My Experience With An HMO

Once in the hospital I needed to sign up for ObamaCare and based on the information provided I was eligible for a bronze level HMO.  It would not be active until 4 weeks later.  I was released from the hospital again after my hip replacement surgery into a rehabilitation facility.  The HMO required that I pay the deductible up front.  The deductible was $6,300 and placed on a credit card.  Oh boy!!!

I knew I was in a good facility.  After being evaluated by the Occupational & Physical Therapist, I stood for the first time before entering the hospital.  What a great feeling, I had lost hope that I would be able to walk again.  I began my physical therapy and gained some strength.  The HMO required weekly updates and by my second week they were ready to release me.  They felt I wasn't progressing fast enough.  I was weak and so disappointed with the HMO.  How can you release someone who isn't able to take care of themselves.  The HMO did not have my whole story, only that I had a hip replacement. 

During this timeframe my facility doctor had weekly blood draws and it became a concern that my hemoglobin was too low.  I was lightheaded at times while in therapy sessions lately and it was decided I needed to go back to the hospital for another blood transfusion.  I had lost a lot of blood during the hip surgery, along with my immune system being compromised from breast cancer.  After the transfusion, I returned to the rehabilitation facility 2 days later.

After spending a total of 54 days in rehab, I was walking with a walker and able to get to the toilet on my own.  This is where HMO's have some deficiencies.  Once released, I was brought home by a friend who luckily had a walker and commode that sat above the toilet.  My HMO doctor had received my documentation along with the home equipment list needed.  My equipment listed a wheelchair, commode, home healthcare and physical therapy.

It took three weeks to get a wheelchair and I was only eligible for physical therapy.  The commode was considered portable and the HMO would only provide one transport equipment.  Thank goodness for my friends equipment.  I had been in contact with the HMO, the doctors office and the referral department daily, weekly.  It seemed the doctors office kept losing my orders.  The constant waiting for everything, such as equipment, radiation treatments became more frustrating with each request.

In my lifetime working for different companies, I had been exposed to different health insurance policies including HMO's and PPO's.  I never experienced this with a PPO.  There are a lot of individuals who praise the HMO system, but I would not want to be sick while on their health insurance plan.  I changed my plan to a PPO during open enrollment with ObamaCare and qualified for a gold PPO plan costing less than the HMO.  Go figure!!!

Share your experience with your health insurance plan, good or bad.  It may help another make a better decision in their healthcare.

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I have a GoFundMe page for donations to help with my medical bills.  Your generosity is humbling and appreciated.

Be genuine, share yourself and have a fabulous day!  Susan (aka SuzzzyGal)

My Medications ... Oh Boy!

I had lost my mother the summer before and didn't have the guidance she would always provide.  I was on my own.  My friends have been a great support system when needed, but I am making major decisions on the fly since the hospitals.  I do my research as well.

I depend on my healthcare professionals to provide the best options for my course of treatment.  Taking Tamoxifen twice daily, plus Zometa treatments monthly to help strengthen my bones and just recently Falsodex (another anti-hormonal drug).  I can remember speaking to an American Cancer Society representative and asked about Zometa.  He gave me a long list of side effects.  I was in for monthly blood draws one week to keep an eye on my kidneys, plus IV infusions the next week.  Blood draws are difficult for me because my veins seem to hide and are deep, sometimes requiring multiple sticks.

Generally, after receiving my Zometa treatment, it drains me for a few days.  But my last treatment along with Falsodex (injections to right and left hips) left me hurting in my hips greater than usual.  I think the doctor hit my bone or possibly a nerve, limiting my ability to walk.  It took a week for me to feel my usual self.

I am walking with a cane these days for short distances and looking forward to warmer pool weather here in Florida for water exercises.  At the turn of 2015, it's a new health insurance year with ObamaCare.   Changing from an HMO to a PPO is the best thing I did for my healthcare.  Thankful that pre-existing conditions were eliminated, I know have an affordable plan.  It is certainly better than not having insurance, learned that the hard way.

March will be my 1st year anniversary of breast cancer and on Tamoxifen.  I still feel the lump in my right breast and will be going for a mammogram.  My Oncologist is suggesting possible radiation treatments based on my results.

I have a GoFundMe page for donations to help with my medical bills.  Your generosity is humbling and appreciated.

Be genuine, share yourself and have a fabulous day!  Susan (aka SuzzzyGal)