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Wait for Care IPA – ADOC – Affiliated Doctors of Orange County

Posted Mar 08 2011 10:30am

Medicare HMOS confuse patients for a living. They basically seize your Medicare benefits and sell the responsibility for your care to an IPA, which then controls your access to care.

I saw a Medicare HMO patient who had his care contracted to ADOC, the Affiliated Doctors of Orange County. I was asked to see him in the wound care hospital where he was staying with large wounds in his leg. The doctors taking care of him wanted skin grafting to facilitate healing of these wounds.

In order to expedite a patient’s care, the better IPAs will agree to fund care by non-contracted doctors at an mutually agreed upon rate. ADOC is not such an IPA instead choosing to transfer the patient to a nursing home without surgery to delay the cost of surgery. They actually sent him by ambulance to the office of a provider doctor within days of my first inpatient visit with him.

ADOC prefers to deal with the patient’s wounds at their convenience as an outpatient when a contracted doctor can get to him. This delays his time to skin grafting for weeks to months. In my opinion, this defines poor quality care. If they were your wounds would you rather have them dressed with gauze for the additional time or have the repaired before you left the hospital?

This is why your Dr D is not an ADOC member.

Sneaky HMO Tricks:

ADOC used two Sneaky HMO Tricks here:

(1) Transfer the patient out of the hospital before surgery happens even if it delays or denies the patient care.

(2) Without so much as a phone call to the consultant on the case, send the patient by ambulance for an office visit with a provider doctor.

Best Regards,

John Di Saia MD

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