Guaranteed Healthcare

On September 1, 2007(Saturday of Labor Day weekend), I fell and broke my kneecap while at work. I was transported via ambulance to the nearest hospital. The ER staff x-rayed my knee and told me that it was broken. They gave me a brace and some pain meds, then told me that I needed to see an orthopedist as soon as possible. There are no orthopedists on call where I live, so I was on my own. I began working for my present employer two years ago and they only offered Summerlin insurance. Previously, I'd had Kaiser for about 20 years, which I loved.

The few doctors who accepted Summerlin were not accepting new patients, so I had no primary care provider when my knee broke. So, I made it through the weekend and on Tuesday I called the closest orthopedist only to learn that I couldn't make an appointment unless I was referred by my primary provider - the ER doctor didn't count, nor did the x-rays I had. I started calling doctors within 60 miles, but no one would see me. On Thursday, I found a clinic that basically doesn't turn anyone away and took worker's comp - I had an appointment for Friday. The clinic was great. They compiled all the necessary paperwork for the referral to the orthopedist and faxed it over.

On Monday I left numerous messages to the orthopedist's office, but no return call. When I finally got a human the next day, they "lost" my paperwork. Anyway, they got my paperwork on Tuesday, but ignored my messages on their voice mail. When I again finally got a human on Thursday, they said they didn't call me because my WC paperwork was confusing - God forbid they should call to clarify things. I had to have the WC rep call them and clear it up - all of this BEFORE they would even entertain the thought of scheduling me. At this point, my leg was grossly swollen and discolored.

After the billing issues were cleared up, the exchange between me and the orthopedist's receptionist was classic: she told me that the earliest appointment available was on 9/26 - at this point I was resigned to the system and did not want to piss these people off and said okay. She began taking my info and got to the nature of my injury (bear in mind she has all the paperwork in front of her & I'd left 20-plus unanswered messages) and I tell her. She says, "oh my, you need to come in as soon as possible." Duh!

I rushed over (the 13th) and saw the doctor that day. His first question was why did I wait so long. I told him and afterward his staff apologized to me. He operated on the 17th. Since then I've lobbied my employer and was successful in getting them to offer Kaiser, which I am happily back with.

In Hawaii, we have mandated employer-based health insurance, but here on the Big Island we are facing a huge shortage of medical care. Two of our major hospitals just laid off more than 50 people. If there are no health care providers, insurance is of no use and flying to Oahu for care is cost prohibitive for most. The reason I love Kaiser, is that they foot the bill for Oahu visits. By the way, I am still getting collection letters for my ER visit and other services, so the WC insurance company is holding up payment. The system is broken!