Going nowhere fast. New OS / KP San Diego says I'm too young.

[LaylaHips]

I believe Southern CA Kaiser is a better organization than northern, so hopefully you will figure out how the system works. If I remember correctly, you do have to go through your GP for everything. I had a bad one, and when he looked at an x-ray of my knee he said it was fine. When I finally got to the orthopedist (Dr Dilibero-he was great but I think he's retired now) at Sunset Kaiser, he told me I had the knee of an 80 year old- with barely any cartilage (also said I would need a knee replacement in 10 years, it's now 20 and I need to do it soon!). I thought Kaiser was great and they had everything well planned. Meetings with the anesthesiologist, everything was perfectly in place on their part. It also helped that I worked at a place that held monthly orthopedic clinics for the kids we worked with, so spent a lot of time with a private group (SCOI) and was friendly with their doc who referred me to Dilibero when he found out I had Kaiser. At that time I just had arthroscopic surgery to repair a torn meniscus, and had no problems until 8 or so years ago. I'm putting the knee thing off until my hip is done. So, I'm hoping that once you find the right channels, it all works well for you. My experience was 20 years ago, so I'm hoping it's as good as it used to be.

 

[Josephine]

That really makes my blood boil when I hear that 'too young' theme song! We have members on here in their 20s had hip replacements and even one age 14! If your hip's shot, it's shot and no amount of cortisone is going to change that. I bet if/when it come to that surgeon's time to have his hip done, he won't be checking his date of birth first! (well, you know what I mean!)

May I suggest you print off this form and complete it? You can then take that to the surgeon you next see and show him what your quality of life is like.

 

[Flosamuels]

@Cherie Two things: First, my one and only fight with Kaiser (Northern CA) ended in a win but it was years ago. I had two hammer toes that needed to be straightened as they were causing corns on the toes that were being pushed up by the hammer toes. These corns then became extremely painful when I wore shoes. Kaiser refused to authorize the operation (at the office and local anesthesia) because it was considered as podiatry which they did not cover. Podiatry was considered as cosmetic, on the same level as old people getting their toenails cut. When dealing with issues, I go straight to the top. I wrote letters to five Kaiser executives and five Board members pointing out that a) there was nothing in their literature saying podiatry was not covered, therefore it was false advertising, b) an issue that causes pain and cannot be fixed without surgery is hardly cosmetic and c) if they did not do the surgery I would write letters to all the local newspapers and note how Kaiser determined what was covered at the time you needed coverage. In addition, I would make up flyers and hand them out at work and in supermarkets, etc. Now this was when most employee benefit programs gave you a selection in health plan. The surgery was authorized and from that point on I was NEVER denied any service and, in fact, had X-rays and MRIs that might normally not have been required.

Second, I could be wrong but I do not believe Obamacare allows for discrimination in provision of services due to age. If you cannot be denied coverage due to a pre-existing condition or age, how can you be denied a procedure due to age? I would contact my congressman to be put into touch with someone who is working in whatever office is administering Obamacare and ask some questions. If, as I suspect, you cannot be denied a procedure due to age, you can then write the Kaiser execs and tell them you are going to file a complaint with the Federal healthcare agency. Even if Obamacare is silent on the age issue, many states have agencies that oversee health plans. Tell the execs you will file complaints there. (These complaints are used to rate the health plans for consumers). And tell the execs you will be contacting newspapers, employers, health benefit advisors, in your area, online petition groups, etc. To any organization, bad publicity is not a good thing. But you need to be prepared to follow through if you don't get action. Once the bad publicity starts, you should see a change in attitude.

 

[Cynthia777]

@Flosamuels
YOU GO GIRL!

 

[Jamie]

These are encouraging stories. It proves one should never give up. Don't get mad, but be determined and work within whatever an insurance provider's system is. They all have avenues to express complaints. The squeaky wheel theory does work. And, it never hurts to politely indicate that you may seek other complaint avenues like the Federal government or the media.

 

[Cherie]

Thanks for the input everyone! It was encouraging and helped me figure out what worked. I'm not sure why I ran into the road block I did but things are making some progress.

One night while reading the forums and looking things up for the next day's phone calls I found something called California Timely Access to Care Regulations. They basically define the maximum amount of time for things like telephone wait times, call backs, and different types of urgent and non-urgent appointments. It is pretty clear that they should have given me an appointment within 14 days of my first call even if it was with a different OS.

I was able to get a second opinion within KP on June 10 and to finally get an appointment with my OS on June 15. Both OSs say my hip looks much worse now compared to my March X-rays and THR is the only option. No one is making "you're too young" statements now.

The current wait time for surgery is "several months". I asked if that means July and August are full but there are limited days open through the end of the year or is everything full until 2016? He said several months means at least seven. He gave me their surgical information packet and said he would talk to the other surgeons. He said he will call me back by Friday and is going to figure out a way to get me in earlier since I asked for THR in March and he thought the cortisone would give good results but it did not.

With any luck I'll know my surgery date by this time next week. And with a bunch of luck it will be in 2015.

Thanks again everyone.

Oh, and any future searchers having trouble getting an appointment in California should check out:
https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx

 

[djklaugh]

@Cherie Congratulations on getting through the maze of bureaucracy! I am so glad to hear that finally you are seeing the right people and can move forward on getting a new hip. As for the wait time ..... alas that is par for the course at Kaiser (and many other places too). Ask if they keep a cancellation wait list - if you can be flexible and available on short notice that might be an option for you. Doctors and hospitals don't like blank spaces in their operating schedules .... but folks do cancel surgeries at times or come up with some last minute medical problem that means surgery has to be rescheduled.

Good luck to you and hopefully soon you will be posting over on the recovery side

 

[younghippie]

I had a friend who adopted a little girl from China. She had Kaiser and they refused to cover the adopted little girl. Their plan clearly stated that adopted children were covered immediately upon legal adoption. Kaiser refused and said there was a 6 month waiting period (the little girl was special needs and needed serious, immediate health care.) I told her to contact our insurance commissioner and get on the phone with the highest ranking person she could find at Kaiser and let that person know she was filing a formal complaint with insur. commissioner. She did that and had coverage and a formal letter of apology within 24 hours (before the little girl even made it home.)

I was 37 when I had my THR. I waited for 5 years because I was told I was too young (until I found my phenomenal surgeon at Emory who didn't blink an eye at my age.) My recovery was longer than most because I waited so long and had gotten weak. You are doing the right thing to move forward. It is wonderful and you'll get your life back. If you have any trouble and you do have the opportunity to switch with open enrollment, you might want to consider it. The surgery is expensive and it helps to have good, clear insurance coverage (and access to the best doctors and hospitals.) Best of luck to you!

 

[Cherie]

@djklaugh Thanks! I absolutely intend to ask about a cancellation / on call list. I guess a positive of being unable to work is I am able to go in no matter when they have a spot open.
I didn't realize how good I had it before I moved. With my previous provider my longest wait for hip surgery was 3 weeks. I could get an appointment with the chair of orthopedics (who only has office hours Monday afternoons) in 10 days. The way Kaiser operates has been shockingly foreign.

@younghippie Your friend's experience is absolutely terrible. Even after the last couple months I can't imagine being treated that poorly. To have worked through the lengthy adoption process, multiple trips to China, all the documentation, forms, and lawyers only to have Kaiser say that is ... beyond words. I hope she is doing well now.

I've already started looking at the other plans available and called a few doctors so I'm ready for open enrollment. If Kaiser schedules me into 2016 or continues to fail I'm going to try to fast track THR somewhere better.

My recovery will take longer than normal but not because of Kaiser. The last time I had a normal gait was June 1995. I've been "too young" for THR the entire time. My left leg is 2" shorter from previous trauma and AVN surgeries and 2" smaller around from 20 years of uneven weight bearing. I've started PT/pre-hab and feel like I've gained a lot of strength but there is no way I'll be able to get my left side ready before surgery. Not even if I have to wait until 2016. I just hope it doesn't take that long.

 

[younghippie]

The wait for surgery with surgeons in the big group that many people use in metro Atlanta is just a couple of weeks (I visited 6 surgeons before making choice.) The wait is still only about 6 weeks at Emory (which has the longest wait in Atl.) So, the wait at Kaiser is terribly unreasonable. I'm sorry you are going through this.

I couldn't walk up stairs on my left (operated) side for 5 years before THR. That is what I should have rehabbed before surgery. I probably couldn't have done the stairs, but there is some work I could have done to make that side stronger. A lot of the therapy I do now for that side, I do lying or sitting down (so... I could have done those things easily). The fact that you are doing anything will help you a great deal. You will do really well and have a great outcome!