Guaranteed Healthcare

Anyone who talks about the availability of the American medical system has no idea what delays and limitations are present for most of us. We chose an "affordable" HMO via my husband's employer. The ACL ligament in my knee tore and it took 1 year, 7 docs and providers, 1 fancy knee brace, and 2 insurers before I was able to get the necessary surgical repair. (The paperwork for all this is unimaginable. Not to mention, the wait.)

Knee went out in January 06, leaving me in constant pain, increased when I walked. HealthNet HMO insurance, limited to Hill Physicians Medical Group GP #1 (for permission) in early March (tried first via acupuncturists, etc.), Surgeon #1 in May (easiest to get in to see, but a dunce; he said I had arthritis) Xray #1 Surgeon #2 in June (saw the ACL tear, referred me to physical therapy) MRI #1 PT #1 (dunce, said she'd never seen the symptoms) PT #2 (dunce, gave me exercises that hurt my back) Surgeon prescribed expensive (titanium?) knee brace to hold leg in place, due to pain. Insurer refused out of network PT, and PT's said that insurer had cut so far back on reimbursements that PTs would not work for them (local hospital PT dept said they were willing to take low reimbursement, but insurer unaccountably would not put them back on the list of approved PT's)

Changed to second insurer: HealthNet HMO, limited to Alta Bates Medical Group [Oddly, HealthNet does not allow HMO members to use doctors from another HealthNet medical group if their group does not have adequate services.] GP #2 (for permission) September Surgeon #3 November (saw the ACL tear and a meniscus tear, referred to PT, scheduled surgery) MRI #2 XRay #2 PT #3 (understood the problem, prescribed appropriate exercises in preparation for surgery)

Surgery - January 07

Without the insurance limitations: Surgeon, Xray, MRI, PT, surgery in 2 months.