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Trying to stay well, despite your HMO

By SHEILA STOLL

© St. Petersburg Times, published January 30, 2001


We have joined the chorus of people who are fed up with the treatment of seniors on Medicare whose care seems to depend on the bottom line expected by the bean counters in the Medicare HMO.

Darling Husband is older than 70, healthy and active, but he has high blood pressure. Treatment for hypertension started before he was on Medicare. Then, beta-blockers were the best available treatment. He continued the treatment past age 65, although his friendly neighborhood Medicare HMO doctor (oops, health-care provider) noted that he had a heart valve problem: "It's not serious."

Last spring, just before we were about to go to Switzerland, Darling Husband's home, his health-care provider told him that the heart valve problem looked serious, that he needed to see a heart specialist. The specialist health-care provider told him that his heart was about to stop altogether, that the problem might be the medication and to cut it in half, that he should see a doctor pronto when we got to Switzerland. En route, a ship's doctor wanted to have him taken to the hospital by helicopter.

The doctor in Switzerland confirmed that the problem was being caused by the medication. He discontinued it, and the problem disappeared almost overnight.

After we got back to the United States, Darling Husband made an appointment to see his health-care provider. The appointment was canceled; the HCP himself was having health problems. Meanwhile, Darling Husband needed to have the prescription for the new medication renewed. Many phone calls. No results.

"You need to see the doctor before we can change your prescription."

"Fine. Give me an appointment."

"We can't. Your doctor is still out."

Eventually, Darling Husband got some of the new medication. In the meantime, in casual conversation, we encountered many other people who also had had near-death experiences with the old medication.

When Darling Husband tried to refill the new stuff, still unable to get an appointment with his primary health-care provider, he discovered that the new prescription couldn't be renewed. He had a standing order for the OLD stuff, however: the stuff that nearly killed him. If he wanted to switch back, there would be no problem.

More phone calls. Still no appointment, no blood work, no tests. Nothing.

* * *

Darling Husband, who is resourceful, checked out the HMO's Web site. There he found a list of approved medications. The old stuff was the only one listed for treatment of hypertension. There is no generic equivalent for the new stuff, which means it is expensive and not recommended.

I remember when I first heard about HMOs. They sounded like such a good idea. We wouldn't wait until we were in a crisis before seeing a doctor. We would have routine checkups, get required tests and save money. Dr. Welby would be there watching out for us, and we wouldn't have to pay for his SUV in the form of exorbitant fees. In addition, the HMO would take care of the high prices for prescription drugs. They would deal with the Medicare bureaucracy.

We're becoming resigned to the notion that Darling Husband is being "maintained" and "managed." For years I thought that maintenance was for the car, the roof, appliances, etc. We'll keep on trying to get his oil checked and his tires rotated. He's becoming expert in his new role as a squeaky wheel.

* * *

You can write to Sheila Stoll c/o Seniority, the Times, P.O. Box 1121, St. Petersburg, FL 33731.

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