Must I be admitted to the hospital? I know, from reading the newspapers, magazines and watching television, that mistakes and errors are made at all levels and in all departments. It is scarey and for good reason.
The initial part of the process of being admitted to the hospital, usually comes through the primary care physician's office. Do we have a qualified person who is relaying the information? Does this person (medical receptionist, medical assistant, LVN/LPN, RN) know how to implement the process? This is often a problem. One example might be the office staff (as above) calls the hospital to set a surgery date. However, this person does not know that there is a very specific routine that must be adhered to, according to the patient's HMO. Two weeks go by and the patient still has not heard back regarding the surgery date. Knowing that this surgery is needed. Not wanting to call the doctor's office, especially since being told the office would call, once the surgery was set for a date and time.
Now, one would wonder why the doctor would not be on top of this situation. Often, the reality is the doctors are so busy with more patients than they can see in a day, therefore, they rely on their staff. These staff should be well trained in all their functions and duties. Some are and some are not.
Finally, the patient calls the office and is told by the receptionist (who is responsible for scheduling surgery)that the case manager for the HMO is having a problem with the schedule. Well, 'hello'.... let the patient know instead of having them wait and wait.. Is there no understanding of what the patient is experiencing, i.e. anxiety for pending surgery? I guess not. A few more weeks passed by and finally, the patient called again. This time calling the HMO and being direct and asking what was happening. Eventually, after, more than 5 phone calls, and many hours on hold (on the phone) a real person answered. The case manager.
The case manager----------at long last, someone who could and did explain the situation. Simple. The receptionist was not familiar with the process for communicating with the HMO and therefore, surgery was delayed longer than the physician wanted.
Moral of Story: If the doctor says you need surgery or any treatment, ask when this needs to be done. Tell the doctor you want to know in weeks, months, etc. Then ask the doctor what the process is to get this surgery or treatment approved by the insurance company, or, if it even needs to be approved/authorized. Before you leave the doctor's offcie, find out who will be handling this so that you can have a contact person to call. Ofcourse, you can always call your insurance company and ask them what the process is for what the physician ordered. Being 'ontop' of your delivery of care is being an informed consumer. Patients have a right to ask questions. So ask and ask, and, ask more, if needed.
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