Hi.
I actually have a whole series of horror stories, all brought about by one Blue Cross or another.
My first run-in with managed care was when I went to the HMO emergency room - a hour away by bus - for severe pain in my back right where the kidneys are. After a 4-hour wait they managed to take a urine sample, and tested it with a dipstick that can detect the 6 or 8 most common infectious bacteria. Since that came up normal, they sent me away with instructions to make an appointment with my primary care physician (PCP).
I did that, figuring I could bear the pain for that long. Two weeks later I went to see the PCP, only to be told that she was not on this service today and I should reschedule. Two weeks after that, I actually did manage to see her. She ordered some blood tests and a urinalysis, and referred me to a urologist.
Fours more weeks went by before I could see the urologist. When I went there, he ordered another urinalysis - the one ordered by my PCP had been THROWN OUT because a PCP is not authorized to order a urinalysis!
Two more weeks of pain, and I went back, only to find that there were no clear results and I should have yet another test.
It took 6 more weeks to get that test scheduled. When I showed up, I was told that the machine that develops the X-ray films was not working, and I would have to reschedule. Four more weeks.
The total elapsed time is now about 6 months. If this had been an unusual kidney infection I would have long since been dead. Apparently the HMO wished I was.
About that time I went to an outside doctor, who ordered tests including X-rays and a complete blood and urine workup. In his hands, they took 2 days to get results.
I submitted these bills to my HMO. they of course said that they wouldn’t pay - but eventually did. Maybe the fact that I could cite several medical residents who, upon hearing the story, all said “malpractice.”
By the way, the pain actually turned out to be unrelated to my kidneys - it was the first of many “trigger points” that I have had.
More next installment.