Denial of Specialty Service
Where to begin? I broke a bone in my foot, the fifth metatarsal to be exact. I went to the emergency room thanks to a good medical advice nurse. After the emergency room took x-rays and immobilized the foot, they told me to see and orthopedic surgeon. This happened on Saturday evening, 4/1/2007. I called Kaiser on Monday and was on the phone with them for two days. First they advised me to see a podiatrist and the first available appointment was not until Friday. I requested to see an orthopedist as I was instructed and my primary physician approved the visit. But then I was informed by Kaiser Member Services that I was denied an orthopedic consultation. I was told orthopedic surgeons don’t handle breaks in the foot and that is the podiatrist’s specialty. I thought that was strange so I called a podiatrist I had seen in the past and trust. The podiatrist advised that I go to an orthopedist. So then I checked with two orthopedists and they both confirmed that I should be treated by an orthopedic surgeon. I went back and forth with Kaiser on this matter. Mind you, my primary care physician had approved the specialty doctor and I got a veto from the member services department. I spoke to several other member service people, and when it appeared that they did not see why I could not go ahead and see an orthopedist, they looked into it further and came back with an additional veto.
So, under their advice, I went to see podiatrist referred to me. He confirmed it was broken and put my foot and calf in a hard no weight-bearing cast for 6 to 8 weeks. A HEAVY HARD CAST. I have No help and no way to carry things. I live in a two story duplex alone and have to get up and down porch steps just to enter. The hard cast has rendered me unable to accomplish normal day-to-day necessities-- take the trash out, grocery shop, etc. Even bathing has been close to impossible.
By the 4th week, my foot began to hurt in a way it had not previously. I called my doctor and they dismissed my complaints. I had had no follow-up, so in desperation (anxious that it may not be healing correctly). I sought the outside opinion of an orthopedist. To my utter shock, he noted that I had not needed a hard cast in the first place. Now I’m utterly exasperated. I could not afford out-of-pocket treatment with this orthopedist, and still have another 2 weeks in this immobilizing cast. My foot hurts and my body aches because I am even unable to position myself for comfortable sleep, and now my mind is going to burst in frustration.
I cannot express to you how horrible this has been. I have lost confidence in Kaiser completely.