Broken safety net

NewFNP has no problem with HMO's. This is quite likely because newFNP is generally healthy, is in the know, and -- in true newFNP fashion -- has her primary care provider through one of the best medical groups in the nation.

When newFNP went to her PCP and told her that she has been having diffuse esophageal spasms for two years and finally thought it was high time to get that mother-effing upper GI and quite possibly some esophageal Botox, she received her referral before leaving the office and had a specialty appointment twenty minutes later. The system is connected and coordinated.

If, however, you are newFNP's patient and you have a state-insurance funded HMO and you need specialty care, you are jacked.

Take, for instance, newFNP's 31st patient of the day last Thursday. Three months ago, she was told at another clinic that she was HIV-positive. She was told to get HIV care. Where to get that care? Apparently that was not a part of the discussion. Thus, this 32-year old woman showed up at newFNP's clinic stating that she heard we did HIV care.

We do not. Yet.

So newFNP picked up her cell phone, dialed a nearby clinic and handed her phone to the patient who proceeded to make the appointment. Only that clinic doesn't take her HMO.

Son of a bitch.

Yes, newFNP could have gone through the regular old system of giving the referral to the referral coordinator who would get to it as soon as she could given the extraordinary amount of work that she has. Then she would mail the referral to the patient. But the patient wasn't "trying to get no mail from an AIDS doctor" so that option was out. And frankly, this woman had been wandering around for three months out of care and that is just not acceptable to newFNP.

The patient got all of the details regarding the insurance switch she would need to make and then spent some time talking to newFNP about how she doesn't want the HIV meds to make her crave drugs again, about how she can't get state financial aid because she committed a felony while crack addicted and then cried for her diagnosis, for her situation, for her frustrations. NewFNP listened, acknowledged, supported.

She left the room forty minutes later -- five minutes before the clinic was scheduled to close -- and was told by a member of the support staff and HIV planning team, "I thought you were taking care of this!" To which newFNP replied, "What the fuck do you think I'm doing??!" As though taking the time and providing the care to this woman was unacceptable.

NewFNP was livid. And then she went and saw patient number 32.