Medical professionals: denial of service? (Honolulu, Hilo: health insurance, how much, transfer)
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Let me start this post by saying: This isn't a complaint. It's a question.
MDand3boys, I'd love to hear from you, as well as nurses.
I am a kidney transplant recipient with a rare inflammatory disease; it is pretty well controlled with medication. But I need regular lab work and twice yearly checkups with a nephrologist. I should also say that I'm one of the lucky ones who is insured to the max, thanks to my husband's former job and Medicare.
The story: Back in October, I signed up with a primary care doc who is an internist, for the express purpose of being referred to the nephrologist who visits Molokai once a month. In January, I was given an appointment, but it was cancelled due to a flight change. Early February, they called to reschedule until today, then cancelled again--no reason given except there's no room on the schedule. Now I am on a waiting list, with no actual information about when I might be seen. (the next opening is at the end of April).
My primary care doc isn't the problem. She wrote the referral back in October. My husband is running into the same problem. They refused to make an appointment as a new patient for two months--no reason given, just "we'll call you." And they have lost his transferred records twice. By the time he got in to see our doctor, he had been out of a critical medication for two weeks. Which the staff knew, because he had told them. We are not, even though it sounds that way, high-maintenance patients. We are reasonably well informed, clean living, compliant, and do not go running into the office for every little boo-boo.
The question: Do you think the staff is "gate-keeping" and denying or postponing care because we are newcomers? Or is it just incompetence?
I was prepared for longer waits for medical services. It's why I started this process three months in advance of my scheduled necessary blood draw. Now it's been five months. What do you recommend?
When I moved to Kauai I selected a primary care manager (Dr.) who was accepting new patients and accepted my health insurance. Even though I was out of BP meds I had to wait for 4 months for my first appointment.
I believe there was a certain amount of incompetence on the part of the office staff and a certain amount of the "Island Way" attitude.
The office staff are local but the Dr. was Haole.
Island way = no hurry no worry.
Since then there hasn't been any problems or delays.
PS: Could it be they don't want to accept new medicare/medicade patients?
I thought of that, too. If that were the case, I imagine they would have told me in the beginning so I could make other arrangements.
I spoke to someone at my church who was on the board there for some years. She said that Queen's wants paying customers (i.e. the insured), since there are so many who can't pay. Which is not to say that I want to take cuts in line. If that's the wait (and it sounds like it might be) then I wait like everybody else.
Today I negotiated a little and asked for a lab requisition. I've been doing this for almost 13 years, so I know what my lab values should look like. If everything looks OK, I can wait for another few months. If not, well, a trip to Honolulu may be in order.
Thanks for the info, Balad1. I'll stop taking the staff attitude so personally.
No gate keeping or anything like that. What kind of insurance do you have (that's critical) whose the doctor/doctors? You say Queens. Well please take my advice and know that just because they are called Queens it is not synonymous with excellence. St. Francis is usually the place kidney patients are referred to.
Know your rights as far as medical records, doctors etc...
If you've been doing this for 13 years you know that if you don't make noise your stuff will go to the bottom of the stack. Unqualified staff are being hired and I bet every time you have called to inquire or find out something you have been told different things or put off in some manner.
As a "new patient" to see certain specialist it takes 4 to 6 months and you have to come to Honolulu for the first visit. It sounds the same with nephrologist apparently. It sounds strange that the first visit could be outer island as usually if the doc practices on Oahu they require you to go their main office for the first visit.
Make sure all your records are available to the doc electronically or get them yourself. You don't want to have waited for so long just for the doc to say he has to wait for your records (make sure you are clear on what to bring to the first visit). Write every concern down and take the list with you.
Make sure you have an appointment and that the doc does not require you to go to Honolulu for the first visit.
Good luck to you.
Regarding insurance, my secondary is Anthem/Blue Cross-Blue Shield. Which pays pretty much what Medicare doesn't pick up and covers my meds.
Queens on Molokai is the only hospital and it has a doctors' clinic attached. I was not making any value judgements. It is my only option. I'm confident in my GP, she's mainland trained with relevant specialties and pretty much type-A.
As of tonight it looks as though we will be going to HNL anyway, which is fine. We can always find something to do there.
Good point about ferrying my own records to Oahu. No electronic documents here yet, and I should have a current copy in my med kit anyway.
Let me start this post by saying: This isn't a complaint. It's a question.
MDand3boys, I'd love to hear from you, as well as nurses.
I am a kidney transplant recipient with a rare inflammatory disease; it is pretty well controlled with medication. But I need regular lab work and twice yearly checkups with a nephrologist. I should also say that I'm one of the lucky ones who is insured to the max, thanks to my husband's former job and Medicare.
The story: Back in October, I signed up with a primary care doc who is an internist, for the express purpose of being referred to the nephrologist who visits Molokai once a month. In January, I was given an appointment, but it was cancelled due to a flight change. Early February, they called to reschedule until today, then cancelled again--no reason given except there's no room on the schedule. Now I am on a waiting list, with no actual information about when I might be seen. (the next opening is at the end of April).
My primary care doc isn't the problem. She wrote the referral back in October. My husband is running into the same problem. They refused to make an appointment as a new patient for two months--no reason given, just "we'll call you." And they have lost his transferred records twice. By the time he got in to see our doctor, he had been out of a critical medication for two weeks. Which the staff knew, because he had told them. We are not, even though it sounds that way, high-maintenance patients. We are reasonably well informed, clean living, compliant, and do not go running into the office for every little boo-boo.
The question: Do you think the staff is "gate-keeping" and denying or postponing care because we are newcomers? Or is it just incompetence?
I was prepared for longer waits for medical services. It's why I started this process three months in advance of my scheduled necessary blood draw. Now it's been five months. What do you recommend?
I'm a doc, so here's my opinion.
1) Doctors love seeing new patients... practice building is a top priority (especially nowadays). I'll be a new doc in Maui soon, and that will be my #1 priority. I will sacrifice much of my "personal" time to achieve that goal.
2) If the nephrologist is only coming to Molokai once a month, there is a limited number of patient appointment slots available. These appointment slots are likely already mostly filled with follow-up visits from other patients who have been seeing the doctor for awhile. In addition, his schedule is even tighter since he had to bump the January appointments. So, it's not surprising that this doctor's schedule is so booked since there are only a limited number of patients he can see.
3) There is often poor communication between the front desk staff and the doctor. This happens in any doctor's office and I can only imagine that it might be worse in Hawaii depending on the training of the staff. It's actually quite ridiculous how much "power" the front desk staff have over a doctor's schedule... but then again, the doctor is usually so busy with other things, that he can't keep track of every patient (especially if it's one [like you] that he has never met before).
A little bit off topic, but medically related. I was diagnosed with Type II diabetes a little over a year ago. I have my numbers in line, and they just took me off meds, but I still have to go and get checkups and bloodwork done a couple times a year. I'm moving to Hilo and was looking at the kaiser permanente plans, which I could afford (have to get my own insurance since I'm self employed). How is the quality of care from them in Hilo? What are the alternatives?
WHen I lived in Hawaii (left in '93) there was an oversupply of doctors in Hawaii. You could get an appointment with the best cardiologist in Honolulu in a week's time. Since then there has been tremendous outmigration of doctors due to the recession, and Medicare reimbursements being inadequate. The Star Bulletin has had articles about this.
The good news: Blood was drawn yesterday, got the results today (yay!) and the values were good enough that I won't have to worry for another 6 months.
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Doh. My bad. 
