Getting screwed again by my HMO   3 comments

I’ve been in excruciating lower back pain, off and on since last September. I’ve had injections, chiropractic, Physical Therapy, Traction, and Acupuncture. Yesterday, I had to use the electric cart at my grocery story and was in unrelenting pain; fortunately one of the employees went around the store with me to get my groceries and help me checkout. On a scale of 1-10, this pain is a 12 and literally stops me in my tracks, and it has been nagging/gnawing at me for a good while, and only recently got even worse.

I have an HMO for health insurance and that means going through a primary care physician to get authorized/referred to a specialist. I have a pain management specialist who treated me for this last May-July. Since then I have been trying for relief through other modalities. I am not one to take narcotics for pain; I do have a tens unit and an ice pack. A week ago I made an appointment for tomorrow with the pain management specialist and have been awaiting the referral authorization since then. It should have been done within 48 hours. It is now a week later and guess what? I’ve just been called and informed that I have been authorized for a ‘visit’/consultation and must do that before I can get any treatment. That is what my appointment tomorrow is going to be even though I was very specific in requesting authorization for a treatment that I had had before from the same doctor.

The doctor has decided that she needs to see me first and then submit a request for treatment. The referral coordinator ignored my request and after a week submitted the request for an office visit. The result is that tomorrow, instead of getting the pain management treatment that I so desperately need, I’ll have 1 minute consultation that the doctor will bill more than $500 for to the insurance company (no wonder the costs are skyrocketing), and then tell me what the treatment will be and that an authorization request will be needed for another appointment.

Under the best of circumstances these referral authorizations take 48-72 hours to be approved. Factor in the time for the doctor to  compose her notes, send them to the transcriptionist so that her clinical notes can be sent to the primary care physician, fax that request to the primary physician. I’m looking at another 3-4 day minimum, before the authorization request will be made. That’s assuming that the referral coordinator does not forget to check the fax machines (and she has gone on vacation before, leaving one of these unattended), and submits the request. Then, if the request is made for STAT (ASA approval, expediting the authorization, it will be 48-72 hours for it to happen. Then I’ll have to make an appointment with the pain management doctor, who does huge business, and it could be at least a week, or even more, for another appointment.

Under the best of circumstances, I’ll be getting the treatment a week from tomorrow. Under the usual circumstance, I don’t really know how long it will be.

To make matters worse, I received a message just now from the referral coordinator telling me that she can no longer handle this matter because I have been transferred to another primary care physician (that does not go into effect until April 1, and I may have to wait until then, after a visit to that doctor on April 2, before the referral request can be made.

I may suffer excruciating pain between now and the second week in April, unless a miracle happens. This is worse than catch 22; it’s a good example of the flaws in the medical care system, particularly in the HMO, less expensive type, health insurance system.

I have a fairly high pain threshold; but this pain stops me in my tracks…I don’t know what I’m going to do until I get that pain injection.


3 responses to “Getting screwed again by my HMO

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  1. Have you tried hypnosis for pain management?

  2. Pingback: Dr’s appointment « Halfway Between The Gutter And The Stars

  3. Health insurance is so messed up right now. Aside from my house and car, it’s my most expensive bill and I feel I have to jump through so many hoops just to use it when I need it. They really need to make it simpler, and re-work the entire healthcare system, it’s getting out of hand.

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