2006/08/14

HMO vs. PPO, Speed vs. Attention, Kaiser vs. HealthNet

I've got a health problem. About 8 months ago I developed tinnitus (ringing in the ears), most profoundly on the left but to some extent in both my ears--a high pitched screeing that never abates. It only varies in volume, going from barely noticeable in the morning to very noticeable in the evening--sometimes affecting my concentration.

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?

22 Comments:

Personally, I'd go with Single Payer Universal Health Coverage, and get both great immediate care and great long term care. But I might be in fantasy land.
gosh, do I ever feel for you! I went through a whole tinnitus ordeal a couple yrs ago. Out of nowhere, never had any previous ear complaints. For me it was much more pronounced in the left ear. All that ringing, whistling, humming & other noise drove me nuts. Human voices all sounded muffled. had to put the phone up to my right ear to hear ANYTHING & even then it sounded like someone talking into a long hollow, echoing pipe. Forget TV. but any crashing sound (like car door slamming) sounded like a bomb going off in my head. nights were worse as there's less other household sound going on to mask it out. it was a very isolating experience.

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.
oh, i hope that wasn't too long a comment! now i can't get blogger to verify, so let me test again now ... D.K.
Diva, works for me, but I don't think that it will happen in the US.

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.
I don't do Dr.'s unless it's an extreme emergency that I can't clear up on my own. None of us have health insurance, but even when I did, I didn't go. When I had tinnitus, someone told me to stop and listen to the noise, to think of it as sort of downloading information. I know that sounds weird. Probably stopped me from tensing up when it occured. It became less and less prevalent and finally went away. So that's the scoop from me today.
It's been my experience that population density makes a difference when it comes to health insurance. I had the same HMO for years and lived in a large metropolitan area. I loved my doctor and usually could get in quickly in an emergency, but it took forever in the waiting room, and it also took forever to get a referral to another doctor or to get an appointment for something minor (like a checkup before getting a script renewal).

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.
what about option three - behind door number two? A national heathcare system that does both and is relatively inexpensive?
"...a high pitched screeing that never abates...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."

Turn off Fox News.
Sorry, couldn't resist. Hope you get to feeling better, unalii.
Mary, Kathy, I've come up with a sort of trick that allow me to...sort of..."turn down the volume". What I actually think is happening is that I'm turning up my ability to ignore it. Anyway, so many of you have said that it just goes away on it's own, I'm hopeful.

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.
Turn off Fox News.

And Kvatch reaches into his left ear to discover...a babelfish translating Fox News into white noise!

LC, you are a funny, funny guy. :-)
I wish I knew about this stuff...

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.

Too bad.
I've had HMO's for years. No real choice. There are good and bad things about them. I can't say I've noticed more or less attention from doctors than those who had other types of insurance. Maybe Healthnet is a separate issue. We can get same day appointments with our primary most of the time, but only if we get sick at the right time of day. As far as specialists go, it depends upon the specialty. Could be a week, could be several weeks.

I just want to see some kind of universal healthcare. PPO, HMO, UFO, whatever.
Are we voting for universal healthcare here? If so, count me in!

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.
Healthnet- that is my vote...I was in Ca a little over a year ago- was not impressed with Kaiser...Tinnitis- as a nurse I have seen patients battle it with all kinds of remedies- naturopathes ( major diet changes and herbs and vitamins given), and also acupuncture...but not sure if either of your plans covers these options...So sorry that you are wrestling with this...take care...
A national heathcare system that does both and is relatively inexpensive?

Good for the people...bad for business... The American way!
I wish I could shed some good light on this...but can't. I've had this for as long as I can remember as a tiny child. I am soooo used to it by now. I've always figured mine was from allergies. It never occured to me to tell a doctor about it...since it is on 24/7/365. I too thought there was nothing that could be done. Hope it goes as fast as it came for you.
Ms. Yenta, perhaps it's just that Kaiser has got the thing so streamlined that they don't need more time. I don't know. They certainly didn't offer me any useful advice.

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.
Kvatch, it seems like I haven't been saying what I wanted/meant to say here at all. I definitely didn't mean you should give up! I meant that I know how hard it is to get the docs on board and find a cause and get something done. I wish my brother HAD NOT given up. I urged him to keep trying, but he was too frustrated.
Julien, don't worry. I got what you meant, and you're right. It is very frustrating. I mean I gave caffeine for two whole weeks and got...nothing. ;-)
I had Kaiser for years and paid next to nothing through work. Only one unpleasant experience.

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.
I've been dealing with tinnitus for almost 16 years now. That was the first symptom to manifest anyway in what has turned into a much larger problem. I had Kaiser when this all started back in 1990 (and I do again) and got pretty much the same treatment you did recently. They tested my hearing (told me it was better than average) and was told that they really don't know what causes tinnitus.

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.

Good luck,
Todd

Add a comment

Links to this post:

Create a Link