Tuesday, January 19, 2010

Calif. To Set Maximum Wait for Medical Appointments

"Regulations to be announced Wednesday require family practitioners in health maintenance organizations to see patients seeking an appointment within 10 business days. The deadline for specialists is 15 days.  A patient seeking urgent care that does not require prior authorization must see a doctor within 48 hours."
The medical groups I went to at the beginning of this relapse always told me "the first available appointment is in 6-10 weeks; if you need to be seen sooner, go to the ER".  (Which then produced the decree from the HMO that they were not authorizing the ER for something that could be treated in a doctor's office, so you'd call the doctor's office back and be told again to go to the ER, and the HMO would repeat that they weren't paying for the ER, go to your PCP ... until finally you decide that it's not worth $1000 out of your pocket, or that you don't have the $1000, to go to the ER, so you're going to play "wait and see" until you get sick enough for the HMO to authorize the ER visit, because now you're sick enough to likely need hospitalization.)
At one of those medical groups, my long-time doctor was able to finagle me a specialist appointment in about 4 weeks by begging him to stay late on a Friday.  At the other, it took about a month just for the appointment clerk to get around to making the specialist appointment for me (patients can't do it for themselves), and then another 2 months after she finally scheduled it before I actually had the appointment -- 3 months between the day I was told to see a specialist and the day I finally did.
My current doctor is part of a different medical group, which 15 or so years ago decreed that they were tired of people going to the ER with things that could be treated in a regular office visit, and therefore they leave 25% of their appointment times open for last-minute scheduling.  The HMO doctors swore up and down that they would lose money with this method, but in fact, these doctors rarely have any unused slots during the day.  There are always those who are thrilled to be told "we can see you in one hour".
Which is a lot better than the standing joke about one medical group that you had to make your pre-natal appointment before you even got pregnant, in hopes of having your first check-up a week before the baby arrived.

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