Now that a million moms in sensible shoes marched on the Capitol to support gun control, we may be seeing a re-energized era in democracy. If grass-roots lobbying is back, how about a new American Revolution—one against the mighty HMOs (slogan: Have More Operations).
Maybe it’s because my move to Rehoboth put me into the HMO system for the very first time, or maybe it’s just my advanced age (My sister just informed me that my old elementary school is now the town Historical Society. Nice.), but I’m fed up with health maintenance organizations.
I remember when HMOs first appeared on the scene as a choice. They were a lot cheaper than regular insurance and offered scads of preventative care coverage. Now, the only thing they prevent you from is seeing a doctor. Not only have HMOs morphed into regular insurance, but they cost more than our old insurance ever did.
I’m particularly ticked off today because I just returned from some routine blood tests to measure my donut to vegetable ratio, and I’m exhausted. Not from the tests, but from the staggering effort it took just to find out where I was supposed to go to give blood.
The prescription ordered tests at a place up the road. I get to the lab and they tell me my HMO doesn’t play on their team. It’s 7:30 in the morning, I haven’t had breakfast, I’m ready to open a vein and nobody will tell me where to go. “Look it up in your HMO List of Providers,” says the clerk.
I go back to the car, where, by sheer dumb luck, my provider list is still on the back seat with some junk mail. My book says I can go to Lab Corp ten minutes away. Bleary-eyed and hungry as hell, I wend my way to the next lab. After standing in a long line of people checking in for their mandatory drug tests and other humiliations, I hand over my insurance card and the receptionist tells me that Lab Corp no longer takes my particularly odious HMO. She saw the whites of my eyes quiver and said, “Wait a minute, I’ll find where you should go.”
Wouldn’t it just be easier to use leeches to harvest my blood? Finally, I pull up to Transylvania Express, or whatever this blood collection depot is called, get the deed done and stagger into Wawa for caffeine.
As frustrating as the experience was, at least I wasn’t sick at the time. Dealing with an HMO when you feel lousy is just sadism.
Once last winter, after a sleepless night of coughing, I called the doctor to refill my cough medicine prescription. Since HMOs rule that doctors must see patients every seven minutes to be profitable, my doctor was busy sprinting from examining room to examining room making her quota, and couldn’t come to the phone.
When I finally got through, the doctor agreed I needed more cough syrup, but told me that since the stuff was a narcotic, she couldn’t just call it in to the pharmacy. I had to pick up the prescription in person. Right. Tell the person with Bronchitis to cough their way to the primary care outpost, spreading a swath of infection and good cheer. I gathered up the written word and hacked and horkled my way to the drug store.
“Sorry,” said the pharmacist, “your HMO won’t approve it. It’s too soon.”
Excuuuse me????
“They won’t approve a refill for another two days. The directions said two teaspoons at night and they calculate how many nights that covers and won’t refill it until that time,” explained the weary pharmacist.
Well here’s the thing. Originally, the doctor prescribed it only at night since it would make me too sleepy to go to work. Once I was too sick to go to work anyway, the doctor told me to take the medicine in the daytime, too. Did the HMO clerk have this information on which to base her decision? Was this all-powerful HMO Pooh-Bah phone operator clairvoyant enough to have seen me hacking away all night?
Are they afraid I’m going to sell this stuff on the street? Have they ever tasted it? And did you see the size of the bottle? There’s more controlled substance in a Starbucks Cappuccino.
Now, mind you, the big bad HMO doesn’t say I can’t have it; they just say they won’t pay for it. Suffice it to say I forked over the price of a ritzy dinner for two for the two ounces of orange swill and went home to guzzle my stash.
These days, when I have nightmares, they’re about HMOs denying coverage.
I remember when Bonnie went to that very expensive high tech sleep clinic, resulting in her diagnosis of sleep apnea. Fine, the HMO paid for all the tests, the overnight stay, the round the clock monitoring and the apple juice and danish in the morning. Trouble was, after her doctor prescribed a machine to keep her from asphyxiating in the night, the HMO refused to pay for it.
Sight unseen, not to mention without benefit of hearing the gurgling sounds she can make at night, they decided she didn’t need the machine bad enough for them to pay for it. I wish them the living hell of watching her try to obtain a good night’s sleep.
Needless to say, we forked over the $1900 for this thing they call durable medical equipment. At that price it sure as hell better be durable.
The one thing HMOs can do efficiently is bill you. In fact, it appears to be nearly impossible to resign from an HMO. I changed policies at the end of December and I’m still getting bills from my old HMO threatening to cancel my coverage because I haven’t paid my bill. Duh, what did they do with the three (3) letters I wrote canceling my policy? Even though I know that my coverage is in place with my new stinking HMO, it’s still disconcerting to receive these ominous threats from the old stinky one.
And just try to be self-employed and get coverage. It practically took an Act of Congress for Bonnie and her former business partner to get a policy. She had to provide more ID and paperwork than if she’d been applying for the Witness Protection Program. But just try and take somebody OFF the policy.
We canceled the partnership when said partner skipped town last fall, and then canned the insurance policy immediately thereafter. For all we know, the jerk really is in the Witness Protection program, but in January they were still billing us for his insurance and still sending his Viagra to wherever he was hiding out.
It’s enough to make you crazy. Which, by the way, you better not be, because finding a therapist who takes your insurance is much, much harder than healing thyself.
I feel sorry for the beleaguered doctors and their staffs. I’ve walked into medical offices where everybody’s running around shouting orders and running for equipment. A patient gone code blue? No, they can’t find the right referral forms and the fax is on the fritz. These days, if the office gets high tech medical equipment it’s a new copier.
And the poor pharmacist. It’s a pitiful night when they have to tell me they’re sorry that my full vial of Prilosec fell in the sink with the Woolite but I’m not due for a refill until July. It’s enough to give you a belly ache.
That’s that. I’m doomed to indigestion for the rest of the summer. I’m ready to march on Washington again. Hey, Hey, Ho, Ho, HMOs have gotta go….