I Am in HMO Hell ...

  1. This is just a vent out of pure frustration. I injured my knee a week ago, I can't walk and, nearly a week later, I still haven't received any treatment for it. Nursing school starts next week and, because of this I'll probably have to miss my first clinical, maybe more ... jeopardizing my ability to graduate.

    Let's just say that I've never been more frustrated with the healthcare system.

    I injured my knee at night so I show up at the doctor's office first thing. They don't have time to see me, so I go to "urgent" care. They take an x-ray. They don't have a radiologist to read the x-ray so I have to wait the entire weekend to get the results ... which show nothing.

    Then I have to beg the doctor to see me on Monday because they say they don't have any time to see me until Wednesday. Only when I break down and cry, do they finally agree to get me in to see the doctor on Monday. She examines my knee, and says she's going to order an MRI ... which will take another week.

    I explain the situation about nursing school and how it's impossible for me to start school if I can't walk. So she says she'll put the order in right away. Instead, the order gets in 24 hours later. Then, I have to bug the clerk who gets HMO approval to pay for it. Then I've got to bug the MRI place to get me in as quick as possible.

    All I do is stay on the phone bugging people to do their job. I've got nothing else to do because I can't walk.

    I injured my knee last week and it's taken until Wednesday to get an MRI done. If I hadn't been such a pain and constantly bugging them, it would have taken much longer. Nevertheless, in a week I've received no diagnosis, no treatment for it ... no brace, no nothing ... except some crutches that I had to beg them to give me. Meanwhile, my husband has had to stay home from work this week to help me get around.

    With any luck, I'll finally get referred to an ortho specialist tomorrow and then I'll probably have to beg for another appointment to try to get some help and treatment in a reasonable time period. I'm praying that they won't tell me I'll have to wait another week to try to get some treatment.

    Yes, I've already put in the paperwork to change doctors and my insurance, but, unfortunately, that won't go into effect until January. Yes, I've already called the director of my nursing program to try to get them to work with me. And yes, I've changed doctors before because of similar problems but this medical group is as bad as the last one. And yes, I tried to go to the ER but insurance wouldn't pay for it. I couldn't risk thousands of dollars of healthcare bills that wouldn't be covered by insurance.

    God help you when you get sick in this country.

    :angryfire
    Last edit by Sheri257 on Aug 23, '06
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  2. 14 Comments

  3. by   donsterRN
    I know you didn't ask for advice, which is good because I don't have any. I do, however, have lots of empathy and am truly sorry for your HMO Hell...

    I'm going through it myself these days. I'm not convinced that there is a resolution coming anytime soon.

    Let's commisserate together, OK?
  4. by   Roy Fokker
    Wow!

    So sorry you're going through this. :icon_hug: It's the PITS when you have to BEG people to DO THEIR freaking jobs! :stone



    Man, I don't even have insurance right now. I better not get sick :stone
  5. by   Sheri257
    Quote from Roy Fokker
    Man, I don't even have insurance right now. I better not get sick :stone
    I shouldn't complain then. I guess crappy insurance is better than no insurance. I have no idea what I would do with no insurance. I could go to the ER but then I'd be on the line for thousands in medical bills that I couldn't pay that would ruin my credit.

    I hope you get some insurance soon because it's really scary. All I did was injure my knee during an exercise class and, now I'm totally out of commission. If I had to pay for the MRI, etc. on top of not being able to work, go to school, etc. ... it would be a financial disaster.

    So, while it's incredibly frustrating, it could be a lot worse. Thanks for putting this in perspective. I'll count my blessings.

    :typing
    Last edit by Sheri257 on Aug 24, '06
  6. by   Katnip
    I fully understand. I had to beg my HMO to help pay for a glucometer and strips, even though my diabetic educator checked the pan and said they are covered.

    I also had to beg for approval for a biopsy. Yes, a biopsy. They don't want to cover it. There are, but they fought me on it. I am getting it done next week. We'll see if I have to fight with them afterward, too.

    Unfortunately, DH doesn't have a whole lot of choice as far as insurance in his company and this was the best one of the lot.
  7. by   Sheri257
    Quote from cyberkat
    I also had to beg for approval for a biopsy. Yes, a biopsy. They don't want to cover it. There are, but they fought me on it. I am getting it done next week. We'll see if I have to fight with them afterward, too.

    Unfortunately, DH doesn't have a whole lot of choice as far as insurance in his company and this was the best one of the lot.
    Well then, I guess I really shouldn't complain. The approvals haven't been the problem as much as trying to get the bureauacy to move and getting the paperwork processed. So far, they've been paying ... it's just been very slow. So, again, I should count my blessings. Obviously it could be a lot worse.

    I guess I've been impatient because I can't walk. Right now I've got Blue Shield but I'm going to try Kaiser. Maybe it won't be any better but, at least we have other choices.

    Again, thanks for helping me put this in perspective.

    :typing
    Last edit by Sheri257 on Aug 24, '06
  8. by   Katnip
    No, I understand your frustration. It's ridiculous. They figure they won't do anything unless customers push and complain, and many don't so they make money that way.

    I have CareFirst from BC/BS I thought they were supposed to be good, but sheesh.
  9. by   Sheri257
    Quote from cyberkat
    No, I understand your frustration. It's ridiculous. They figure they won't do anything unless customers push and complain, and many don't so they make money that way.

    I have CareFirst from BC/BS I thought they were supposed to be good, but sheesh.
    From what I understand it's not just the insurance that's the problem, but also the doctor's offices. I may be wrong but, from what I've been told they get paid the same whether they treat you today or a month from now ... it's makes no difference. Hence the reason, at least in my case, that it's been so slow trying to get some treatment.

    So I think that's another problem.

    :typing
  10. by   Roy Fokker
    Hi Lizz

    No, I mean, I understand your frustration.

    It's so hard when it comes to our health - I mean, if YOUR body, YOUR health. How disgusting is it that you have to JUSTIFY things like that?

    Very frustrating. Very infuriating.

    Here, borrow this: :trout:

    .... and go give 'em some
  11. by   Sheri257
    I finally got the ortho referral but, the specialist can't see me for two weeks. Needless to say, I'm showing up at the office first thing anyway.

    Meanwhile, nursing school starts Monday. I may have to sit out of a semester because of all of this because two ligaments are torn, as well as my meniscus. I probably need surgery.

    Maybe I'd have to wait a semester anyway but ... the delay in healthcare isn't helping.

    If I have to sit out a semester, I'll lose at least $40,000 in income and $10,000 in pension benefits. Lawyers are now on my list of phone calls. I've litigated four cases before and won them all so ... might as well check out some legal remedies and start documenting.

    Man ... this is bad.

    :angryfire
    Last edit by Sheri257 on Aug 24, '06
  12. by   smilin_gp
    Ohh, not fun. I tore my meniscus my first year of college. Not an easy PT process, and definitely not helped by HMO crap- they definately should have had your knee in support ASAP after the injury to minimize the damage. Sorry that you are having to go through this.
  13. by   gauge14iv
    Man when I have a patient who is in bad shape - I sit down right there with them and make the ortho, MRI and authorization phone calls myself on the spot. I'm finding this is often how I spend my lunch hours these days.

    The referral person at our office usually can get them in 24 hours, but if she has 52 of them to do one of them isn't going to be more important than any other. The insurance companies don't make it easy either - they hide the phone numbers, change the numbers - "No longer in service" - and tell you have to call 3 OTHER departments and then wait for a fax, when the fax doesn't come and you call and try to speak to the same person nobody acts like anybody knows what you are talking about. It's just crazy.

    Sorry for your situation, I hope things work out for you.
  14. by   Sheri257
    Thanks Gauge ...

    Well ... it just goes to show that not taking no for an answer pays off. Even though the ortho specialist's office said they couldn't see me in two weeks ... we showed up this morning anyway.

    Turns out I was dealing with an unhelpful assistant in the wrong department. I found the right assistant, and I saw the doctor right away. And for once, it was a helpful doctor. It's ok to walk with a brace and I can graduate from nursing school on time !!!!!

    Despite my primary doctor saying I need surgery I actually may not need it. And, if I do, it can be done after graduation.

    I did end up paying $1,600 for a customized super ortho brace that will get me through clinicals. I just couldn't wait for more hassles with having to go back to the primary doctor, who isn't helpful at all ... to get HMO approval.

    Maybe they'll reimburse us for it or maybe not but ... with a potential $40,000 loss of income I figured it was a small price to pay to graduate on time.

    Thanks for everybody's input on this. I really appreciate it.

    :typing

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