The Trials and Tribulations of HMOs

I am a Kaiser baby. I was born at the Oakland Kaiser. When we were still in the days of paper file, folks were always surprised at how low my medical ID number was, and yet how thin my file was (we moved to Houston shortly after I was born, and I only returned to Kaiser after college). From a business perspective, I liked the efficiency of Kaiser. I knew that sometimes it was harder or took longer to get something done, but I believe that Kaiser is doing a lot of things right. I also know that regardless of the health system you are in, you have to be your own advocate.

The first appointment for surgery that Kaiser San Francisco could give me was April 30 – nine days longer than I wanted to wait. I needed to move forward not only because of my physical concerns – the potential for septic shock – but also for my mental well being.

I asked Jenna at Kaiser, my ob/gyn care provider, if I could go to another Kaiser. This was Jenna who had been so wonderful on Monday. When she measured the fetus size and detected no heartbeat she effectively switched from happy and upbeat to facts, soothing, and outlining my options – all while we were suddenly in the middle of a power outage. My favorite thing she said that day was "This sucks."

Jenna's response to my request to go to another Kaiser was essentially that they had started my care at San Francisco, and should complete my care there. I asked the same question to the nurse who was to help me prepare for the April 30 appointment. She found a referral for me to Choice, an abortion clinic in San Francisco, that was covered by Kaiser insurance. She also told me that if I wanted to be seen at another Kaiser, I would need to reach out to those facilities myself. Great.

I called my friend at Planned Parenthood. Her feedback on Choice was: variable. Some of the providers are good and experienced, others not as much. Great.

I called the Kaiser hotline, and spoke with an advice nurse. I asked her to reach out to other ob/gyn facilities in the area – Daly City, Oakland, Walnut Creek, Richmond, San Mateo. The responses dribbled in over a day as the local offices called me back. Daly City and Walnut Creek could not take me any earlier. San Mateo did not do the procedure. I never heard from Oakland. Great.

I cancelled my appointment at Choice, and made an appointment at Planned Parenthood. Just to give myself options. I know the organization well, and trust its care. Even though it would not be covered by insurance, in this case time was more important than money.

Then Richmond Kaiser called. They would take me this week. They could take me this week! Weirdly, 30 minutes later I got a call back from San Francisco reconfirming that their facility could not take me any earlier than April 30, and they had no knowledge of my Richmond appointment.

Hours of time. And, I'm lucky that my husband helped me with the calls and research. I still want to be a believer in HMOs. All the people I spoke with were very nice and helpful and really understood why the situation was causing me emotional stress. But, they didn't have the ability to help me with my problem. I had to continue to be my tireless advocate. And this was just for one appointment, one procedure.

Strangely and perhaps serendipitously, I'm feeling victorious, not sad right now. The miscarriage feels miles away.