When you read about problems with managed care, they're always big ones, involving denial of costly treatment. But if my mail is any guide, a million so-called "little things" are troubling you too all of which challenge the vaunted efficiency of HMOs.
It's hard to check up on the personal stories readers tell. So when my reporter, Kate O'Brien Ahlers, started grinding her teeth about her own plan, Aetna U.S. Healthcare, I asked her to document what she was going through. Here's her report (concealing individual identities):
June 9: I decide to quit the medical group that I'd picked from U.S. Healthcare's list. Among other things, it lost my appointments, shuffled doctors on me and kept so few telephone lines that I had a hard time getting through. I send a letter, asking that my records be shipped to another office.
Early August: I feel tired, ill and am losing some weight, so I call my new doctor for a checkup. Oops. She has left and no one told me. In her place, I choose Dr. C.
Aug. 25: I hear from the medical practice I just quit. It welcomes me as a new patient. Grrrrr. I write back, saying I want out, not in.
Early September: After receiving the new paperwork, I leave a voice mail for Dr. C, asking for a checkup. No one calls back.
Oct. 6: I call Dr. C again. Linda the receptionist gives me an appointment. My medical records still haven't arrived. Are they being held for ransom? Should I call the FBI?
Oct. 29: Thorough checkup with Dr. C. She even got my records! I'm sent for a blood test to a lab upstairs. Oops. The lab says it doesn't take U.S. Healthcare patients. I'm sent to the New York University (NYU) Medical Center Blood Lab instead. There, the wait is two hours. I'm advised to come back.
Nov. 6: I return to NYU. Now I learn that I'll have to pay for the test because I don't have a referral form. I call Linda. She tells me to call the Quest Diagnostic lab center, for a facility near my home. She'll fax my referral there.
Nov. 10: Quest gives me an office that's miles away. I fax Dr. C asking if that's where I'm supposed to go.
Nov. 11: No reply. I fax again. Calling is useless. The answering machine disconnects me.
Nov. 12: Success! I get the actual Linda on the phone, who advises me to go back to the lab I visited first. Later that evening, I feel lightheaded and pass out.
Nov. 14: The upstairs lab does the test, after telling me that it has had "a lot of trouble with U.S. Healthcare not paying." The test costs about $20.
On my way out, I stop at Dr. C's office. Oops. Dr. C forgot to mention that she was going on pregnancy leave. Linda will call.
Nov. 20: No call yet. When I finally reach Linda, she says my test results are normal. But even in HMO-land, should I accept a diagnosis from the receptionist? I ask for the doctor replacing Dr. C. Linda says Dr. J will call.
Nov. 24: Still no call. I leave Dr. J a message about the blood test and the fainting incident, which worries me.
Nov. 25: Success again! I hear from Dr. J. He found that I'm slightly anemic and says he's sorry for what I've been through.
I'm comforted. But the episode has taken four and a half months. What if the blood test showed I were really sick? What if I couldn't have taken hours off work to pursue an answer? What if I needed help to get around?
I tell my story to Dr. Arthur Leibowitz, chief medical officer for Aetna U.S. Healthcare. He calls my struggle a failure of the medical system, not of his company's "access to care." He explains how U.S. Healthcare monitors its doctors for quality.
I ask Dr. Leibowitz what he thinks I should have done. He says: (1) Call your doctor (was he listening to how hard I tried?); (2) Switch to yet another doctor (and delay my blood test even more?); (3) Call U.S. Healthcare for help.
Ironically, I had called that day about a billing problem. I was transferred four times, then told the computer system was down. "We want to offer the best possible service," Leibowitz said.
Long-term care coverage
Suddenly, I'm getting a lot of questions about long-term care (LTC) insurance. Mostly, they come from baby boomers who are wondering whether their parents should buy.
But older people, too, are trying to decide whether the risk is worth the annual premium cost. They're also concerned about the huge, potential expense of long-term care. They don't want it to overcome their resources, leaving no legacy for the kids.
Congress created two tax breaks to lighten your load. Starting this year:
Part of your LTC insurance premium may be deductible on your tax return, as a medical expense. (But ask your agent; some policies are tax-qualified and some aren't.)
If you're receiving long-term care, its cost is tax-deductible, too. (We're awaiting details on exactly which expenses qualify.)
Even so, full-time custodial care costs more than a tax deduction can repay. So how about it? Do you buy long-term care insurance or not?
No rule of thumb works for everyone. But here are some guidelines from the United Seniors Health Cooperative (USHC), a nonprofit consumer organization based in Washington, D.C.
Consider it if:
- You have more than $75,000 in assets for every person in the household, not counting your house and car. You might want to leave part of that money to your heirs.
- Your annual income is $30,000 or more for every person in the household. At that level, policies start to become affordable.
- You'll spend no more than 10 percent of your income on long-term care insurance. You might never need it, so you shouldn't have to scrimp.
- You could still afford the policy if its cost went up by as much as 30 percent.
For a first-rate book on these and other issues, write for "Long-Term Care Planning: A Dollar & Sense Guide," $15 from United Seniors Health Cooperative, 1331 H St. N.W., Washington, D.C. 20005 or call 800-637-2604.
Syndicated columnist Jane Bryant Quinn can be reached in care of the Washington Post Writers Group, 1150 15th St., Washington D.C. 20071-9200.
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