Unmanaging My Health Care

I was sitting on the floor at Sears, dazed and disoriented, when I decided that my health maintenance organization wasn’t maintaining my health in a necessary manner.

I had collapsed suddenly but was not so dazed that I couldn’t appreciate the timeliness of my decision. Gray Davis had just signed a series of bills overhauling HMOs, and the U.S. House of Representatives was about to pass a similar measure.

What a fine example this is, I said to myself as I struggled to my feet, of an HMO unable to get it all together enough to keep a guy off the floor at Sears. In this case, the HMO was Cigna.

The reason I had collapsed was a rapid heartbeat. At unexpected moments over the past several years, my heart rate has suddenly escalated to twice its normal level, which is fine if you’re riding a mountain bike up the south face of Everest but otherwise not all that terrific.

Without medication, this causes me to black out, which I did in the Woodland Hills Sears store while buying Levi’s.

To correct this (passing out, not buying Levi’s) there’s a procedure called cardiac electrophysiotherapy, in which they stick a wire up one’s vein and burn, I mean ablate, a portion of the heart that causes the problem.

“Have it and you’ll never have to take heart medication again!” I remember my cardiologist saying. I could visualize him standing before the grotto at Lourdes, arms outstretched, welcoming me to a miracle.

So I said OK, let’s go for it, and that’s when my anguished odyssey through managed health care’s torturous maze began.

Normally, medication keeps me from keeling over, but three days before the episode at Sears I was told to stop taking it in preparation for the aforementioned CEP.

I had arisen at 4:30 a.m. that morning to go to Granada Hills Community Hospital to have the thing done, but the woman in admitting scanned her computer and said I wasn’t on the schedule. Too bad, sorry, adios.

The cardiologist’s office had failed to confirm the date with the hospital, which is just as well because the initial authorization wasn’t properly written anyhow.

It was later that day that I faded to black and ended up in an emergency room being told what I already knew, that I needed the procedure.

That was the third time I had prepared to have the thing done, by the way. The first time, it was called off the day before because there was no authorization. The second time it was called off because . . . well, I can’t even remember why.

There was also a fourth time. The medical association managing my health care for Cigna mysteriously insisted that the procedure be done in a cardiologist’s office rather than a hospital.

Since that’s not possible because of the sophisticated equipment required, the request had to go to a committee for another approval, which is where I am now, caught between a committee and a hard place.

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During all of this I have tried to expedite the process by haranguing anyone within range. I demanded results from Cigna service representatives Dee and Sheree and Rena, the latter of whom got so tired of it all she quit and moved to Seattle. Then I pleaded with Grace at my doctor’s office and Jennifer and Jackie at the cardiologist’s office.

All of them worked their butts off in a grand effort to get me treated. They even listed my case as urgent, which impressed Cigna about as much as a dog scratching at the operating room door. Well, actually, not that much.

Another reason for the delays was that in the midst of all this, the medical association closed shop and I had to start all over. At one point I was handed off like a relay stick to a new primary physician, who didn’t know me and wouldn’t approve anything unless I began the whole idiotic process anew.

So that’s how I ended up passing out at Sears, as much from frustration as physiological failure. I staggered off to my wife, who was nearby and who bought me a cinnamon roll to calm me down. Take two cinnamon rolls, drink plenty of Diet Coke and call me in the morning.

I said to her that I didn’t want to die on the floor at Sears. That would be too, well, plebeian. She promised that if I collapsed there again, she’d rush me over to Neiman Marcus and dump me in menswear. Image is important in L.A.

Meanwhile, I’m still waiting for an appointment. I’m not going to sue Cigna and I’m not seeking a second opinion at the moment, although state law will soon grant me those options. All I want is to find my way to that shining vision of Lourdes where I can be ablated and made well.

It will probably take another miracle to get me there. So Merry Christmas, in case I’m not around.

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Al Martinez’s column appears Sundays and Wednesdays. He can be reached online at [email protected]