LETTERS From CAMP Rehoboth |
CAMP Out: Fay's Rehoboth Journal |
by Fay Jacobs |
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 demo-cracy. If grass-roots lobbying is back, how about a new American Revolutionone 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 declaring war on HMOs. I remember when HMO's first appeared on the scene as a choice. The good news was that they were a lot cheaper than regular insurance and offered scads of wellness and preventative care. Now, the only thing they prevent is letting you see a doctor. Not only have HMO's morphed into regular insurance, but they cost more than my old Blue Cross ever did. I'm particularly ticked off today because I just got home 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. 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 list of providers book is still on the back seat with some recent junk mail. Lab Services, Lab Services, here it is. My book says I can go to Lab Corp on Savannah Road. Ah, just around the corner. Bleary-eyed from the early hour, 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 quivering and said "wait a minute, I'll find where you should go." Ah, it's just down the street. Gee, wouldn't it just be easier to use leeches to harvest my blood? By this time I'm probably the first reported case of road rage in Lewes history. Traffic is one thing, but I've been fasting for pete's sake, now get outta my way. 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. One time last winter, after a sleepless night of coughing, I called the doctor to refill my cough medicine prescription. A no brainer, right? Since HMO's 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 to consider my request until later in the daythose few moments, I suspect, reserved for peeing and returning phone calls. 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. Who the hell feels well enough to drive to the doctor's office for a narcotic in the throes of Bronchitis, except perhaps a wheezing junkie? How much sense does this make? So I coughed my way to my primary care outpost, spreading a swath of infection and good cheer, gathered up the written word and hacked and horkled my way to the drug store. "Sorry," said the pharmacist. "You're 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. Hell, once I was too sick to go to work anyway and stayed home, 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 about my dose of cough medicine? Was this all-powerful HMO Pooh-Bah phone operator up hacking away all night? What? Are they afraid I'm going to sell this stuff on the street? Have they ever tasted it? No junkie would want 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 dinner for two at Fusion for the two ounces of orange swill and went home to guzzle my stash. When I have nightmares, they're about CEOs at HMOs denying my coverage. Like the time Bonnie went to the 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, sufficiently alarmed about her high blood pressure and daytime sleepiness, 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 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 $1900 for this piece of what they term durable medical equipment. At that price it sure as hell better be durable. And just try and get an appeal form. It's like applying for copies of the Watergate tapes through the Freedom of Information Act. It took at least a dozen phone calls to people who refused to give you their names before somebody agreed to send me a form. That was January. I'm still waiting. The one thing HMO's seem to 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 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. They both had to provide more ID and paperwork than if they had been applying for the Witness Protection Program. But just try and take somebody OFF the policy and there's nobody home. 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 paying for his Viagra. It's enough to make me crazy. Which, by the way, you better not be, because finding a therapist who takes your insurance is much, much harder than healing thyself. And you better not have an accident, either. I want to know how many people have bled to death while waiting on hold for pre-authorization to go to the emergency room. People actually do that!!!!!! Today we got dunned by a collection agency representing a doctor I visited last November on my old HMO policy. Never mind that I'd paid my co-pay, never received any other kind of bill, and now was being arraigned for debtor's prison. For an hour I was lost in space in the HMO's automated voice mail system. When I finally talked to a humanoid they could find no record of me or my unpaid bill. But they swore I owed the money since their Billing Consultants were never wrong. I figure I have only two choices here. Walk out to the front of my house and bang my head on our stone faade or pay the lousy $107. I'm paying up. And you know who I feel sorry for? The beleaguered doctors and their staffs. I've walked into medical offices where everybody's running around like chickens with their heads cut off, shouting orders and running for equipment. A patient gone code blue? No, they just 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. Augghhh!!!!! That's that. I'm doomed to indigestion for the rest of the summer. Anybody want to join me for the Million Misery March? Hey, Hey, Ho, Ho, HMOs have gotta go..... Fay Jacobs, a Vice Versa award winning columnist, is a regular contributor to Letters from CAMP Rehoboth. You can find more of her CAMPOut columns at www.camprehoboth.com. |
LETTERS From CAMP Rehoboth, Vol. 10, No. 6, June 2, 2000. |