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Why I Hate My HMO

Vince Reel, 83, lives in Claremont

It was exactly 2:23 a.m. on a Sunday when my prostate reached out and shut off my urethra. For months I had suspected it was going to happen but, like most men, I was too stupid and cowardly to do anything about it. Every day it hurt more and more and finally on that Sunday morning I could stand it no longer. I drove myself to the hospital emergency room. It was April 2. I weighed 181 pounds.

The emergency room staff was very good. Got me on a table and inserted a catheter connected to a tube and a bag. When they finished, nothing hurt and after returning home to bed, I slept for hours. For several years, I had not slept for more than two hours at a time. But now, with the bag strapped to my leg, sleep came easily. I also was at peace thinking I didn’t need to worry about medical bills or receiving good care. I belonged to an HMO.

The hospital emergency room staff gave me the name of a urologist to contact. I got in touch with the recommended doctor. No available appointments Monday, but I did get one for Tuesday. The catheter, tube and bag were working all right, although uncomfortable.

I found the doctor’s office, but the secretary announced that my HMO determined that a direct referral to this doctor had to be made by my “primary physician,” not an emergency room. I hadn’t been to a doctor for at least 20 years and had never heard of such a title.

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“Go home,” the receptionist said, “and we’ll find one for you.” I went home. It was April 4. I still weighed 181 pounds.

Three days later, I got the name of my primary physician. His receptionist scheduled me for an appointment for April 12, 10 days after this all started. I met the good doctor, showed him my new equipment and told him the story of how I got it. He looked me over, (I was always fully clothed), and he spotted two small suspicious spots on my face and arm. He “fixed” them with some sort of liquid. His secretary gave me the name of a urologist and told me to make an appointment.

Two days later, I was at this urologist’s office. He gave me a cursory examination (still fully clothed) and sent me back to the primary physician with a list of tests he wanted ordered.

The appointment for the tests was set for April 25, 23 days after my problems began. I was feeling worse and worse. Always tired, days and nights spent on the couch or in bed, not eating, feeling very weak. On April 18, I was notified that my tests had been moved to April 27. I now weighed 146 pounds and had difficulty getting out of bed.

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I have a friend from Jamaica who lived with us during her senior year in high school. She went on to become a doctor and practices nearby. When she heard of my situation, she rushed to our house and, after scolding me for not calling her, admitted me to a local hospital. There were lots of tubes in the arm, but by the next day I was sitting up in bed, eating, watching TV, feeling ever so much more like a human.

I was waiting for lunch on April 22 when the hospital secretary came to my room and said my HMO would not let me stay at the hospital; I had to go home. Right then. Without lunch.

The next day, my primary physician assigned me to yet another urologist. This one rescheduled those hospital tests for April 27. He then removed my catheter, tube and bag and said something like, “Let’s see how this works.” Since I had not yet received any treatment or diagnosis or anything else, my impression was it would not work too well. Unfortunately, I was right.

By midnight, I was unable to pass urine. I duplicated my movements of April 2, drove to the hospital emergency room and writhed and hollered as they again hooked up a catheter, tube and bag.

Back home in bed I thought this whole thing over. Here I was, 21 days after my first visit. I had seen four urologists plus my primary physician. No exams, no X-rays, no tests, no medication; no one mentioned anything about cancer. I was exactly the same as I was when I first went to the emergency room 21 days earlier. But now I weighed 141.

My tests were scheduled for April 27, but on April 24, I was told by my primary physician’s office that the urological group to which my newly assigned urologist belonged had withdrawn from my HMO. So once again we were to start anew. I would be assigned to my fifth urologist and the needed tests rescheduled once again.

My fifth urologist and I had an appointment on May 5, but when I arrived at his office, the secretary said my “referral” had not come through and to come back on May 17. That would be 45 days after my initial contact with the hospital. I weighed 132 pounds.

Evidently I am a slow learner, but I was beginning to understand why people say that HMOs only make their money when you’re untreated.

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My friend, the exchange-student-now-a-doctor, went into action. At her urging, I resigned from my HMO--no easy feat.

What has happened since then? A feeling of security. My own doctor, not an HMO representative. Someone who works for me, not an insurance company. Three days after I first saw him, Dr. Neville Wallace had me back in the hospital for biopsy surgery and the cancer was discovered.

The good news is, I’m finally getting treated. When I first met Dr. Wallace, my weight was 132. Now it is 174.

And here is a laugh. I received a letter from my HMO, which evidently never knew I had withdrawn. The letter said: “You’ve just illustrated how quickly your HMO cuts through Medicare red tape.”


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