in this grand hot mess that is the debate over nationalized healthcare, I'd like to submit a case report of one healthy person who has been thus far completely thwarted and failed by Aetna, my employer's HMO of choice.
I have been working for my company over six months, eligible and enrolled in Aetna's basic HMO plan for five months—as I, a young and generally healthy person already imbued with hearty student loan payments every month, could not afford the PPO plan. In case anyone is unfamiliar with these terms, HMO plans offered through one's employer generally have little to no monthly cost, while PPO plans can be very pricey. In my case, I believe it was around $200 a month. Plus, the PPO co-pay at the doctors' offices is generally higher than it is through an HMO. The difference in service is that with an HMO, one must use a provider found in the organization's "network," while with a PPO, the choices are often much broader, and one generally does not have to be referred by one's "primary care physician" to go to, say, a dermatologist or other specialist.
Thus, I signed up for HMO, ready to get my one office visit a year, thankful for the coverage that would (and will, hopefully) be provided to me in the event of some devastating emergency.
The problem, however, is that apparently that "one office visit a year" is one of the most difficult things to obtain.
When I signed up, the company's website offered me a list of physicians covered in their network. I went through it, selected a name that I liked, wrote it down on my paperwork. All well and good, until I got a terrible rash right after I'd enrolled. I was freaking out—so I called my doctor.
"Gary Smith's office."
"Hi, I'd like to make an appointment."
"For what?"
"I've got this terrible rash, I-"
"Doctor Smith is an ear, nose, and throat doctor. He doesn't do rashes."
"Well, he's my primary care physician. I signed up with him."
"He's a specialist. He can't be your primary care."
"So he won't see me?"
"No, he will not."
Right, okay. So I called Aetna to try to resolve this problem. Aetna, who had let me put my name on the rolls of this doctor who would probably have been collecting a monthly stipend just for having the name of a patient he'd never see on his rolls.
The person at Aetna was about as helpful as the receptionist at Gary Smith's office. In addition to the gross error made by having Dr. Smith listed as available to be a primary care physician on the website, Aetna also managed to misspell my name, which I'd carefully written on the paperwork. After explaining both of these problems, the operator sounded exasperated and annoyed with me.
"So you don't want to have Gary Smith as your primary care provider anymore?"
"Well, seeing as how he refuses to see me, no, I need to change physicians."
"Okay. Who do you want to change it to?"
"I was hoping you would be able to tell me that."
"Okay. Hold on. This is going to take a few minutes." Aetna put me on hold for about ten minutes—and this conversation, by the way, is taking place during a break at work on my personal cell phone—and when she came back on the line, she started reading names and phone numbers to me over the phone. After she'd gotten through about ten, I told her that was enough, and thank you. Needing to see a doctor right away, I didn't have the patience to call the doctor and try to get Aetna on the phone again, so I chose the name of a nice Jewish lady doctor who was in my neighborhood as my new PCP.
I called that doctor immediately after my phone call with Aetna to schedule an appointment, and there was a recording—in Russian. Looking online, Valery Shulman is a male doctor who has been practicing for over 50 years. Imagining a doctor barely speaking my language, I knew immediately I would have to change yet again.
So I did research online this time. I scoured Aetna's provider list. I started calling doctors first, myself, to make sure they were general physicians and accepting new patients. This is not an easy feat, as most doctors' offices are open from 9-12, and then from 2-5; as I personally work exactly during those hours, it's very difficult to carve out large blocks of time that I can spend cold-calling potential physicians.
It's been over five months since I've been enrolled with Aetna, and so far every doctor listed on Aetna's website as available GPs whom I've called (eight of them so far) are not accepting any new patients or are specialists. Not only that, but contacting Aetna itself is nothing short of a part time job in and of itself. Just to send some feedback information via the website, you have to provide them with your member ID number AND your group number, as well as your home address and social security number (which I don't feel comfortable providing over the internet!). The amount of discomfort is immense, but I'm sure it saves them valuable time not reading what people have lost the will to tell them.
Is it really that difficult for Aetna to employ an individual to keep the website list updated with current, relevant information? Is it keeping healthcare costs down to make their enrollees jump through these kinds of hoops to be able to just see their general physician one initial time, at least? As far as I understand it, an ounce of prevention is less costly than a pound of cure. Are HMOs sinister, dense, or both?
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