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Kaiser Permanente Patient
Horror Story
Stephen Keller Pacifica, CA HMO Denies Heart Patient Access to Cardiologist, Denies Hospitalization for Drug Treatment I have a condition called "atrial fibrillation" which is an irregular rhythm of the heart. I take medication to control this. I have had this condition for 10 years.
Three things happened to me while I was insured under an HMO that I consider to be medically dangerous decisions. First, my wife called the office of my MD to inform them I was having an attack of atrial fibrillation. The office told her that the doctor was booked up and couldn't see me. We went to my cardiologist instead. (We pay for an individual health plan because my cardiologist who I have been going to for 8 years wasn't on the HMO plan.) If we were medically uneducated or didn't have enough money to pay to see the cardiologist, I would not have had any medical attention at all when my heart was beating irregularly.
Second, my cardiologist wanted me to change medication to a drug called Cordarone. He told me that I would be hospitalized for about five days while I took a very high dose of the drug to build it up in my system. I would then take a lower dose daily. The HMO refused to pay for the hospitalization. As a result, I had to take a lower (but still quite high) dose at home over a longer period of time. During the first two weeks, I was unable to go to work as my wife had to watch me for side effects of the drug. After the dose was lowered, I could go to work, but could not drive; a co-worker had to pick me up to go to work. All in all, it was 6 weeks before I was lowered to the maintenance dose and could resume normal activities.
Third, during the period when I started on Cordarone, I had several attacks of fibrillation. On one occasion it was late at night, so my wife took me to the emergency room. They put me on a heart monitor for a couple of hours, then sent me home while my heart was still beating irregularly. In the past, on another health plan, the hospital had admitted me for observation when I went to the emergency room. I believe that they sent me home because they knew the HMO plan would dock them under the capitation agreement. This happened more than once when I was under the HMO plan.