HMO Obstacle Course

Pain wakes me up at 1:00am and 7:00am like clockwork. Some Vicodin and icing keeps me from crying. I send an e-mail to my boss stating that I’ll be out for the week.

On the way home I had tried calling the insurance company to get instructions for the next step, but the only advice I got on a Sunday evening was to call back on Monday at 8:00am. I had recently changed HMOs and selecting a primary care physician had not been a top priority. Ooops. A computer had randomly assigned me to a medical group four cities away.

Miraculously there is no hold time at 8:00am and I get connected right away and explain that I need the closest surgeon. Because I have an HMO and not a PPO the only way to get in contact with a surgeon is to be referred by my primary care physician. I am also informed that requests to change medical groups take a few weeks to process. I have to convince her that I’m in a lot of pain with a broken bone and don’t have a few weeks; I need the closest doctor right now! She gives me the name of a local doctor that is just four blocks from my home. Perfect! … or so I thought.

The answering machine of this mom and pop operation states that the office does not open until 10:00 but the gives a number for call for urgent situations. This is an urgent situation so I call.

“Hello Dr. C I’ve just been assigned to you for my doctor and I need to see you right away about surgery because I have a broken bone.”

“WHY DID YOU CALL THIS NUNBER??!!!”

“I’m in a lot of pain and I need to see a doctor right away.”

“GO TO EMERGENCY ROOM!!!!”

“I’ve already been to an emergency room.

“WHY DID YOU CALL THIS NUNBER??!!!”

“I’m in pain.”

“GO TO EMERGENCY ROOM!!!!”

I burst out sobbing and throw the phone. My husband picks up the phone and the doctor gets in one last “WHY DID YOU CALL THIS NUNBER??!!!” before JP tells him that we won’t bother the doctor again.

I call the insurance company again asking for yet doctor because I can’t have a doctor that yells at me. I decide this time to ask for the largest medical group in San Francisco – but she is only working from a list and can’t tell a mom and pop shop from a corporate giant. Also when she does a search for San Francisco, she gets groups that are as far away as Palo Alto. It’ clear that the woman has no knowledge of the region. I have to ask if Brown and Toland is on the list, because I, at least know, that they are a large group in San Francisco.

Finally we find a doctor that is close to my job and I call that office.

“Hi, I’ve just been assigned to Dr. A and I need to see him right away because I have a broken bone and I need surgery.”

“I’d be happy to help you. There are two things you first need to know. Our office is dedicated to spending more time with patients so there is a membership fee of $149 per year. Also, Dr. A is no longer accepting patients, but I can help you find another doctor in our group.”

A membership fee for a doctor’s office??? I’m exhausted and in a lot of pain.

“Do you have a doctor who can see me today?”

“Yes, Dr. M is available.”

“Sign me up!”

“Can you be here in an hour?”

“Yes!”

“Before you get here you will need to log on to our website and pay the membership fee.”

Whatever! I’m just so happy to finally have a doctor’s appointment! One more call to the insurance company to change my primary care physician yet again and I’m on my way!

It’s love at first sight with Dr. M. She’s wearing a pink sweater, not the typical scrubs, and somehow comes across as full of empathy. She looks at my X-rays and quickly makes arrangements for me to see a surgeon and writes a prescription for something stronger than Vicodin to help with the pain.

It takes JP an hour running to three pharmacies to get the prescription filled while I camp out on a park bench. People give me odd looks, but the only way to keep the pain down is to keep the foot above heart level by laying down and putting my foot on the arm rest.

The surgeon is across town so it’s another trip where I lie down in the back seat of the car and keep the foot elevated with the help of the other leg. A challenge on pot hole filled roads as JP weaves in and around city traffic.

Although he seems too young to be completely bald, I immediately take to Dr. D’s shiny dome and soft blue eyes. As he analyzes the X-ray he muses that this is a highly unusual break and that it is going to be difficult to repair. He questions if this is my first accident and points out a line fracture about a centimeter away from the floating piece of bone. He is concerned that the other fracture may split further when the screws are inserted and orders an MRI for the following day. Surgery will be on Friday.

It’s been a long day and another backwards crab climb up three flights of stairs. The new drugs are working and I feel better having secured the surgeon when I get a phone call from Dr. C wanting to know if I went to the emergency room. It takes me a moment to recall the doctor that yelled at me this morning.

“I did not go to the emergency room, I saw another doctor.”

“YOU CANNOT SEE ANOTHER DOCTOR!”

“Well, I did see another doctor.” I can’t believe this doctor has called just to yell at me again.

“YOU CANNOT SEE ANOTHER DOCTOR! INSURANCE WILL NOT COVER ANOTHER DOCTOR”

“I worked it out with the insurance company, you yelled at me and you are no longer my doctor.”

“YOU CANNOT CHANGE DOCTORS”

“I worked it out with the insurance company, I need to sleep now – goodbye.”