A Pain In The Knee?..............4.8.2012
I dummied up my right knee a few years ago and over the past year it has been giving me grief more frequently to where I finally decided to get it checked out. As I am covered under my wife’s health insurance plan through an HMO, I called to set up an appointment with my HMO approved doctor to get my knee fixed. I didn’t know how much fun this was going to be.
You see, you can’t just set up an appointment directly with a knee doctor when you belong to a High Maintenance Organization, (HMO). Nope, you first have to see your regular doctor to whom you pay a tidy sum, (referred to in the health plan documents as a “Payment Obligation to Organization Physicians” or POOP), to be told you cannot be helped by them so they will refer you to the doctor you wanted to go see in the first place. This referral procedure is called the “Referral Under Managed Protocol” or RUMP.
However you are not out of the woods yet. Your RUMP must first be inspected and approved by the HMO before you may proceed. I was told my RUMP inspector was a little behind in her paperwork and she could take a few days to clean things up.
My RUMP arrived in just under a week and I excitedly called the knee people to set an appointment anxious to finally be rid of the pain.
“Hello, Orthopedic clinic. How may I direct your call?”
“Hi, my RUMP came in the mail, I have my POOP, and my knee hurts.”
“Right. I’m not sure we can help you with that but let’s see….the first available appointment is in 27 days….”
“Twenty-seven days?!? But my knee hurts now. Ok, I guess I’ll have to take it.”
“Be sure and arrive at least 45 minutes before your scheduled time to fill out paperwork.”
I dutifully arrived 45 minutes early and showed the receptionist my RUMP.
“Your RUMP looks fine to me. Did you bring your POOP?”
I filled out the paperwork and finally got to see the doctor:
“How’s the knee?”
“Fine, today.”
“Then why are you here?”
“Well it hurt 27 days ago. Look, you took my POOP and now I want it fixed!”
“No problem. I’m prescribing physical therapy for the next six weeks. Then come back and we’ll see how you’re doing. By the way, you’ll need your new RUMP inspected and more POOP for each session….”
