Two months ago I saw two hospitals patient dump my wife in need of critical care for a potentially fatal adverse medication reaction. She went unconscious in the emergency room in one hospital and was untreated for over 10 hours while in the Emergency Room. The doctors as well failed to diagnose her or never even attempted to do such. They were too busy doing the HMO's dirty work of getting the cheapest care possible from another source rather than treating her. I did through an on line artice get an accurate diagnoses of her condidtion that the doctors missed. This was after their giving her the same medication and a second adverse reaction occured. HMO's are a pyramid schemes sponsored and unconstitutionally protected by congress. I support their being held accountable for their malpractice they choose freely to engage in by making medical decessions.
My HMO claimed that I didn't file a piece of paper within 30 days of my son's birth. I had called to inquire if the form was required and an operator at the local office told me 'no'. She made a log entry of the call, and I took and saved notes regarding the call.
Three months after my son's vrey difficult birth and week in intensive care, I got a bill from the hospital for $25,000.
It seems the form WAS required.
What followed was a comedy of red tape and catch 22s that ended up with the HMO firing their ombudsperson (for concealing faxes I had sent in support of my case to an eligibility hearing) and my agreeing to pay one month's premium to get them to pay the $25,000.
Time elapsed: 18 months.
My brother, a physician, tells me that the insurance companies do this to collect interest on thousands of cases at a time.
Even though there was a huge difference in age, diagnoses and medical treatment, I shivered nonetheless while at the same time thanking God for American health care and a competent HMO. (Yes, even while we love to complain about our country’s medical care, and it is beyond dispute that the system is plagued with many problems, it still beats what’s available in most other countries). While English physicians in Britain’s notoriously inept National Health Service had apparently been unable to diagnose my mother’s condition, at least I knew my wife’s diagnosis: pneumonia, laryngitis and dangerously high blood sugars.
I thought back over the past week. Sylvia had been well eight days before when I had left in the early hours of the morning for my regular Monday commute to Biola University in Los Angeles, California. When I called her a few hours later to let her know that I’d arrived safely, she was still well. Then when I called her Monday night, my son Joel told me she was sick and sleeping. Tuesday morning I arrived home and Sylvia didn’t feel at all well. However, knowing that the flu was going around and starting to get a sore throat myself, I initially wasn’t terribly worried. I just figured that we’d both take lots of vitamin C and soon we’d be feeling better. Over the next few days a number of people I talked to seemed to be getting sick. I was hearing that the best thing to do was to get lots of rest and just ride it out. Basically, it was a three or four day flu that left as quickly as it arrived. However, after a few days, while people around me who’d had the bug were getting better, Sylvia showed no signs of improving. Despite having a temperature and a hacking cough, she didn’t want to go see the doctor. It had now been eight days since she had gotten sick and she appeared to be getting worse; almost delirious.
That morning I called a physician friend who agreed to see her after he finished work. The visit was set for five o’clock. After grabbing a quick business lunch, I headed back to the house to check on Sylvia. I asked her if she would see “Dr. Pete.” Her mumbled response was that she didn’t want to see him, but she would see “all the king’s horses and all the king’s men, though.” That was enough for me to realize that Sylvia was in urgent need of medical care, even if she really didn’t want it. Fighting back tears, I called 911 and told them I needed an ambulance at my house at once. Within a few minutes, county paramedics and the local ambulance service were at my front door. I let them in and explained what had been going on. They gave Sylvia oxygen and an IV, took her blood pressure (and I am sure performed a number of other medical procedures that I can’t remember), and took her to the hospital. Adding an almost humorous touch to a horrible day was an ambulance service paramedic who solemnly informed us that the trip to the hospital would cost us $500.00. I know that he had to say that but what did he expect us to do; say “Well, in that case, just leave. We’ll find alternative transportation!”
Although I wanted to, I didn’t go with Sylvia in the ambulance to the hospital. My youngest son Josiah had been experiencing some ear problems and we had an appointment about 30 minutes later with his doctor on the other side of the same hospital to which Sylvia was being taken. While my initial thought was to delay Josiah’s appointment to the next day, as Sylvia was being wheeled out of the door on the gurney, she was coherent enough to gasp out to me, “Keep Josiah’s appointment and come and see me when you’re done.” I did just that. Arriving at the emergency room later, I found her out in the hallway where she had been put until a bed was freed up. However, X-rays had been taken during that time, as within a few minutes a doctor told me that Sylvia had pneumonia. While hospital staff weren’t initially certain whether to admit her or not, when blood tests revealed very high blood sugars they told me that they’d find her a room “somewhere.”
Six days later, having been more medically dosed up than she’d probably been for most of her life, Sylvia was home. While she is far from well (our doctor told us that recovery from pneumonia can take about a month), thanks to a lot of prayer and medication she is on the road to recovery. And the hospital bill? Well, it’s eminently manageable (and our insurance will take care of the ambulance as well!) So the next time you’re tempted to write off HMO’s in general, I encourage you to think again. (Just thank God you’re not in England, or Uganda, where I visited a couple of years ago).
While I know that some people have had terrible experience with HMO’s, without the Lord, our HMO and its hospital, after the experiences of the last week or so I don’t know where we’d be.