One HMO patient's struggle to get some medical attention


WHEN MY reporter, Kate O'Brien Ahlers, started grinding her teeth about her HMO, Aetna U.S. Healthcare, I asked her to document what she was going through. Here's her report (concealing individual identities):

June 9. I decide to quit the medical group that I'd picked from U.S. Healthcare's list. Among other things, it lost my appointments, shuffled doctors on me and kept so few telephone lines that I had a hard time getting through. I send a letter, asking that my records be shipped to another office.

Early August. I feel tired, ill and am losing some weight, so I call my new doctor for a checkup. Oops. She has left and no one told me. In her place, I choose Dr. C.

Aug. 25. I hear from the medical practice I just quit. It welcomes me as a new patient. Grrrrr. I write back, saying I want out, not in.

Early September. After receiving the new paperwork, I leave a voice mail for Dr. C, asking for a checkup. No one calls back.

Oct. 6. I call Dr. C again. Linda the receptionist gives me an appointment. My medical records still haven't arrived. Are they being held for ransom? Should I call the FBI?

Oct. 29. Thorough checkup with Dr. C. She even got my records! I'm sent for a blood test to a lab upstairs. Oops. The lab says it doesn't take U.S. Healthcare patients. I'm sent to the New York University (NYU) Medical Center Blood Lab, instead. There, the wait is two hours. I'm advised to come back.

Nov. 6. I return to NYU. Now I learn that I'll have to pay for the test because I don't have a referral form. I call Linda. She tells me to call the Quest Diagnostic lab center, for a facility near my home. She'll fax my referral there.

Nov. 10. Quest gives me an office that's miles away. I fax Dr. C asking if that's where I'm supposed to go.

Nov. 11. No reply. I fax again. Calling is useless. The answering machine disconnects me.

Nov. 12. Success! I get the actual Linda on the phone, who advises me to go back to the lab I visited first. Later that evening, I feel lightheaded and pass out.

Nov. 14. The upstairs lab does the test, after telling me that it has had "a lot of trouble with U.S. Healthcare not paying." The test costs about $20.

On my way out, I stop at Dr. C's office. Oops. Dr. C forgot to mention that she was going on pregnancy leave. Linda will call.

Nov. 20. No call yet. When I finally reach Linda, she says my test results are normal. But even in HMO-land, should I accept a diagnosis from the receptionist? I ask for the doctor replacing Dr. C. Linda says Dr. J will call.

Nov. 24. Still no call. I leave Dr. J a message about the blood test and the fainting incident, which worries me.

Nov. 25. Success again! I hear from Dr. J. He found that I'm slightly anemic and says he's sorry for what I've been through.

I'm comforted. But the episode has taken 4 1/2 months.

What if the blood test showed I were really sick? What if I couldn't have taken hours off work to pursue an answer?

What if I needed help to get around?

I tell my story to Dr. Arthur Leibowitz, chief medical officer for Aetna U.S. Healthcare.

He calls my struggle a failure of the medical system, not of his company's "access to care."

He explains how U.S. Healthcare monitors its doctors for quality.

I ask Dr. Leibowitz what he thinks I should have done.

He says: (1) Call your doctor (was he listening to how hard I tried?); (2) Switch to yet another doctor (and delay my blood test even more?); (3) Call U.S. Healthcare for help.

Ironically, I had called that day about a billing problem. I was transferred four times, then told the computer system was down.

"We want to offer the best possible service," Leibowitz said.

Pub Date: 12/15/97

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