HMO vs. PPO, Speed vs. Attention, Kaiser vs. HealthNet
Now please bear with me. I'm not here looking for solutions, though if any of you have experienced this and managed to get rid of it, I'd love to hear how. No...this is a post about the differences in health care systems because at about the same time the tinnitus developed I switched from HealthNet, a Northern California PPO I'd been with for years, to Kaiser Permanente.
It's been a long time since I've been with a pure HMO, and I'd heard a lot (bad and good) about Kaiser Permanente, but I must admit that my first experience with Kaiser was very positive. Last December before the tinnitus developed, I got some kind of infection and made an appointment with my primary. Voila! A same day appointment! That is something that never happens with HealthNet. Then I arrive at the office a little early, and again... Voila! They take me early. But here is where things get a little odd. My primary spends exactly 15 minutes diagnosing my condition, giving me a prescription, and sending me on my way. Now part of that is the fact that Kaiser has computerized everything--your chart, hell your whole history. But the 15 minute rule is not limited to the primaries, it seems. When it came time to deal with the tinnitus, an EEN&T specialist put me through an extensive hearing test, then took 15 minutes to examine me and delivering his verdict: "We don't really know what causes tinnitus. You'll probably just have to learn to live with it." Now I'm no dummy, I know that there are factors that can start or aggravate tinnitus. So how come he didn't mention: Caffeine, TMJ, aspirin, or hyper-tension? Come on! I'm dealing with something profound here.
So...fast forward four months. I'm back with HealthNet while I'm between jobs, and I'm still dealing with the tinnitus, but HealthNet is a very different system--one that the Frogette and I have learned to play over the years. First, do you need a same day appointment? Well forget it. You won't get one. HealthNet schedulers vet patients and assign appointments based on their perception of the urgency of your condition. Vomiting your guts out? Tomorrow or the next day to see the "on-call" doctor. Tinnitus? How about 3 weeks from now? The only way to get a same-day is to show up at your doctor's office unannounced and plant yourself in the lobby until they take you, but be prepared to wait and be sure to do a lot of coughing and sneezing. (Gets you in faster.)
On the other hand HealthNet is not without it's advantages. My primary (I've had two) has always been very concerned with my condition. Some years ago I had a brief bout with a neurological disorder, and my primary after admitting that he really didn't know how to treat it, pulled strings and got me in to see the best neurologist in the City, and as far as allergies go, my primary has paid attention to and taken care of things that even my allergist didn't notice or care to treat.
So here is my dilemma, and it's one that I'm sure many of us have faced. If I need urgent care, I'd go with Kaiser in a minute. But for long term attention to an ongoing issue, I'd go with HealthNet. So for the future, which is it, speed or attention? HMO or PPO? And why can't I have both?
MY EN&T doc did quite a few tests, but never had a real diagnosis. He treated it as "atypical meuneiere's" & suggested a low-salt diet & taking a low-dose diuretic-type HBP med (I do NOT have high blood pressure, use caffeine or aspirin). TMJ? -- I started using my mouth-guard EVERY night, the one my dentist made to help with teeth-grinding & that did help take away some pressure.
In the end, it just took TIME, in my case about 6-months before the residual ringing & popping subsided. I did get some slight comfort from my mom's advice of dripping in a few drops of warmed-up baby oil, then stuffing in a cotton ball & laying my head against a heating pad set to very low.
Today, I still have minor flare-ups, but nothing like that original bout. When I think back about it, it was the muffle-head effect that I hated the most. I sure hope yours clears up completely & soon. 8-months is too long to just live with something, especially if there's been little or no improvement.
ps, I just switched into an HMO pln last yr & this week will be my first opportunity to use it. Never had any problem with our PPO & am not looking forward to the differences. D.K.
D.K., TMJ refers to the temporomandibular joint, a class of medical problems associated with the jaw joint and where it connects to the skull. Supposedly tinnitus can be a side effect of TMJ problems, and I have had some of those in years past. Thanks for the other suggestions. I'm going back to my HealthNet primary on Wednesday, so we'll see what they can do.
Several years ago, I moved to a rural area and kept the same HMO. What a difference in service. I get in immediately when I call with a serious illness or else they refer me to the urgent care center in my area after hours (no deductible if they refer me versus the deductible I would pay if I went to the ER but was not admitted). I also get any referrals to specialists that day or within a day or two. The waiting room is great too. I usually get called to a room within 5 minutes of arrival. My doctor takes her time too and doesn't rush me through.
My daughter has a PPO and likes it, but she pays higher co-pays. (I'd rather not have any co-pay surprises at my age!) Overall, though, her level of service satisfaction is so-so, and she lives in a high population suburban city. Her major complaint is the wait time to schedule any major test like a CT scan since the hospitals are so crowded. That's one advantage to living in a rural area where the population demands are not as great.
Good luck on finding a solution to your tinnitus. The reasons for it are numerous and your doctor has to start ruling them out one at a time. Keep the faith and be patient that he'll find the right solution.
Turn off Fox News.
Sorry, couldn't resist. Hope you get to feeling better, unalii.
WS, As I said I'd love to see national health care, but I suspect it would be closer to the PPO experience than the HMO experience.
And Kvatch reaches into his left ear to discover...a babelfish translating Fox News into white noise!
LC, you are a funny, funny guy. :-)
Both Hezbollah and Israeli Leaders Declare Victory
I wish my anonymous Faux News troll (from 206.15.101.# (NEWS CORPORATION)) were intelligent enough to be able to hit the "refresh" button on their browser. That way they could have added their comment spam to an actual post dealing with just this issue.
I just want to see some kind of universal healthcare. PPO, HMO, UFO, whatever.
Kvatch, this (tinnitus) happened to my brother, and I think he just gave up trying to find out what to do about it. Just the condition itself is frustrating, so you definitely have my sympathy. Good luck to you.
Good for the people...bad for business... The American way!
Julien, E4E Thanks--not at the giving up point yet; hope I don't get there. I'm working on the diet thing starting with caffeine. Gave it up 10 days ago and am seeing if that helps.
TPM, I know, but we've got too many uninsured in this country not to apply some creativity to the problem.
Sumo, sorry to hear that. If I find something that works I'll let you know.
They took care of my sons' dad for five years until he died. They were wonderful. The hurry up impersonal approach may vary doctor by doctor. It did with us. His oncologist was like that at first but the one who followed him wasn't. She was wonderful.
If I had been with anyone else except Kaiser, my family would be paying off the bills until the 22nd century. We would have maxed out in the first couple of years.
I wish I could have kept it when I retired by the COBRA premiums were too high.
Over the years the tinnitus got louder and eventually my jaw muscles started getting sore. At first the tinnitus was louder and the soreness was worse on the left side of my face but now it's pretty much about equal on both sides.
Back in 1999 I discovered a so called TMJ specialist and went through his treatment for it. His theory was that TMJ problems are a result of improper bite. He made a bite splint for me to wear 24/7. For about the first week my pain began to diminish along the fullness in my ears and tinnitus subsiding as well. After that week, it all just came back again.
After searching around the Internet a bit, I found the NTI Tension Suppression System that another dentist has developed. I managed to get my TMJ specialist together with the inventor of that device and was fitted for one. That helped out for about a week as well before all of the symptoms came back. The NTI device is supposed to keep your teeth apart while you sleep to prevent bruxism but I kept waking up with my tongue pressed into the back of my teeth and all of my jaw muscles clenched.
I can tell you from my experiences that my tinnitus and jaw pain are more than likely caused by my nocturnal bruxism. I clench my teeth in my sleep with great force on a nightly basis. Oftentimes I wake up with my teeth clenched together, my jaw in severe pain, and sometimes I'm quite dizzy for a few minutes.
So, in my case, if I can somehow figure out how to stop clenching my teeth in my sleep, my symptoms should all go away in time like they have in the past when I tried the bite splint and the NTI device. You just might have a similar problem so I'd suggest looking into whether or not you are clenching or grinding your teeth excessively in your sleep.