By not filling out the right form.
Meet SuperDaughter...flying in to the rescue after a sudden diagnosis of cancer hits her doctor-averse father. Yes, he's one of those men I talk about: hasn't been to the doctor in 30 years. And he's a guy who smokes and drinks and eats like crap. But even he was convinced to go to the doctor when he couldn't eat for days in a row. And when he had to admit that yes, he had lost 80 pounds or so in 6 months.
Yes, I can hear some of my occasional HealthyConcerns commenters now: 'this is a guy who didn't take care of himself, who delayed care, who did everything wrong. You're not really going to blame anything on the HMO are you?'
Well, let's bear in mind...this is someone's dad. And that someone has flown in to help her mom and her dad wade through what they rightly anticipated would be the red-tape nightmare of dealing with such a health emergency with an HMO they had never even visited before.
So, no, I would never blame cancer on the HMO. But I might just blame hospital staff neglect and improper instructions on the HMO. Is that so wrong?
Problem #1: Does this qualify as hospital neglect?
SuperDaughter's dad was in the hospital for 6 days. And in that time they never got him out of bed and walked him around. All those scenes you see on TV of mean nurses with your best interests at heart who shove you out of bed within 2 minutes of waking up from surgery? Apparently a big fantasy. From what SuperDaughter can glean, now that she's arrived, they never got Dad up, and Mom couldn't do it on her own. Hence his muscles atrophied. Hence he developed a blood clot. Hence they already had to delay chemo once to handle that.
Problem #2: Just show up and get your chemo...psych!!
My friend, SuperDaughter, arrived this weekend to help her Mom get Dad to the hospital for a Monday morning chemo session. The week before his primary care physician (PCP) had given Dad all the info on what facility to go to and when the appointment was, but apparently neglected to mention that it was still the family's obligation to make sure his referral had been properly filed with the HMO. They didn't. They dutifully wrote down when and where to go, and showed up, only to be turned away. Remember, the guy wasn't going to the doctor, so it's not like he had a wealth of experience dealing with HMO bureaucracy. Meanwhile Mom belonged to a PPO via her work, so she, too, wasn't well-versed on HMO procedures. They both, I guess, were pretty overwrought too, so asking questions and figuring it all out wasn't top of their list. (Hence the decision for SuperDaughter to fly in in the first place.)
At this very moment, their efforts to actually get the referral filed are thwarted by the fact that the same PCP who gave them incomplete or vague instructions to begin with hasn't actually finished filling out his portion of the paperwork himself. So they are still not all clear for the chemo.
To make matters even more annoying, the chemo facility does blood work itself, of course, but sn't covered by the HMO to do so. So they have to get Dad (who still can't walk) to another facility tomorrow for his blood work, and then bring him back to the facility to do the chemo on Wednesday.
This is the chemo that was so urgent the doctors wanted to start it immediately.
Problem #3: How did you get this number??
When SuperDaughter got in and started taking charge of course she wanted to speak to all relevant parties. She got the various phone numbers from the hospital staff, including Dad's PCP. Only the hospital seems to have given her the PCP's super-secret batphone number.
She called the number once and got voicemail. (In keeping with the fact that the number was a super-secret batphone number the outgoing voicemail message did not reveal that she had reached a super-secret batphone number.)
On her 2nd try, she got the doctor directly.
He quite literally asked her, "how did you get this number?! I can't take this call now!" Can you hear the recriminating tone of his voice? Well, SuperDaughter certainly could!
So, apparently the hospital isn't supposed to give out his direct line. Got it. Take up your beef with them Doctor, not SuperDaughter!
Problem #4: Seriously, which costs the carrier more?
BTW: while exploring what their future plans should be SuperDaughter discovered that the HM would not cover having someone come in to help Mom take care of Dad, but would cover putting him into a assisted living facility.
Because one part-time caretaker must cost less than full-time residence in a facility?
So there you have it. In a brief one day of trying to help her Mom handle this unexpected, if not shocking, medical development with her Dad, Super Daughter has already encountered 4 unpleasant realities of health care today!