Taken for Granted:

The health-care debate is primarily focused on the uninsured. What follows are the misadventures of someone who is insured and became a victim of the typical HMO bureaucratic morass. It’s an insight into a system that creates angry patients, overworked doctors and unmotivated, rude personnel.

This is a scenario familiar to many of the 21 million Californians enrolled in HMOs.

My friend injured her knee Oct. 26. As of today, she is still awaiting treatment, in dire pain and unable to walk. She immediately contacted her primary care doctor. He could not see her until Nov. 12, or 17 days after the injury.

After the visit he submitted a request to the HMO for authorization to see an orthopedic specialist. The best the orthopedic group could do was schedule an appointment with a physician’s assistant Nov. 24 (12 days later).

The assistant told her she definitely needed to see an orthopedic surgeon, and he annotated the chart “urgent.” The earliest appointment was Jan. 5, subsequently changed to Dec. 29 after she pleaded that the pain was unbearable. The office manager’s snooty reply: “It was not fair to overbook the doctor.” In other words, please suffer in silence.

Ruffles and flourishes! On Dec. 29 (35 days later), she saw the surgeon and he agreed to ask for authorization from the HMO to do surgery. After several unreturned calls to the orthopedic group, my friend secured a copy of the authorization from her primary care doctor and alerted the orthopedic surgeon’s office of its existence. They assured her that they would call as soon as they found their copy.

Unreturned phone calls continued, and finally, on Jan. 20 (22 days later), the group informed my long-suffering friend they had the authorization. The first available date for surgery would be Feb. 19 (29 days later).

Four months after the injury and suffering unrelenting pain the entire time, she may finally get the treatment she should have received within two weeks of the injury. Compare this to the experience of another friend insured in a PPO. Suffering a less painful injury, surgery was performed by the same orthopedic group within 10 days of visiting the surgeon. I’m sure there is a long-winded, bureaucratic explanation of the inequity.