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We’ve all  heard stories about  long waits for health care in Canada and other countries with socialized medicine.  It’s the same story with HMOs. Is this the path we’re headed down with Obamacare?  To be treated as a number, and not a patient?  If you’ve had a bad experience dealing with a bureaucracy or an HMO when you should be dealing with a doctor, please share your experience.

51 Comments

  1. I recently dropped my PPO, and maintained only my HMO. I really felt I was over insured, and wasting money. Overall I'm in good health. Never had a disease, or serious illness. No broken bones, or organ problems. So naturally, I dropped the slightly more expensive PPO. I will be dropping my HMO (Kaiser) the next open enrollment, and return to my PPO (Blue Cross/Blue Shield).

    In the early 90's, I suffered a severe injury to my right breast. No need to envision a scary damaged breast, it was all internal, from a severe impact. Although, if a giant purple tit excites you… lol. Anyway, years later after my first mammogram, I got the dreaded call back. I'd like to take a moment to share the difference in care between that call back, and the call back I received yesterday, from my HMO.

    *To be continued….

  2. After the dreaded switch to Kaiser…

    Kaiser: ''It's time for your mammogram.''

    Me: "Okay, we should get my baseline from Providence. It was abnormal.''

    Kaiser:' ''Providence is state of the art digital, and we can't read digital.''

    Me: ''Let me call you back''

    I call Providence, the lady tells me the person I'm talking to is an idiot, and she'll push the images and reports through, as she always does.

    Me: Hey, Kaiser, Providence said you're wrong, and they've pushed the images through. Did you get them?''

    Kaiser: ''Nope.''

    I call Providence back. And they are as frustrated as I am. They say,

    ''Fine, I'm going to convert and download the images to a CD that any system can read and mail them along with the reports.''

    Now I'm at reception in Xray, at Kaiser. Can't really call it mammography, because it's the old fashioned xray that the tech has to load slides in and actually develop. I ask if they received my records form Providence. I'm told ''I don't know, I'm just the receptionist.'' I ask the xray tech, and I'm given a similar answer.

    So I get the call back. It's an appointment setter. I ask what this means. Of course she doesn't know. I ask if they are comparing to my baseline. Of course she doesn't know. I ask to speak with the radiologist. Of course I can't. I tell her two weeks out is a long wait, but surely if it was something to be concerned with, they'd be seeing me sooner. I'm told that doesn't matter, unless it's an immediate medical emergency. And even if it's cancer, it's not considered an immediate medical emergency. I call my doctors office and ask to have him call me. He's out until Monday. I ask to have whoever is covering to call me. She says she'll give him a message, what do I need. I want him to contact radiology and see what they're looking at. Is it the same area, did they get my baseline records, should I be concerned? I'm told they can't do that. I ask what the report radiology sent, said. She says they have a generic message in all cases. ''One or more suspicious areas found, schedule further testing.''

    Now I'm told that I can't go where I went before, because they don't have the best equipment. Now I need to travel over thirty miles from my home, where the equipment is better. And like everyone else I have to wait my turn.

    I call my doctors office and tell them my anxiety is going through the roof. She asks what would help. I tell her, answers. What kind of answers, she asks. I again relay… Can you ask if the radiologist has my baseline to compare? Can you see if this is a mass, or a shadow? Is it in the same area? This would greatly alleviate my fears. She says she'll ask and call back.

    When she calls back, she say's, ''Doc says it's outside of the policy and procedures. That he won't call radiology. That they'll be able to address my concerns at my next appointment, two weeks out. However, he's called you in a prescription for Antivan, so you won't worry so much over the next few weeks. This is standard procedure.''

    But, but…. I don't feel like I'm a standard patient. I'm a number three mother fuckers! I need answers, not pills.

    So the moral of the story.

    Many people suffer serious conditions. Whether I have one is yet to be determined. Answers would help me more than pills. Even if the answers are bad. Not knowing makes me think this is really bad, and no one wants to tell me. They've already told me there's no difference in how it's handled, so I can find no comfort in the fact that ''surely if it was cancer, I'd get right in''. I think this is a horrible way to treat people. Is this what we want? To feel like cattle? A number? Inferior equipment? Inferior care lacking any personalized human touch?

  3. In my opinion, there are three distinct types of patients.

    (1 ) Maintains routine check ups and treatments like any other aspect of their life.
    ,
    (2) Obsessed with their wellness (or lack of) and seek care for every little thing.

    (3) White Coat Syndrome sufferers who avoid all contact at any cost.

    I'm number three. It's an irrational fear, but real none the less. With my PPO Providence preferred (but not required) I received the letter.

    "It's time to schedule your first mammogram.''

    Uggg… I'm scared. I was able to directly call my doctor and share my fears of ''testing''. The tests don't scare me, it's the possible results. She noted this in my chart and assured me that they would basically hold my hand through this process. So when I did get the dreaded call back, my heart sank. The fear reared it's ugly head. I asked the appointment setter for more info, that a week was a long time to wait and worry. She of course couldn't provide it, but readily offered to have the radiologists that read my slides call me, also assuring me if it was serious, I wouldn't be waiting a week to get back in. She sent a message to the radiologist who returned my call within minutes.

    This is what she said.

    ''I don't want you to worry. I'm not looking at cancer. I'm not sure what I'm looking at, but want to make sure we identify it. This is your first mammogram and it's important that we set a good baseline, by which to compare future images. By any chance did you ever suffer an injury to your right breast?''

    ''Yes.''

    ''Ah, that makes sense. I still want to have you in to get more images, and make extensive notes for the next guy. But this isn't cancer.''

    Nice. Instant relief.

    Fast forward to present time, and my Kaiser experience.

    *To be continued.

  4. I'm a strong woman. I can take on any truth. I can face cancer if that's what fate has in store for me. I can kick it's ass. I can't face unknowns. I can't begin to come up with a game plan while locked in a void of not knowing what the game will be, or if there will even be one.

    Just so you know, Kaiser, your pills stopped the tears, and brought out the anger. Should have left me crying and worthless, cause NOW I'm going to run my mouth. And maybe that seems like an empty threat coming from a small time blogger named Lips. But it certainly isn't, coming from Big time corporate girl named ******* who has the ability to have Kaiser removed as a provider. And the thousands upon thousands of interactions I have in any given month. Lips is your playful, harmless, online buddy. The woman behind Lips, is not.

  5. I've always had private insurance so I've, fortunately, had no experience with HMOs, but the conflict of interest inherent in an HMO (or socialized health care) is obvious. http://www.ehow.com/about_5255336_problems-hmo-pl….

    • Yep, and there's a host of other problems not mentioned. When I had the exact same procedure done at Providence, I spoke with three people. I received the same information from all three. Each person was professional an consistent in the information provided. With Kaiser, I spoke with a total of 11 people. Their mannerisms ranged from nice, to rude. The information varied greatly, depending on who you spoke with, and what you asked. Too many patients. Too much staff. I looked at my financial records and to see what my savings has been. Grand total of $182.00. Only because Kaiser doesn't charge a co-pay for mammograms. And you seriously get what you (don't?) pay for. I would rather pay a co-payment for superior care. I'm in the process of creating my own survey to be handed out to our employees. Given enough negative feedback, I'll be taking it to the corporate offices. Perhaps without an option, we can get our PPO to provide us a little more competitive premium.

      • Yeah, when you google 'HMO problems' there are almost 7 million results, so it stands to reason that there are many more issues than just the ones listed there. I hope you're successful in getting better coverage for your company. The law of supply and demand should eliminate inferior services, but our health care system is so screwed up that it defies logic. National heath care would be a real nightmare.

        • I agree. We have a choice between the two. I'd heard enough horror stories to have known better. Because I require so little care, the low to no co-payments were attractive. I will be going back to Providence in November., during open enrollment. Hopefully, I can. Barring any preexisting conditions. It's almost tempting to not return to Kaiser, and not risk a negative diagnosis. I can't imagine what going through chemo with them would be like. Versus Providence's state of the art cancer center. See how sad that is? That you'd be so turned off that you''d consider delaying care.

          • Do you really want the anxiety hanging over you till November? Chances are good that it's nothing, so think positively. I know that's easy for me to say, but I don't know what else to tell you. You've told me how badly the not knowing gets to you, so I'd say find out one way or the other, then go from there. I believe in the power of positive thought, and I think you do to, but those thoughts have to start with you.

            • Actually, I know in my gut that I don't have cancer. It's just hypothetical. A scenario that literally thousands of women will face, right here, at my local Kaiser. I'm sure I'm okay. That doesn't make inferior care, okay. Many women aren't as lucky.

              • No, it certainly doesn't.

                There is one other piece of advice I can give you. You said a few weeks ago that you've never cried in any ones arms. If you haven't already done so, you should go to your ol' man, crawl into his arms, and cry it out. All your anxieties, and frustrations. Just get them out.

                • I wouldn't say I've never cried in any ones arms. I rarely cry for myself. And when I do, I'm the type that will sneak to the bathroom, turn the water on and cry silently. That wasn't going to be allowed the other morning. So yes, I did just that. It's an emotionally exhausting act. I've been on the hostile side every since. I'm focusing my anger at Kaiser. But, I'm not going to let that rule my day, either. As Ozzy would say…
                  http://www.youtube.com/watch?v=1td4sgFQRgQ

                  • Good Morning. Good. Guess I misunderstood your comment the other day. :)

                    Great song, btw. Hope that's a sign that you're in better spirits, but keep that righteous anger at Kaiser, just don't let it eat at you.

                      • Lips
                      • Posted June 17, 2012 at 07:21
                      • Permalink

                      Morning. Happy fathers day. :)

                    • Good Morning to you too. And thank you. :)

                      How are you today?

                      • Lips
                      • Posted June 17, 2012 at 09:35
                      • Permalink

                      I'm really good, thanks. I had a great day, yesterday. Hoping for another, today. Going to spend it with my dad and the rest of our clan.

                      Have you talked to your daughter, yet? Wish she could hop a plane and come see you.

                    • :)

                      Yes, that would be nice. I haven't talked to her yet, but I will.

                      • Lips
                      • Posted June 18, 2012 at 08:05
                      • Permalink

                      Morning. Hope you had a good weekend. Ready for school, tomorrow?

                    • Yeah, my daughter called just seconds after I hit the submit button for the above comment, then I called my dad. How was your day?

                      Just need to do a few things and I'll be ready, like pack some lunches for the week. Easy stuff.

                      • Lips
                      • Posted June 18, 2012 at 09:06
                      • Permalink

                      Nice.
                      My day was good.

                      I've never seen it rain as hard as it is, right now. It's literally going to crush my flowers. Wow, it's really coming down.

                    • Oh no. Not the tulips too, I hope? ;)

                      No rain here. Just overcast.

                      • Lips
                      • Posted June 18, 2012 at 09:42
                      • Permalink

                      LOL…. no, they're long gone. But my roses took a major beating. That was weird. Oh well, it's passed. They'll bounce back.

                    • Yeah, I've seen it rain like that a few times, and unless the blooms are old, they always survive just fine. Nature generally doesn't water her plants so hard she destroys them.

                      Picked up the dogs from the groomers. Now they'll smell good for about half a day. Still have other chores, though. How's your day going?

                      • Lips
                      • Posted June 18, 2012 at 21:02
                      • Permalink

                      Awww… I bet they looked all clean and spiffy. That was eight hours ago, I'm sure they've hit the dirt by now. lol.

                      Busy, but productive day.

                      All ready for the week?

                    • Well hello.

                      Ah, they still look pretty clean. Knuck still smells clean, even. Pebbull usually stays clean for a few days, even before her latest injury.

                      Busy and productive is good.

                      Yeah, just gotta print out the driving directions that were e-mailed to me. Picked up some tools and brushes, and some more sunscreen today.

                      • Lips
                      • Posted June 18, 2012 at 21:29
                      • Permalink

                      Tools and brushes. Sounds so exciting. Crocodile Dundeeish. lol
                      Can't wait for details. And, don't forget to keep your sixth sense out for ghosts.

                      Well, hope you have a good day. I'll talk to you soon.
                      G'night. :)

                    • Maybe the ghosts will lead me to a lost soldier's skeleton. Or maybe not. I can hope, can't I?

                      Alright, you have a G'Night and Sweet Dreams. :)

                    • Good Morning. Hope you slept well, and that you have a Great Day. ttyL8r, if you're online.

                      • Lips
                      • Posted June 19, 2012 at 16:06
                      • Permalink

                      Hi, how'd your first day go?

                    • Hello. How are you doing?

                      First day was kinda boring, almost all of it was spent in the classroom going over rules and how to fill out forms, stuff like that, but we did have about an hour long tour of the place. Tomorrow is more of the same with the fun starting on Thursday.

                      • Lips
                      • Posted June 19, 2012 at 17:31
                      • Permalink

                      That makes sense. Cool place though, huh? What will you be doing? Have they told you? You mentioned looking for a lost soldier. Were you just kidding?

                    • Yeah, I was kidding, but they did mention today that a body was found awhile back outside of the normal grave sites, and that if you found human remains to be very careful and notify one of the team leaders immediately, so I suppose it's possible.

                      The first six weeks we'll be at Ft. Vancouver excavating in what used to be the village area, where the laborers and their families lived. Then the final week we'll be camping out and working at Ft. Astoria.

                      I took a few pictures, I'll put them up on the Ft. Vancouver post.

                      • Lips
                      • Posted June 19, 2012 at 18:04
                      • Permalink

                      Oh that's cool. Camping out will be awesome. Oooooh… I hope you find something unexpected and unusual.

                      Okay, I'll go look on the FV page.

  6. I can understand both sides of this frustration but as one that went years without insurance and end up owing hospitals 1,000s of dollars (50k+) because I didn't go to a doctor sooner because I had no coverage (yes I worked but because of my being classed as a ''part time" employee even thought I worked almost 40 hours a week I didn't qualify for insurance even though I wanted it) my condition got to the point it needed surgery and hospitalization. If I had insurance I would gone to the doctors office way sooner and avoided all of that.

    Once I got insurance, yes it was kaiser, it was a blessing, because I was able to go when I needed and with confidence. Even emergency visits were less stressful because I didn't have to worry about the financial aspect (my plan had a $75 copay no deductible for emergency). When my youngest was two weeks old he got a high fever and when I called the nurses line they told me to take him to SWWMC and once we were there they shipped him to Dornhbeckers at OHSU. When I started to panic they said that all of kaiser babies automatically get sent there. He was there for two weeks (cost only 500 dollars out of pocket for us) If I had to worry about cost during this I would of been more frazzled and stressed than worrying about my baby.

    I guess my point is, everyone has a different experience with HMOs and so far mine have been pretty positive. Now I find myself in the same boat without insurance (kids get covered by their dad and because we are not married I cannot get on it) I just hope nothing happens to me. So I would gladly take an HMO over having nothing at all.

    • Just curious Danda, when you say you can't get on the kids dads insurance.. Have you tried? Remember, I have been unmarried my entire adult life. And I've been on all of my long term ''spouses'' insurance. Have him add you next open enrollment. Check the box, ''spouse''. In the 30 years I've done this, never has anyone questioned our marital status.

      • The kids are on but I am not because we are not married…

        • I know. But, have you tried by listing yourself as his spouse?

          • He tried but his boss ratted him out by telling them we were not married

            • That's messed up. The insurance company would never have known or cared. Amazing that homosexuals can do it, but a man and woman living as domestic partners, can't. They say they want equal rights, seems they have slightly more than equal. They've chosen to be in non traditional relationships, and are now protected by laws. A man and a woman that chooses to be in a non traditional relationship, is shit out of luck. Some will use the old argument that a man and a woman can marry, but what if they don't believe in state sanctioned unities? Shouldn't they receive equal rights under the same laws?

              • I know, I always thought the same thing as we are 'domestic partners'

    • As far as the incident with your baby. I can see where you were relieved that you were able to get treatment for him, and not run up thousands in bills. Did it ever bother you that your provider had to farm you guys out? That they actually said, ''We send all Kaiser babies to Dornhbeckers at OHSU'' ? This is the type if inferiority I'm talking about. OHSU does some great work, but why not send your baby to Emanuals neonatal center? Another example of what happens when you purchase your insurance from the same people that decide your care. And where you'll receive it. They farm you out for everything that isn't general practitioner care.

  7. I have numerous things I could say about Kaiser. I have actually had to threaten to sue them, just to get them to look at my Mom. And you can't sue for malpractice. I had to threaten to sue for age discrimination. It worked but without my call, my Mom would have had a massive stroke and been unable to care for herself because Kaiser wouldn't listen to her.

    • I'm so glad you got them to listen. If not for you, someone who doesn't just do what they're told….

      This morning I'm just sorta hanging out, waiting to see if my supposed doctor will call me. As stated above, when I tried to contact him, I was told he was out of the office until today. He still would have received the messages. Curious if he'll take the time to contact me.

      • I have two stories about Kaiser, probably more. The story of getting my Mom care, coincides with what began as an eye exam for our then, 12 year old daughter. Their lack of compassion & empathy should not be able to exist in healthcare.
        And let me tell you, if you give birth in a Kaiser hospital, they can't get you out the door, fast enough. Might be a little different now. But I was booted out less than 36 hours after giving birth.
        They gave my daughter her immunizations too close together when she was little and we had to do almost all of them over again just to get her into school.
        My DH has them now (he had no choice) and to them he is just a co-pay.

        I am a lot like you, I won't go to the Dr unless I absolutely have to. I don't want a pill, or a test just because I have experienced a certain birthday. I will go to the Dr. when I feel I need to, not before.

        I hope you can "persuade" Kaiser to treat you like a person. It's difficult to do.

  8. I wonder if America is a place where we have a special culture, and we know we do, and for this reason… no matter what argument one makes for socialized medicine elsewhere… we know our own situation and we know that the rules are different here… and we know what does and doesn't work for us.

    I wonder if we know that socialized medicine would manifest as a particular failure on these shores, even while it may be viable elsewhere.

    • I know that a private physician with fewer patients is better able to serve an individuals needs. I know that flattening a breast that has been previously injured, injures it. I know that if they bothered to listen to the patient, and based their care on the patients unique circumstance, rather than trying to process us through like we're all the same, it would save time, money and distress.

      • Its easy to see how the patient-doctor ratio can affect quality as you describe.

        I wonder if it is a hard-and-fast rule that private = fewer patients and that public = greater patients.

        • I think the greater public is financially crashing and second rate medical care is our future. I think our government will make it so middle class can't afford private care. Force them to go with organized so the poor will get coverage. I think in time the only ones that will have quality care are state and government. I think organized care is without a doubt a ''you get what you pay for'' deal. And deal they do. Would be very interesting to see the difference in cost for benefits from one business/corp to the next.

          • I think you have it there.

            My thought process on this is a bit "Star Trekian". E.g. I wonder what we'll have figured out 200-500 years from now, on this subject?

            "This subject", perhaps defined as: "How can crowd sourcing help individuals take care of their own health in a respectful, meaningful, and effective manner… that is mutually beneficial and agreeable for everyone involved?"

            • I think that will depend upon how many diseases are funded for cure, verses treatment. How much control is turned over to medical scientists, and taken away from pharmaceuticals. There's just so many variables.

      • That is why I go to Osteopathic Doctors (DO) not Medical Doctors (MD) as Osteopathic doctors' principle is to treat the whole patient and not just the symptom. They will find out why your tummy hurts and fix that then just give you something for the tummy ache … I know its a poor example but that is the gist of it.


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