I AM IN HMO HELL

I have not blogged in a couple of weeks because Dante left a very important vestibule out of The Inferno. He left out the ever dreadful HMO.

Important abbreviations for this story:

HMO = Hideous Medical Overkill (but it is better than nothing)

PCP = Primary Care Physician

OB/GYN = Doctor who cares for the exclusively female parts of you

First of all, let me say that I have been blessed to have had relatively good health for the past ten years. Therefore, I haven’t had to spend time in a hospital unless it was to visit someone else. I haven’t had any surgery, any major health malfunctions, or any prolonged illnesses. Therefore, I haven’t had to venture out into the world of HMO. I visited my PCP when I had insurance for all my minor ailments, and that was that. No red tape. No hassles other than trying to get an appointment on the day I was actually sick.

After five years with no coverage at all (another vestibule Dante forgot to mention) I managed to get some medical coverage through my current job. I chose the HMO because it was free to me and, as stated in the prior paragraph, I had yet to venture beyond my PCP. Once I had insurance, I waited a few weeks, then scheduled an appointment with an OB/GYN (and you don’t want to know how long it had been since my last visit to an OB/GYN). Those initial tests came back clear. Good news. Cholesterol, good. No abnormalities. We take the next step and he tells me to schedule my baseline mammogram… and this is where my journey into HMO hell begins.

I go for the initial mammogram on November 4th. Bothersome, annoying, irritating, yes, but not the painful experience everybody tried to prepare me for. I had to go to a diagnostic clinic for the exam which means means they do the test and the reports get sent back to the doctor. Fine. They told me that if I had not heard from my doctor in a week, to call him. He should have my results no later than a week after the exam. Got it.

Three weeks, dozens of phone calls and a boatload of confusion later, my doctor finally had the results. His immediate response was to schedule an ultrasound back at the diagnostic clinic. No explanation of why, just that I should go.

Initially, this was not what I wanted to hear, I wanted him to say, “looks good, you’ve beat the family curse,” and I would move on with my life triumphantly, but instead a tiny alarm bell started tolling in the back of my mind. I made an appointment for December 9th, the first I could get.

I arrived bright and early that morning and did my crossword puzzles while other names were called for a myriad of other appointments and ailments. Then, before the ultrasound, a technician pulls me out into the hallway and said she read my initial report and wants to do a “spot” mammogram. This is a mammogram concentrated in one area with much more compression and the horrorific pain everyone tried to prepare me for the first time. While I waited for all this fun to begin, I tried to keep myself calm, wondering why nobody would tell me why I was having this test done. In the back of my mind I knew, I just wanted someone to tell me. Spell it out. Keep me in the loop.

Back to the spot mammogram. Ouch. Several times. At one point, the technician told me to pick a point on the wall to focus on and to brace myself for some pain. As if I hadn’t had any already, but I took her advice. I spotted a calendar on the wall and stared at it while she nearly flattened my breast into a pancake. I can’t tell you what the picture was on the calendar, but I can tell you that it said, “My peace I give to you,” at the bottom. I kept telling myself not to cry. At this point, though, I was on autopilot, so it wasn’t so bad. Then I went back out to the second waiting room and then they came to get me for the ultrasound.

The room was dark and the nice technician chatted away while she worked. Then she was abruptly silent. I saw the screen and saw what she saw. She covered the area again and then stopped to take images. Several images. The spot looked about as big as a quarter. Not comforting. Given my family history (maternal grandmother, mother, 3 of 4 aunts) I said, “That can’t be good can it?” and she said she couldn’t say anything either way. She told me to “relax,” and then she left the room.

I lay there in the dark and wiped away a tear. I was overly emotional that day anyway (my brother’s 39th birthday would have been that day) and the fact I was having a breast ultrasound made me think of many painful memories of how cancer can hit unexpectedly and rob even the young of their once vibrant lives. I took deep breaths and told myself I was okay, and for me, kept relatively calm instead of letting my mind get completely out of control. Though I can easily jump to panic mode, I was calm, certain that I wasn’t alone. I kept thinking of the calendar, “My peace I give to you.”

The technician came back with a doctor in tow. He looked at the ultrasound, nodded at the screen and said, “I am recommending a biopsy.” He shook his head again. “How could you not feel that?” I took a deep, shaky breath and he clarified quickly, “oh, it looks benign, but with your family history, we can’t be too careful now, can we?” Apparently not. Then he asked, as if I hadn’t heard him the first time, “How did you not feel that?” I don’t know. I’ve been doing breast self exams since I was a teenager. I didn’t feel this lump. I still can’t feel it to be honest.

The diagnostic clinic people tell me it takes 24-48 hours for a report to be made, filed, and transfered. Ok. Now I’m in for more drama as I try to communicate between the OB/GYN’s office and the diagnostic clinic over the next 24 hours. Words like, “surgeon,” “biopsy,” and “referral” mixed with, “we don’t have that yet,” “I don’t know what the doctor’s going to do,” and “I can’t tell you that.” I got so frustrated with being the one having to mediate between the two offices and even more frustrated with my inability to find out ANYTHING worthwhile, that I finally made an appointment with my OB/GYN that Monday (13th).

I took that entire day off. I was mentally drained, and I had been fighting a sinus infection and had been running fevers off and on for a week. I just wanted answers and figured if I had the doctor’s attention for five minutes, I might at least understand more of where I was in this process. I hadn’t done any of this before, and I wanted someone to take my concerns seriously.

I was glad I took the whole day off, for they moved my morning appointment to 2 pm. I saw the doctor for about five minutes and all he said was the report didn’t look bad, they just wanted a biopsy because of my family history, blah, blah, blah. Same thing I was able to piece together from words the four people I saw on the Thursday before were tossing around. He said he was sorry everybody was overreacting but with my family history I should expect this every time I get a mammogram. They will probably always find “something,” that will need further review. He wasn’t worried and even seemed to wonder why I was there. I told him I was in his office to get some answers because nobody would tell me anything in a complete sentence and that’s not how it should work. Silly me. Finally, he gave me some antibiotics because I told him that I could cope with all that was happening so much easier if I wasn’t so sick otherwise. He said he would refer me to a surgeon, but that his scheduler wasn’t there and to call her in the morning.

I called in the morning and of course she had no idea what I was talking about. She was still thinking back to Friday when I was worried the diagnostic clinic would not get my records to the their office on time. She was up to speed but then my OB/GYN was out of pocket for two days and all we needed was the name of the surgeon. I was growing more weary of how the people in the HMO machine were treating my concerns. Okay, so it looks benign, but that doesn’t mean I want to wait another month to start the process to find out whether or not it is benign or not. UGH

I finally got the doctor to refer me to a surgeon Thursday (16th). One week had already passed since the ultrasound. Too bad the surgeon isn’t in my HMO! The only two doctors he refers to aren’t on my plan. The OB/GYN receptionist said, “look through your HMO for a general surgeon and call us back and we’ll ‘refer’ you to him.”

I thought, “This ‘referral’ will keep the insurance chain of command going, but I am in HMO hell!” I asked the sweet lady in personnel to see what she could do to help with this problem. I don’t have a clue as to how to “pick” a surgeon. She tinkers around on the insurance website and it spits out 185 names of general surgeons in my HMO.

Beyond frustrated with how long and how difficult this process had become, I took a long walk around the church. I stopped to “talk” to my favorite babies in the daycare (the 9-12 month olds) who cheer me up whenever I see them (who can resist smiling at a kid who can put his whole foot in his mouth), and talked to a couple of people who have actually had this procedure done and asked which doctor they used. Another friend came down, looked over the list and circled the name of a doctor she’s worked with and he has a great reputation. I brought the doctor list home for my nurse roomie to look at and Friday night our doctor friend was over and he looked at it and made some suggestions as well. That helped to narrow the choices down.

I don’t think it’s being too picky to want at least one person to know something or have experience with one of the surgeons, because I just don’t like having to pick someone at random to stick a big needle in my breast.

Thursday night, I took a benedryl, checked out at 9:30, got a good night’s sleep and got my allergies under control. The antibiotics started working, so I felt so much better. I took a day off from the doctor drama on Friday. I finally got a “grip,” and I was feeling much more at ease. I don’t know why I expected it to last.

I took all that information and started calling doctors this morning (the 20th), and their earliest appointments were in the middle of January. Not what I wanted to hear. I finally contacted the surgeon who has done this procedure on a lady I work with and he had an appointment for a consultation on Monday morning (the 27th). The receptionist was beyond nice. I told her my story and she was very sweet and took my concerns seriously and found me the earliest appointment possible. I booked that appointment. Then she tells me I have to get the referal from my PCP for a procedure like that. The receptionist at my OB/GYN agreed when I called her back to verify the referal process.

By now, I’m confused, I thought the OB/GYN referal would be enough, but I ask personnel and she says, yes, that’s correct, call the PCP. The PCP will not do this by phone but they will write up a referal if I come in and see my PCP tomorrow morning. More copays. I am really loving the red tape I’m stuck in at this point. I’m grateful I don’t have anything urgent wrong with me. And by the way, I have to go pick up my ultrasound pictures at the diagnostic clinic and take them to the doctor with me Monday. I still have no idea when I’ll have the actual biopsy.

Don’t get me wrong. So far, I’ve spent less than $100 and had many tests and office visits. Without the insurance, this lump would have gone undetected for Lord knows how long. I just had no idea how complicated the HMO made my healthcare and I had no clue how frustrating this process would be. I also know this is mild compared to how complicated it could have gotten. I know when it’s all said and done, I will get the biopsy results back and the lump will be benign. Everything will be, as they say, all good. The journey between points A & B, however, will have been an enlightening tour through HMO hell.

Too bad Dante didn’t warn us.

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