What you MUST know about health insurance is that it cannot
"work." It is a concept which, inherently, can only fail.
I wrote
about this many years ago. It is one of the fundamental flaws of
current society -- to think that the concept of "health insurance" can work.
(more below)
Health insurance "works" only because the healthy pay more into the system, get less, and the sick pay less into the system and get more. At some point the healthy will see this and rebel. Also, politicians will always vote to increase coverage. Health care is moving toward as much as 16% of our gross domestic product. This cannot continue. In theory it is impossible. In practice we can probably go a bit higher, but soon the theory will bump practicality on its head.
National health expenditures are projected to total $2.6 trillion and reach 15.9 percent of Gross Domestic Product (GDP) by 2010, after having declined from 13.4 percent in 1993 to 13.0 percent in 1999. In 2008, health spending is projected to total $2.3 trillion or 15.5 percent of GDP, compared to our previous projection exercise in 1999, which forecast expenditures for 2008 of $2.2 trillion, or 16.2 percent of GDP. Since the 1999 projection, historical GDP estimates were revised upwards. In this projection, health spending as a percent of GDP increases over the projection period due to faster health spending growth and slightly slower GDP growth, relative to the most recent historical period. (source)
The hospital where Ms. Nix
was treated, New York Methodist in Brooklyn, typically bills HMOs about $2,500
for an appendectomy with a two-day stay, compared with the $14,000 -- plus
doctors' fees -- that Ms. Nix was billed. The hospital gets paid about $5,000
from Medicaid, the state and federal health program for the poor, and about
$7,800 from Medicare, the federal program for the elderly, for the same
procedure. "Why does a single person
get stuck with the whole bill?" Ms. Nix asks. "An uninsured person would have
a lot less money than those government agencies or insurance companies."
Ms. Nix stumbled onto a
troubling fact of health-care economics: Most major U.S. hospitals are
required to set official "charges" for their services, but then agree to
discount or even ignore those charges when getting paid by big institutions
such as insurance companies or the government. As a result, almost no one but
uninsured individuals ever faces the official charges. In some ways, hospital
charges are like automobile "list prices" or hotel "rack rates" -- posted
prices that everybody knows nobody pays. But in the case of hospitals, the
pricing disparity isn't publicly known and falls most heavily on the
vulnerable. America's 41 million people without health insurance tend to be
young, working-class and unaware that they are being billed more than everyone
else for the same services. At the same time, charges
at virtually all hospitals have soared in recent years. That's partly due to
the rising costs of new procedures and drugs. Also, deregulation of the
hospital industry removed limits on charges in almost all states. But some
hospitals say they are raising charges to offset what they view as overly
harsh reductions in their reimbursements by HMOs, insurers and the government.
That would mean hospitals are effectively subsidizing their lower income from
patients who are insured or have a government safety-net by boosting fees paid
by the uninsured. (source)
An
article in the Wall Street Journal in March 2003, should mark the death-knell of
at least the present form of government endorsed "health insurance," which
relies on so-called private health insurance.
![[image]](../images/Nix_Rebekah-GC39203162003210757.gif)
Very few people today can completely self-finance their own health care. If you have health insurance, yourself, and if you are a part of society which greatly values health insurance, you generally have to "live within" the system.
For more than 70 years of my life, while raising six children, I have never had private health insurance. I had health insurance for any part of that time when I or my wife was an employee of some group that provided health insurance, but I have never paid for any personally. Only after writing this page did I see how my own attitude could have slid me into the same category as Ms. Nix, above. It was not luck that I have had good health, but had I had some terrible health problem, with no insurance, I probably would have had the same type of free service as she got -- big service, big bill, and bankruptcy.
Jean Ross, my wife, and I, have health insurance NOW, but only because we are 65 or older and Medicare is automatic. Even though I strongly disagree with the concept of Medicare, I don't think it is wrong to take advantage of it being available to me.
So, I signed my Medicare money over to an HMO -- Secure Horizons. You understand? At my age, currently almost 72, the government is ready to pay about $600 per month to some HMO for health insurance for me. You can "stay" on Medicare by itself, if you wish. I have done that before, or you can "sign over" your Medicare rights and money to an HMO. They get the money and promise to pay you various benefits.
PacifiCare, which runs Secure Horizons, the largest Medicare HMO in the country, announced premium increases for its HMO members for 2001. In some cases premium increases will be quite significant. The company pointed out that this will vary widely from area to area, depending on the level of reimbursement the company gets from the federal government, which is different in each county. For instance, they said that in Los Angeles County beneficiaries will pay no monthly premium other than the regular Medicare Part B premium, and the copayment of $5 to see doctors, $7 for generic drugs, and $15 for brand-name drugs will remain unchanged for the second year in a row. In contrast, in Pueblo County, Colorado, where Secure Horizons will be the only Medicare+Choice health plan operating next year, beneficiaries will be charged a $99 monthly premium over and above the regular Medicare Part B premium. They will also pay $15 co-payments for doctor and specialist visits, and will receive a $750 annual prescription benefit for brand-name pharmaceuticals and an unlimited prescription benefit for formulary generics. (source)
The benefits you can get from Medicare and from an HMO are different. You have to look at these various benefits and decide which direction to go.
I went for a while with Medicare. They I signed up with an HMO, then I didn't like that, and got off, back to simple Medicare, then felt that the HMO might be better, and that's where I am right now, but strongly considering switching again.
So, I've had lots of experience with this concept and have strong opinions about it. I'm with the HMO, Secure Horizons, now.
Now, I had been "warned" by a friend, older than I, and into
the HMO business some years before me -- he said, "You have to learn how to
be a squeaky wheel!" That sure is true, and this page, below, shows
you how much I have squeaked, so far, to get service.
Let's look first at the inherent flaw in ANY type of insurance.
The first insurance ever used in the West was
back several hundred years ago, in England. At that time rich people would
pool their money to send a ship to the Indies and return. Just about any
ship that made it to the Indies, and returned, meant a great deal of profit for
the investors.
The investors would invest, say £100,000 to equip a ship, with merchandise that cost very little in England -- to sail to China. There the ship crew would barter with the "natives" and pick up silk, spice and jewelry worth £5,000,000 or much more. The profit was a sure-fire event.
But what was not "sure-fire" was whether or not the ship would return at all!
Many ships would sail, knowing that the entire journey would take many months. Then, many months later the ship did not show up. Presumably it was lost at sea!
So, the rich guy put up his hunk of money, and a year later he was left holding an empty bag -- with no word on what storm or pirate may have stolen his ship.
As more and more merchants began to see what was happening, some of them realized that they could "insure" this action. Each would put up some money to pay for that trip, into a common fund -- an insurance fund. Then, if a ship did not return, the fund would pay back these people.
They may not have made their fortune, but they didn't lose their investment.
This is the modern Western origin of "insurance."
From the very earliest times of maritime trading, it was appreciated by both traders and carriers alike that maritime risks constitute a greater hazard than those encountered on land. To try to minimise this risk, early merchants usually sailed with their goods as 'supercargo'. This enabled them not only to supervise stowage and carriage, but also to finalise the transaction for the sale of their goods, and obtain payment for them at the port of delivery.[3]
But merchants could not always accompany their vessels, nor could their presence ensure shielding from the risk to which their goods were subjected. What was needed was a contract which would protect merchants against the caprices of fortune.[4] The earliest contracts, in which the burden of the happening of uncertain events was transferred to another at a price, were not what we know today as insurance contracts at a premium. They were an extended facility of the maritime loan developed by the Babylonians in the 3rd millennium BC.[5] The Babylonian system was not a 'stand-alone' contract of insurance. It involved rather a 'premium' percentage of interest chargeable on a loan for the purchase of the goods to be traded. The lender of the money, in return for the 'premium' interest, assumed the risk of the goods in transit. (source)
This usage is reasonably sane.
There was no incentive for the crew to
want to get
stormed by pirates, nor by weather, so the "danger" was truly an "Act of God" as
far as the investor was concerned. In other words, the investor, and the
crew, did NOT want the harm that often came. Also, if that harm arrived,
usually the crew were dead, so they had no incentive to die in order for the
insurance to pay off.
As long as the insurance was to not guarantee the PROFIT, that type of insurance does not encourage the insured person to WANT the harm, or to feel that he is better off with the insurance payment than he would have been with the profit from a returned ship.
That would be sane.
But, insurance gradually evolved into a system
that pays you to be sick. In the case of welfare
type insurance, it has
come to pass that a person may well feel that they are far better off collecting
the welfare (insurance) than not. A woman, for instance, can often collect
far more money for the next baby than she could earn in any other way.
Mothers on welfare had more and more babies since each baby bought in government money. Often that government money was spent on crack and the babies grew up in a violent criminal environment and turned to crime. As welfare and overcrowded prison costs drain society, corporations have less money to invest and eventually there is less corporate money to tax. So in the end liberal policies may lead to less funding for the poor. (source)
The case against health insurance is more complicated since most people don't WANT to be sick, and the money for health insurance generally does not go to the insured person, but to the doctor.
But the simple truth is that people die!
On the way to death they get sick! The sickness starts, usually, with
something mild, but if the mild disease doesn't kill you, then a worse disease
will come along to do the job.
All along the way you don't want to die -- so you ask your doctor to help. What can he do? He follows his best training, but he lives within a system that cannot possibly pay for every possible treatment you could need or want.
The older you get, the more serious is your disease, the more health care you are going to want and need.
Obviously, not just in theory, you want an
infinite amount of health care from a system that
MUST be bound to some sort of
budget. Any business has to weigh the income and the expenses and balance
the system. When the income comes from the taxpayers, the health care
budget seems immune to economic reality -- but, there must be a limit somewhere.
So, health care is something which people want, always, MORE of, and they want MORE, the older they are!
No possible health insurance system can give all of what people want and think they need.
Currently it is political suicide to say these things -- so every politician must run on a pledge to IMPROVE health care -- that means, spend more money on it.
The politicians would never suggest rationing,
but that is the only possible solution to this flawed system.
So, points of rationing are built into the
system.
Some of the rationing takes place in the form of "unapproved procedures." The insurance company says, "That procedure is not standard practice." Thus the true breakthrough in cancer or heart disease will languish until it can replace some other form of treatment, and make room within the fixed budget of the insurance pool to allow it. Often the new procedure is approved as a result of demonstrations and riots.
Most of the rationing, however, is hidden from you. The government passes laws and regulations giving HMOs and other insurance forms, the job of approving health care claims -- against some sort of fixed budget for expenses. The government makes the politically-correct claim that the insurance companies are making too much profit, and that they can reduce their profits and give the additional coverage people seem to want.
This will never solve the problem, obviously.
So, HMOs find ways to ration care and maintain their desired profit margins.
The main point of this page is to reveal some of the ways HMOs ration care and what you can do about it when it affects YOU.
Obviously, if everyone used the "tricks" described in this page, then the HMOs would have to find newer ways to ration care.
It is in setting that Jean Ross, my wife,
found herself, being covered by an HMO which receives its money from the
government. She had "bad knees" which developed slowly over many years.
At first it seemed just to be only arthritis -- our own MSM should solve that problem. It seemed to help, but after some time MSM cannot do the job.
So, she went to her "gate keeper" doctor -- the one assigned by the HMO for you to go to first. He is called the "gate keeper" because you cannot get "serious" health care unless you FIRST go to your "primary care physician." He gets a fixed sum of money every month for the patients assigned to him. If he gives them "too" much attention, he still gets the same money, but is starting to starve himself. If he is "lucky" and gets a healthy one, he doesn't spend any of his time with the healthy one, and spends his time on the sick ones.
He is "free" to refer patients to "higher level" health services. But, his freedom to do that is secretly limited. One way or another the HMO lets him know that he allowing the "gate" to be too wide open -- he is referring too many people to expensive higher levels of service.
The limits are not likely to be ever put in writing -- the HMO knows better. They find subtle ways!
They don't renew some doctor as part of their service when his referrals are too many, or they find other ways.
I've found one way.
The HMO gives the doctor secret warnings.
The doctor is now in a bind, instead of the HMO, and it is up to the DOCTOR to
do the rationing.
How?
Well, you go to him with a "bad knee pain" and he tells you to take aspirin. He knows that is not a cure, but he also knows that the pain will be less and he will not run over some secret quota he has from the HMO. If you complain again? He will prescribe a drug for killing the pain! There are always fairly cheap drug solutions to health problems -- this is the direction the health insurance industry is pushing medical care. This is why the drug companies love this, and why you hear all the publicity about a "senior drug reimbursement bill" that MUST pass Congress -- and which no politician dares to oppose.
Those who don't know better accept his prescription, grumble and do nothing more. The HMO, and the doctor, count on a fairly large number of "sheep" who will get poor service, but not complain.
Now, Jean and I are not sheep!
So, when Jean went with her "bad knee" to the gate keeper doctor, after a few visits, and no real remedy, he used up one of his quota of referrals -- gave Jean a form requesting HMO authorization for an MRI. The HMO can hardly afford to turn down a request like this -- since they don't want to appear to be putting their (business) judgment ahead of the medical judgment by a doctor.
So the request for the MRI is approved -- but to help the system cope with the infinite demand on the services, the approval takes a week or more, and then it takes a week or more to get an appointment with the place that does the MRI.
Then, of course, DOING the MRI is not really a final health care service, but only a diagnosis that can ONLY be explained by a doctor. So, after you get the MRI report back, you then have to make an appointment with a "real" doctor -- in this case, presumably, with an orthopedic surgeon, since the knee problem is likely to call for evaluation of the MRI by a doctor trained in "knees."
As you then arrive at the doctors office for the evaluation of the MRI, you may not realize, as we did not, that the first person you will meet is NOT a doctor qualified to do knee repair, but another "gate keeper" whose sole job is to be pleasant and tell you, in some convincing way, WHY you are not a candidate for surgery.
Now, of course, you could have a situation where this doctor says to you, "All you need is to do some exercise." Or, he might say, "You need some pain killer." He could say one of those things, but if he looks at your MRI and sees that there is no possible hope for you other than knee surgery, he has his toughest job.
He has been told, secretly, not in writing, that the real knee surgeon CANNOT do more than some quota of knee surgeries. After all, knee surgery can cost $25,000 and that is several years worth of premium income. Be sure you realize, there is nothing in writing on this because if there were it would be evidence of "bad faith" on the part of the insurance company, and enough of them get sued, and loose, that they just don't want to make it easy for people to find out about this rationing. The story below is about MY HMO. They are sensitive to charges of bad faith!
In January 1999, a San Bernardino County jury awarded $120.5 million in damages against Aetna-U.S.Healthcare, one of the nation's largest HMOs.1 The widow of a stomach cancer patient sued the HMO for "bad faith" disapproval of cancer therapy that promised to prolong her husband's survival. The verdict included $116 million in punitive damages against the HMO for placing its own financial interests above the needs of the individual patient. (Aetna has appealed.) Significantly, treating physicians were not held liable. (source)
That about brings us to the point of the letter published below. Recognize that the doctor is "on your side" and would like to give you service, but also recognize that he may lose his practice because he gives too much service. What a conflict he lives with!
But, there is more to know about this.
You could BELIEVE that this rationing is happening in your case. But, you should realize from the above that the HMO and the doctor surely don't want to make it easy for you to prove that, and either embarrass them into giving you something "beyond the quota" or even worse, to sue them and get lots of money!
So, whether you believe this rationing is taking place, in your case, or not, you may be faced with a denial of service by some gate keeper person, and wonder how to go about getting that decision reversed.
I write this on Sunday, March 2, 2003, and
tomorrow, at 9:15 AM, Jean Ross and I go to visit the doctor, as explained below
-- our "second chance" at getting the service Jean thinks she needs.
Notice this important phrase -- she "thinks" she needs this service.
In the olden days when doctors were honest, they would tell you straight up what were the alternatives for you when you present some health problem. In those very olden days, of course, you would choose and you would pay. As soon as the payment comes from a different person who gets the service? The system is fatally flawed!
Now, you must realize that you and the doctor are NOT on the same team. He is paid by the insurance company, and the insurance company does NOT want to pay for so-called unnecessary health coverage.
So, you may love your doctor, but you should not trust him.
That puts you between a rock and hard place.
HE is the expert! You are not! Here I am suggesting that YOU have to
decide what service you should have. This puts a great burden on you to do your
own study and research. You could not do any better than coming to my
20,000 pages since you can count on ME to be on YOUR side.
In Jean's case, I had done all the research on damaged knees, and knee surgery -- HERE.
She and I had to read this stuff and understand it. Then it was SHE who had to decide if she really thought knee surgery was correct for her.
Possibly if the gate keeper doctor had given her medical or logical reasons why knee surgery was NOT right for her, she would have quickly changed her mind. But, she approached that meeting with the doctor, expecting an evaluation of the MRI report. She did not expect what happened.
So, for Jean the next action was easy. From the short time with Dr. Lee she easily came to the conclusion that he was rationing care, in bad faith, and that she should NOT accept his denial of service.
So, we then had to decide what to do.
I sought advice from one very good friend, a chiropractor, whose opinions I could trust as not biased by HMO considerations. He gave me the advice to write a letter to the HMO, and to the next doctor we were scheduled to visit (Monday, March 3, 2003), and what should be said.
The result is the letter below.
Now, before you read this letter, there are still vital matters you should understand.
It is one thing to have pain and describe it, truthfully, in a way that minimizes it.
It is the old question, "Is the glass half full? or half empty?"
The letter below is absolutely true as to all
the data given -- there is no false data.
But, if you were to talk to Jean Ross, yesterday or today, and ask her, "How are you doing?"
You would get a polite and optimistic answer. She is NOT one to emphasize the pains she may have, nor their consequence. She IS the type of person who would put a rosy glow on her condition.
I know, because I often talk to people who go in the opposite direction. They have a toe ache, and from their description of the "ache" it would sound like she was near having to have an amputation.
The HMOs and doctors are far more familiar with the second type of person -- who exaggerates his or her problems.
So, as I was drafting the letter to send, I realized that I would have to "set aside" the normal way I might communicate, and Jean's normal tone level, and put ONLY the truth there, but the truth in a way that emphasizes the seriousness of this health problem.
I had to write in such a way as to "push" the
buttons I know to be valid -- the HMO is rationing care and doesn't want to get
caught doing that.
If you accuse them too bluntly, they can get their "backs up" and just deny it all.
But, if you are more subtle about this rationing thing, they might think they can "find a way" to allow you to get the service and never admit that any rationing had been going on.
So, that's what this letter attempts to do.
It raises the issue of rationing, somewhat bluntly, but not as bluntly as I would raise that issue in a lawsuit.
It mentions the phrase "bad faith" because that is a scary subject for an HMO to confront.
It does NOT threaten legal action -- that would be far too blunt at this point.
But, you should not write a letter like this without the willingness to move ahead on an appeal, if there is precedent for one, or a lawsuit. You certainly hope you don't have to sue, but you should have the mental attitude that you are willing to do that -- but do NOT tip your hand on this.
Let this be the iron hand in a velvet glove!
So, with all of this in mind, take a look at the letter which was sent out just a few days ago, and you can guess, along with us, what will be the outcome at the doctor's visit just another few hours away from now.
The outcome of the visit is below -- click here.
Karl Loren
Jean Ross
1831 N. Bel Aire Drive
Burbank, CA 91504
Phone: 800 225-2308
FAX: 818 558-7299
February 26, 2003
Secure Horizon
PO Box 489
Cypress, CA 90630
FAX: 714 226-5055
cc: Dr. Phillip Conwisar
Orthopedic Associates Medical Group
10767 Riverside Drive
North Hollywood, CA 91602
Dear Sirs,
I am writing a complaint about the medical service I received, on Tuesday, February 25, 2003. I had just had an MRI for my knees, and understood that a doctor would evaluate the MRI report for me.
I did not see any of the three doctors listed on the information sheet for Orthopedic Associated Medical Group, but got assigned to a Dr. Lee.
I have been in a great deal of pain from my knees, for many years. The pain has been increasing and my quality of life has been diminishing.
As I read the MRI report I noted that each knee had a degenerated meniscus, and there were macerated tears. From my own research on knees, it did not appear to me that the meniscus could be repaired and that probably only a knee replacement would provide relief.
I certainly would not want a steroid injection – as I’ve only heard that they are very temporary, and ultimately harmful.
I took with me to the office visit both the MRI images and my most recent knee X-Ray. I expected a doctor to explain the MRI report to me and explain what my treatment options were.
Dr. Lee immediately took the X-Ray, and said that the MRI would not be needed, in fact would not be helpful, in his evaluation. He never looked at those MRI images or commented on the three-page MRI report.
It became clear to me that his ONLY intention was to screen me out of the system of further knee health care.
He showed me on the X-Ray where my knee has bone on bone and then told me that this condition would not get any better, and that the MSM, Glucosamine and Chondroiten I had been taking would not help in any way.
He then asked me questions about my knee, and the pain, but in very short order he announced that I was young, fit, and that my pain level did not reach the requirement for knee surgery.
I found this hard to believe. He did not ask any questions about the quality of my life. He kept referring to me as “young” and “active.” I certainly don’t feel that way!
He simply said that my pain level would have to be much greater before he could recommend knee surgery.
He also tried to scare me, saying that this knee surgery was the only one in their specialty that had a risk of death, and that there would have to be a very long and slow recovery period. (The people I have talked to who had knee surgery did not describe recovery that I would think was slow or painful.)
He also commented that a knee replacement did not last very long – implying that I should wait until I was old enough so that only one such surgery would be likely within my lifetime.
My husband was with me, and rather upset at this. He suggested, and I agree, that it appears that Dr. Lee was imposing a rationing of health care. I was told later that some HMOs remove doctors from the acceptable suppliers of service when they recommend TOO MANY such surgeries.
Dr. Lee seemed to back down a bit when I told him (he had not asked) that I was forced to take both prescription and non-prescription pain-killers and did not like to do that. He agreed to get an appointment for me with Dr. Conwisar. I realized, then, that Dr. Lee was NOT the knee specialist that Dr. Conwisar is, and that perhaps his only function in this visit was to screen me out of any further help.
I’m wondering if there is not only rationing going on, but even some bad faith – I went to this medical group for an evaluation of my MRI and did not get that. I went, expecting to see a person who was expert in knee surgery. I did not see that doctor.
I come to Secure Horizons with a life time of avoiding drugs, and very, very seldom ever needing medical care. Now, as I am moving into my Golden Years, at 66, I have some considerable pain, on a constant basis, and to be told that my pain is “not enough” and that there is “no cure” and that “the pain will just get worse” gives me a terrible outlook on these years which should be pleasant enjoyment of a life in which I have been, and want to be, still very active.
I have 15 grandchildren. My husband and I run a business out of our home and have the leisure to leave it for travel and visiting my grandchildren. Now that I can travel, free of home or business responsibilities, it appears from Dr. Lee’s decision that this would be exactly the time when I cannot travel or even live without constant pain.
Now, I cannot go up the stairs to my bedroom without each stair requiring pain and putting both feet on one stair before I go up, or down, one more step.
When I get up from some chairs I can barely stand, and cannot walk at all until I have stood there for a minute, rubbing my leg and trying to get enough strength to walk. My arms are strong and that is the only reason I can get out of a chair. When I sit at the dining table I have to sit where there is the back of a couch behind me so I can use it to push up from the chair. I have difficulty moving a leg while driving to put on the brake. (My husband no longer drives in part because he too has hip and/or knee weakness and pain.)
Five years ago my favorite activity was hiking in the mountains. I have not been able to do that for some years. I cannot even walk my dog more than a short distance.
In short, the full and active life I have enjoyed has drastically changed in just the last few years. After my pleasant and healthy life it is terrible to think that, in my later years, I look forward only to more pain until some doctor decides that my pain is “enough” to allow me to get what I think health insurance should give me now.
I have talked to many people who have had knee replacements and marvel at the enormous change in their quality of life. At least the ones I talked to were unanimous in their pleasure at the relief from constant pain.
I look forward to Dr. Conwisar’s evaluation on Monday, March 3, 2003, and the hope that knee replacement would not be withheld as a matter of rationing by Secure Horizon or any doctor.
Sincerely Yours,
Jean Ross
The second visit to the doctor was very successful. It appears that the above letter was the likely cause of the change of position. A few days later we even got a letter from the HMO saying that they were going to investigate this matter.
(The down side of this is that because we were squeaky wheels, and got the service, someone else will be denied -- that is the painful logic of the health system.)
Dr. Conwisar was supposed to see us at 9:15 AM, and we first saw a nurse about 10 AM. He took down information from Jean. He had a copy of the above letter, plus the MRI report on the "patient record" which, I presume he then gave Dr. Conwisar. Another 40 minutes went by before Dr. Conwisar came in. I was convinced that the delay was for him to read the letter, and possibly even to call the HMO.
He was friendly and straight-forward.
Essentially he said that the condition of the knee was such that he could only recommend complete knee replacement.
He did say that it depended on Jean's pain -- that a "mere annoying ache" would not be enough pain, but a "severe pain and damaged quality of life" would be enough. Jean actually had second thoughts about surgery and pursued alternatives with him.
There is a medical treatment, short of surgery, called Viscosupplementation with information here. This is a procedure where an artificial fluid is injected into the knee area -- a fluid similar to the normal human fluid in the knee. This is temporary, only, but can be useful particularly when a person is not a candidate for knee surgery. He left it up to Jean, but rather than press her for a decision immediately, he asked her to get another, new X-Ray, and come back in 2 weeks. In the meantime he would get approval for the surgery from the HMO. So, Jean could come back in two weeks and let him know whether she wanted to go ahead with the surgery, or not.
He commented that it would probably take another two months to get an open schedule for the operating room.
Since that office visit Jean studied the material about the injection procedure and is now planning to go ahead with the knee surgery.
I will write more about this as something happens.
The HMO approved the knee replacement. It is set for June 4, 2003. She is probably also going to get the injections -- that has yet to be approved by the HMO, but the surgeon agreed to it.
The "Surgery Coordinator," Angelina Urquhart, was unusually helpful. When Jean was getting the word on the surgery, I brought up the possibility that I, too, would be getting hip surgery. I asked, jokingly, if she could schedule me?? She said, "yes." She marked me for the same data, tentatively, June 4th. Jean and I will be again seeing Dr. Conwiser Monday, March 24th, for me to learn from his evaluation of the X Ray and MRI whether he recommends hip replacement.
If yes, then I'll ask if my surgery can be about a week after Jean's so that we are not both right out of surgery on the same day.
I am convinced, now, that the doctor is more than willing to do the surgeries, and that there will always be an "informal" but very strict limit on how many he can recommend to the HMO. Obviously the HMO will now be paying at least $35,000 in surgery fees for two operations -- and they cannot possibly afford to do that for every person who has symptoms similar to me and Jean.
The letter of complain was, I think, instrumental in getting us onto the approval line.
Karl Loren
|
I promise to answer your message -- click here to send me a personal message
|
SUBSCRIBE: The Wednesday Letter is a free electronic monthly newsletter written and published by Karl Loren. You can view more than 50 back issues of this publication by clicking here. The Wednesday Letter subscription list is maintained on a secure server, no name is ever given or sold to anyone, and it is never used except for this Newsletter. It is automatically published on the Tuesday night just before the first Wednesday of every month. You can subscribe to this free monthly electronic letter by entering your eMail address and name below. You will then automatically receive a request for confirmation, sent to whatever address you have entered. If you do NOT receive this confirmation request, then you will not be subscribed. There may have been an error with your address and you should resubmit. The letter is never sent twice to the same address -- so you do not have to worry about a duplicate subscription. When you receive this confirmation request you must reply to it, or your subscription will not become active. No one can subscribe your name, and address, without you being notified, and if you get an unwanted notice of subscription you only need to DO NOTHING and the subscription will NOT be active.
REMOVAL: You can remove yourself from the subscription list in several different ways. Click here to read about this entire newsletter system. Every edition of The Wednesday Letter is delivered to your address with YOUR name and address in view on the letter, with a link that allows you to remove THAT name from the subscription list. If you try to send this removal message from an address different from the one you used to send in your original confirmation, then you will get a warning notice first, sent to the subscription address, asking you to confirm that you want to be removed from the list -- by replying to THAT request for confirmation, you will then be automatically removed. Thus, no one else can unsubscribe you, from some other computer, without your knowledge. But, if you send in the unsubscribe notice from the same machine used to receive the Letter, then the removal from the subscription list is automatic.
Personal Message: When you send a personal message to Karl Loren, you will receive a personal reply as per his instructions. Karl pledges that every personal message will get a personal answer. When you provide your mail address, we will send you free information including our free catalog and a cassette tape lecture by Karl Loren about heart disease, no charge, by mail, even if outside the US. You can select particular information you would like to receive, along with the free cassette tape and catalog.
You can reach Vibrant Life in many ways, including by mail to Vibrant Life, 2808 N. Naomi St., Burbank, CA 91504. Within the US and Canada, use the toll free number: (800) 523-4521, the local number: (818) 558-1799, the FAX: (818) 558-7299, eMail to kimberly@oralchelation.com or any one of the hundreds of message forms throughout the 50 web sites. Vibrant Life normally ships the same day we get an order. There are message forms on each of the 100,000+ pages on this and other sites where you can communicate with Vibrant Life. Check out our companion site, at: http://www.oralchelation.net where Karl's 2000 page book is published. Karl Loren is the author and webmaster for this BOOK, as well as for another web site about ORAL CHELATION. His personal philosophical articles are at PHILOSOPHY.
Copyright © April 25, 2008 2:38 AM by Karl Loren on behalf of Vibrant Life, ALL RIGHTS RESERVED. Permission is granted for non-commercial downloading, copying, distribution or redistribution on two conditions: One, that some form of copyright notice is included in every copy distributed or copied, showing the copyright belonging to Vibrant Life, Burbank, CA, at www.oralchelation.com . The second condition is that the material is not to be used for any purpose contrary to the purposes and objectives of this site. This permission does not extend to materials on this site which are copyrighted by others.
