A friend of mine–I’ll call him Sam–recently broke his big toe.
But Sam has a bigger problem than his big toe. He’s on Medi-Cal, the California medical plan for the poor.
And if you think the nation’s veterans have it bad, try getting medical care when doctors refuse to honor your insurance.
After breaking his toe while tripping over a bag, Sam went to his regular doctor, a general internist at California Pacific Medical Center (CPMC) in San Francisco.
The doctor examined Sam’s toe and said he was worried. It was a big fracture, and if the bones didn’t knit together properly, Sam could be in for big trouble.
So he advised Sam to see an orthopedic surgeon.
Luckily for Sam, said his doctor, there was one close by in the same office. The doctor would ask him to check out Sam’s injury then and there.
Unluckily for Sam, he was on Medi-Cal--and the orthopedic surgeon refused to honor his insurance and see him.
Sam’s doctor sent him home, saying, “I’ll try to find someone as soon as I can.”
At home, Sam called Anthem Blue Cross, the private insurance company now providing coverage to the poor under the state Medi-Cal program.
The Anthem representative soon emailed Sam a list of Anthem Blue Cross orthopedic surgeons who would supposedly accept his insurance.
He then printed out the list on his computer.
Sam then made another phone call–to the office of Dr. Vernon L. Giang, Chief Medical Executive for CPMC.
There he spoke with an assistant to Dr. Giang. He explained his difficulties in getting medical care at CPMC.
He added that he had obtained a 14-page list of Anthem-Blue Cross-approved orthopedic surgeons who should be willing to accept his insurance.
The assistant said she would gladly check out the list for any doctors affiliated with CPMC.
But there was a problem.
Sam needed to fax her the information–and Sam didn’t have a fax machine.
Nevertheless, Sam hobbled several blocks to a nearby Kinko’s/FedEx office, which had fax machines.
The next morning, Sam called Dr. Giang’s office. He reached the same assistant, who told him that the faxed material had come in.
The bad news: There wasn’t a single doctor on that list whom she had called who would accept Sam’s insurance.
In addition, some of the doctors were “out of our plan.” Which meant that even if they had been willing to accept Sam’s insurance, he couldn’t have seen them.
The assistant was polite and sympathetic, but candid: CPMC’s doctors aren’t required to treat any patient whose insurance they dislike.
In fact, CPMC cannot demand that they do so, since the doctors who are practice under its name are considered “independent practitioners.”
So Sam aimed higher. He phoned the office of Dr. Warren S. Browner, the CEO of California Pacific Medical Center.
But he didn’t reach Browner–or even a secretary.
As a rule, when you call a giant corporation and ask to speak with its CEO, this doesn’t happen. But what usually does happen is that you’re put through to the executive offices.
You won’t speak with the CEO, but you’ll usually reach a secretary for him. And if your message is one that poses legal or public relations disaster for the company, the odds are excellent that you’ll soon get a call back.
Not from the CEO (except in rare cases) but from someone deputized to speak in his name–and to probably address your problem.
But, in this case, there was no secretary to answer the phone for Dr. Browner. Just a message machine. So Sam left an urgent message, outlining his difficulties in getting medical care from CPMC.
No one from Dr. Browner’s office called him back that day.
Meanwhile, the pain in Sam’s foot was getting worse. So, later that day, he hobbled into an emergency room of CMPC.
A doctor examined Sam’s foot and ordered several X-rays taken of the broken toe. After examining these, he told Sam what he already knew: The toe was broken.
He also warned that if it wasn’t treated properly, Sam could have great pain–such as from arthritis–in the future.
Sam explained how he had been unable to get an orthopedic surgeon to look at his toe.
The doctor said he would try to find one who would.
Sam waited in the ER for almost four hours. When he finally saw the doctor again, the latter seemed embarrassed to give him the bad news.
He hadn’t been any more successful than Sam at finding a CPMC orthopedic surgeon willing to treat Sam’s injury.
When Sam asked what he should do, the ER doctor said that “time” would take care of the injury.
The website for CPMC boasts: “At California Pacific Medical Center, our mission is to always give each patient the personal, hands-on attention they deserve.
Unless, of course, all of its doctors in a particular specialty refuse to honor the patient’s medical insurance.