If one HMO draws a lot of complaints, it may be turning doctors into double agents. While the old-line HMOs paid doctors discounted fees or on salary, the new guys play hardball. Large bonuses go to the most frugal. Or part of doctors' pay is withheld until the end of the year to see if they've met guidelines. Riskiest of all is "physician capitation" -- that is, giving each doctor a pot of money, based on the number of patients, that is supposed to cover part or all the cost of their care. If capitated doctors come in under that ceiling, they keep the difference. If they spend more, they lose money. Capitation has led to a frenzy of cost-cutting by providers who have their own bank accounts on the line. Patients who are being subjected to this danger deserve to know it, yet most HMOs keep it a secret. To get this story:

* Find a doctor who quit the HMO and isn't intimidated by the HMO's gag clause.

* Call the state medical association. Some are collecting and analyzing contracts.

* Cultivate faculty at the state school of public health. They can lead you to obscure industry and academic journals that have examples of HMO contracts with doctors and help you to understand them.

If it seems to take federal, state, and local agencies a long time to act on complaints, it may be because they believe HMOs are saving them money on Medicare and Medicaid patients, and they don't want to rock the boat. Such conflicts of interest could result in:

* Agencies that are eager to place patients in cheap health plans dropping requirements for accreditation, a state license, or financial reserves.

* Officials failing to check the criminal, civil, and professional records of those who apply for contracts or HMO licenses.

* Warnings issued for years that don't result in any discipline.

A caveat for the zealous reporter: if all you ever hear is complaints about HMOs, you may develop tunnel vision. Many HMOs are fulfilling their promise to emphasize preventive care. Other innovative HMO programs are reducing fraud in workers' compensation and even preventing accidents. If HMOs in your area are doing these things, they deserve applause. If they're not, ask why.

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