HMOs: ‘When Managed Care Means Mediocre Care’
In the August 16 issue of Newsweek, California nurse Lila Larimore Anastas recounts her tribulations as an HMO patient trying to get care for a hand injury. After falling on her outstretched palm, Anastas was told by her HMO family practice doctor that she had a sprain and was sent home with "an uncomfortable canvas splint, a prescription for anti-inflammatory pills and the admonition 'These soft-tissue injuries take a long time to heal.'" Six months later, her hand still unhealed, she went back to the same doctor. She waited several weeks for X-ray results -- which showed a torn ligament -- and "two months for an appointment with a hand surgeon." After surgery and eleven weeks in a cast she had recovered limited hand motion, and "a new X-ray show[ed] significant bone loss and displacement." When the doctor listed options from doing nothing to "surgical fusion of the bones" in her wrist, Anastas decided "to take control of the spiraling nightmare," visiting four surgeons across the next four months -- two in her HMO, one at a "California medical center" and one in private practice. These doctors pointed out "mistakes that were made by my HMO and insist that the organization pay for my surgery. I meet before the HMO grievance committee to request that they cover the procedure, and they take their time pronouncing the inevitable 'No,'" she recounts. Finally, with her "level of frustration ... off the charts," Anastas decided to pay out-of-pocket for "the best hand surgeon to do the job." She was immediately comforted by the thorough personal attention of the surgeon and his staff: "My hand is examined and X-rayed from every angle. I'm seen by several physicians, and the best treatment is determined by committee ... I feel fortunate that I'm able to have my surgery at such an excellent facility." She concludes: "Being an R.N., I may have more savvy in navigating the system than the average person. But I don't think I'm unusual in my frustration with today's managed care plans. ... We may have to travel a few miles, but quality medical care is still available in this country. Unfortunately, so is mediocre care" (Anastas, 8/16 issue).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.