HMO Havoc

It has been so nice to act like I don't have any health concerns. I have focused on settling details about being in a new place with new possibilities - things like transferring car insurance, getting library cards, setting up bank accounts, decorating the apartment, unpacking. It was pretty easy to dismiss any thoughts of health problems and pretend I am normal!

But eventually reality sets in, the new insurance cards arrive, and you are forced to think about doctors and hospitals. I now remember why I have opted for the non-HMO insurance in other places. Rochester is, unfortunately, the HMO capital of the world. There is no choice of health care plans. There is one plan and its an HMO. It's not that I think you get a different quality of care - it is the stupid hoops you have to jump through to get into the system.

I naively sat with the HR person as she introduced me to the plan. For one thing it is more expensive than I have been paying for health insurance. But she smilingly assured me that their provider network was quite large and as far as she knew, no one had been denied the right to see the doctor they wanted.

She encouraged me to ask around at work and see who employees might recommend as she plopped the telephone-sized book of providers on the desk in front of me. Sounded simple. Ask who people like, call the most recommended doctor, get an appointment. WRONG! What was I thinking?!! I hadn't been down this road in such a long time that I have forgotten the insanity involved.

I called the first choice name on my list. Even though they are listed as taking new patients, they weren't. In fact, the receptionist nearly laughed at me for thinking I could get in anytime soon. She suggested I call back every 3 months, and in a year or two there might be an opening, depending on a variety of factors, not the least of which was whether they got a replacement doctor who had just left the practice.

Next I went to the insurance company's website and clicked on "Find a Doctor" only to find out that I have to register as a user to get any information. I didn't have my new card on me, so I waited until the next day. I registered and clicked on the link. It asked me a series of questions that seemed almost too much. I selected the "only doctors accepting new patients" link, and got three pages of primary care providers who would accept new patients. I carefully cross referenced them with Google maps to see how far away from me these clinics were and began with the ones closest to me. Turns out neither the close clinics nor the far flung clinics would accept a new patient.

I mentioned to my sister that I was having a hard time finding a doctor, and she gave me the names of her doctors. Her primary doctor has relocated on the far side of the city and is not accepting. The doctors in the clinic where he used to be have all left the clinic, and the doctors now in that clinic are not accepting.

I called a few more names. Same story. I asked one receptionist why they were listed as taking new patients online when in fact they were not. She spieled off a load of reasons. Bottom line: the Rochester area is about 100 doctors short of being able to handle the patient load. People are moving out of the area, including doctors. She at least suggested I call the hospital referral line.

I dialed the number she gave me, only to discover that the number was no longer in use. I went online to the hospital I preferred and scrolled about. I finally found a referral number, and soon was speaking with a sweet young lady who gave me four doctor offices that were definitely taking new patients and were in fact fairly close to where I live. I thanked her profusely and called the first number. Not taking new patients. Same with the rest of the numbers she had given me.

Now I am not being picky. I will take any doctor, regardless of location or specialty, I just need to get someone to give me the needed referral to see the colorectal oncologist recommended by my Yale doctor. Then I realized that the doctor I am trying to see has privileges at Strong Memorial and the referring doctor PCP will need to be in that same hospital in order to give the needed referral. ARGHHH!!!

Time to turn it over to the Lord and let Him work it out. I quit for the day. On the next day, I began the process again. I call the hospital referral line and ask again. They take all the information again to put in their system, then give me a list of names. For each name she gives me, I tell her that I have already called them and they don't take new patients. She acts surprised. I assure her I am not joking.

She finds some new names. I write them down. I call them all. The very last name, the receptionist says YES! they are indeed taking new patients. She looks at her appointment calendar and mutters, "Gee, all the doctor has are new patient appointments for the next three weeks. Do you have a crisis situation?"

I tell her I am a rectal cancer survivor and I need a referral to an oncologist for follow up care. She apologizes and says the earliest appointment available is August 10 at 4 pm. I snap it up like a fish gasping for water. Then she rattles off a list of paperwork that I will have to submit before the appointment - including complete records from my last doctor, permission to blah blah blah. My mind is reeling. And I haven't even made an appointment for Drew yet!

They won't see you for an illness until you have had your initial assessment. Good thing I have the rest of the summer to set things up. Meanwhile, I called back the first clinic that I would prefer, and asked if they have a waiting list. They do not. But if I call in three years. . .