Another case of HMO woes?

punchenpie_IHB

punchenpie_IHB

New member
So my aunt had been complaining about a stomach problem she's had since November. Every time she's been to her MD, he dismisses it as a stomach flu and dispenses whatever prescription meds he thinks will work that time.



Fast forward to last week, when my aunt says she's had the same "stomach flu" for a couple weeks now. Doc says it's an intestinal flu, prescribes more meds, and that's that.



Last night, she was in the ICU because she had turned yellow, complained that her eyes were itching, and that her stomach pain was worse.



This is sad. Personally, I haven't had problems with my HMO, but I've heard so many horror stories from friends and now it seems my aunt is just another example of how the service is less than stellar for HMOs.
 
so sorry to hear that... that's terrible! my friend once had a very bad cold that wouldn't go away. he went to the HMO doctor who kept telling him it was just a cold. 2 wks later, still the same cold, still the same response from the doctor. his wife kept pressing the doctor to get chest x-rays done. luckily his wife was very adamant and demanding but it still took far longer than it should have. of course, that particular doctor couldn't read the x-rays and it had to get kicked up to a specialist, who right away diagnosed my friend with pneumonia.
 
Unfortunately, this scenario really has nothing to do with HMO/PPO but with the clinician and a poor clinical decision. If this clinician did not consider checking liver function tests for your relative's abdominal pain, and missed the signs of hepatitis, it is unfortunate. But this really can happen anywhere.
 
Just because you have an HMO doesn't mean you don't have any options! If you're on an HMO and feeling sick, head to URGENT CARE for usually the same amount as your office visit copay. And insurance carriers do allow you to switch primary care physicians / medical groups. Call Customer Service on your ID card to make the change over the phone! Granted it's not like having a PPO and selecting any doctor you want anytime, but there are pros/cons to HMO vs PPO. And like everything else, we have to be proactive...and it always helps to have a health advocate when you're not feeling well...if you're under meds, you might not always be making the best decision for yourself (I got that one from Oprah, haha)
 
Like I said, I'm on an HMO myself and have never had any problems. However, it has been seven days since she was admitted in hospital, and she has yet to be released. As it turns out, her gall bladder was totally ruined and gall stones were up her bile duct. They initially performed a laproscopic surgery, and then changed their mind mid-way and did an open surgery instead, and then the next day decided to do an endoscopy (my other aunt works at Cedars and the doctors there were questioning the order in which these procedures were executed).



Yesterday, an infectious disease doctor visited her to say that she needs a CT scan because they want to see if she has any abscess, but they would not tell her just exactly why.
 
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