Riding the Roller-coaster in HMO Land

4 Feb

Roller Coaster

I’ve been meaning to post for about a week now.  I wanted to write about how the vagaries of HMO-land, coupled with my bizarre condition and my own craziness, set me off on an emotional roller-coaster, a ride that seemed to have no end in sight.  My rather sluggish blogging reflex, though, delayed my response and has, in some sense, made my first story seem…superfluous.  Since last week things have become clearer.  I see the end of the ride, or at least an end to this most recent ride.  I have some clarity, some sense of where I’m headed next, some…certainty….not a lot of certainty, mind you….just some…a bit. And that certainty is, at once, reassuring and frightening. I have stepped off of one roller-coaster and gotten on to another.  As with all thrill rides I am curious, exhilarated, scared, and, of course, nauseous. Let me explain.

Last week I found in my mailbox a letter from my medical group, a letter that  surely held my referral to a consultation with a thoracic surgeon—an E-ticket (for those of you old enough to know what that phrase means)* for the next adventure in my ongoing medical saga.  My stomach dropped (as it does on all E-ticket rides) and I was filled with a sense of apprehension as I opened the letter, deathly afraid that I would soon meet with a surgeon and learn about the operability (or perhaps inoperability) of the benign mass in my chest.  I know this sounds counterintuitive.  After all, I wanted to see a surgeon.  I’ve been saying so for several months now.  But facing the reality of that visit filled me with a fair amount of dread.  You see, while I am very interested in learning if this thing can be removed, I am, perhaps, a bit less interested in actually having surgery.  The idea of surgery is scary to me.  It involves a level of trust and a loss of control that I am uncomfortable with.  Surgery is risky and filled with complications.  I mean I do want to get this tumor out of me, but I would prefer it if it could be done by a chiropractor or faith healer.

As it turns out, there was nothing to fear.  The letter was actually a bureaucratic bulletin alerting me to the fact that my medical group was going to delay their decision for up to 45 days while they determined if my doctor had tried more “conservative” means of treatment before resorting to a surgical consult.  Relief washed over my body as I realized there would be no surgical consult soon.  Someday I would see a surgeon, sure, but not today, and not tomorrow….phew!  Almost immediately, though, I began to get a little peeved.  “What the hell is wrong with these people?” I wondered.  “More conservative treatment?  Like what….talking the tumor out of me?  Perhaps I would get to see those faith healers after all!  One thing’s for sure, though, I’ll never see a surgeon, now!”

I realize how nuts all this sounds, but that’s how I felt.  Part of my reaction was, of course, my own special brand of crazy, but part of it also comes from some insight into HMOs and how they operate.  A colleague of mine is a trained nurse who once worked on specialist approvals for some HMO here in California.  Months ago she explained to me that once you pass a certain level of care, all requests are initially delayed or denied.  It’s just a game these folks play.  Sometimes it’s a medically sound game, and other times not.  And that’s what pissed me off, really.  I had no idea whether their delay made any sense or not.  Did they really need proof of my doctor’s efforts to try more conservative approaches to remove my tumor, or were they just messing with me?  And if they were, well damn it, don’t they know that I want to see a surgeon….sort of?

Nine days after receiving the offending missive about the delay, I got a call from a surgeon’s office.  “Mr. Greenberg, We’ve got a referral for you, and we like to call as soon as we get them so you can see the doctor right away.  What is your schedule like this month?”   Well, apparently my schedule, and the surgeon’s schedule (should I say “my surgeon?”) came together on February 20th, and so I have my consultation appointment.  Hooray….and shit!  Later this month I get to do the thing I’ve been simultaneously wanting and not wanting to do.  Amy and I will sit in some doctor’s office and make small talk while we wait to hear what the next step in my journey might be.  We’ll listen intently and ask lots of questions.  If the doctor is a jolly sort, we’ll make a few jokes.  If he’s more serious, we’ll be serious too, and then when it’s all over, we’ll go on with our day while we try and figure out our next move.  Naturally, I will share the details in this blog as soon as I can.

Stay tuned.

*For those of you unfamiliar with the phrase “E-ticket ride,” please see the following link.



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