I was dissatisfied with Kaiser as my Medicare HMO, so I tried Humana's
Medicare HMO program, starting January 1st. After signing up, I found that
this was something called PFFS. The fine print required that I go out and
find a doctor myself that would accept Humana's PFFS, which pays the doctor
the same as being on regular Medicare. I could not find *any* doctors, even
a general practitioner that would take the PFFS insurance. Humana had no
list of doctors that would take their insurance. Humana told me to use the
government's Medicare website to identify doctors that take Medicare. I
found that the doctors on the government's list were either closed
practices, or they were refusing to take new patients.
I found out that Medicare allows one change of HMO choice during the January
to March period. I looked for the most expensive premium program that had
lists of in-program doctors to chose from. At $100 per month, Secure
Horizons looked like the best bet. The Secure Horizon website had lists of
contracted doctors. I made the switch to Secure Horizons. The primary care
doctor I picked made me an appointment. When I got there I made a friendly
comment saying "I guess you get to be my primary care doctor." The doctor
frowned and said: "You picked me, so I don't have a choice." It was obvious
that my even being there pissed him off. I guess he had signed a contract
that gave him a mix of in-program patients that the insurance pays different
amounts for. The Medicare based in-program patients pay less (the insurance
company pays less).
I got a referral to a Urologist. This was a very very old doctor, who was
past retirement age, but loves his work so much he keeps a full schedule.
He would provide his best service even if he were giving it away for free.
The problem is that he was trained to withhold info from scheezers. In the
US, the patient really needs to know what is going on to get proper care,
and make treatment choices. I think the young doctors are trained to lie to
scheezers too, but the young doctors see it as unethical, and find ways of
letting you know what the test results are.... The old doctors lie and
obscure, even if it interferes with the patient being able to make choices
for something like surgery....
The insurance company had a list of psychiatrists. I contacted every one.
With psychiatrists, they didn't care what contract they signed, they were
not going to take a Medicare patient. The p-docs often had some excuse,
like: "I don't handle disability cases." I filed an appeal with the
insurance company. The manager at the insurance company gave me a referral
to a program linked to a major area Hospital under their contract. The
Hospital has a slow slow evaluation process for accepting patients. I
contacted the Hospital Psychiatric department on March 30th, and this week I
was confirmed for a first p-doc appointment in July 2007. It has been about
a year since I saw a p-doc. Most scheezers would never have managed the
dozens of phone calls and several letters I had to do to get a psychiatrist.
Just being schizophrenic is not enough to get quick service. It is a fight
the whole way.
Come the end of the year I'll go back to Kaiser. Kaiser is very organized.
The reason I left was that Kaiser has shifted their policy to make each
visit and service have a higher and higher co-pay. If I got hit by a truck
and was hospitalized at Kaiser I would owe thousands of dollars in co-pays.
Under Secure Horizons a 20 day hospital stay would cost me a $400 co-pay.
I would much rather pay a very high monthly premium and not have to worry
about fees for every doctor or CT scan. However, Kaiser does not offer any
options. There is just the one program, and they know that by making every
utilization expensive that the fixed income folks will just go without
services. The non-profit, Kaiser is being run somewhat like a business.
I left the frying pan, and fell into the fire. Having each doctor and
specialist not know each other makes things very difficult. At Kaiser all
the doctors are linked by computer, and by a common written chart that gets
circulated from doctor to doctor as one has appointments.
My feeling is that the US failure to have universal health care, as many
industrialized countries have, is a moral crime. It is like we had
preserved slavery, or something.
medicare HMOs 
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