Damaged Care

'if you're having a heart attack, please press 2...'

After scrutinizing the reconfigured contracts and making numerous phone calls to clear up his remaining confusions, Raymond decided PHS was a better bet for him because the people on the phone were slightly more accommodating. But when he asked PHS for the list of drugs the company covers, ''They said we don't have that available,'' he recalls. When the ever vigilant consumer mentioned that HMOs are required by law to make their drug formularies available, the company's representative promised to look into the issue. A few days later, the PHS staffer called to invite Raymond to come to their offices in the Chrysler Building and take a look at the company's drug formulary. ''This guy came out with a booklet and Post-it notes so that I could mark the pages that needed to be copied.''

In fact, PHS was adhering to the letter of New York State law, which requires that HMOs must ''allow prospective enrollees to inspect drug formularies.'' Nevertheless, Raymond was frustrated. ''He was nice enough, but this is no way to review a formulary.''

Despite the inconvenience, Raymond stuck with his choice of PHS (in part because the Blue Choice formulary, which they sent him readily, was more limited). But, as his new plan kicks in, the patient who has tried to foresee all complications is already running into new problems, particularly getting access to all the providers he's used to seeing. He had, not surprisingly, already checked to make sure his eye doctor--who had diagnosed him with an HIV-related condition that Raymond describes as feeling like there's ''a shifting polka-dotted cloudy film'' over his eyes--was included in the PHS plan. But when he went to see that doctor a few weeks ago, he learned he is no longer covered by the plan.

''I'll have to try to find a person who specializes in that who's in the plan,'' sighs the persistent patient, who seems to have developed an almost religious zeal for coping with life's obstacles. (For inspiration, he quotes what someone said about Nelson Mandela's source of strength: ''If you are deliberate in taking risks of a certain course of action, then nothing can shock you because you've already come to terms with the possibility.'')

Even the daily epileptic seizures don't stifle his obsession with getting the care he deserves. He describes these episodes as ''an inner focused state of consciousness--it looks like a junkie nodding out.'' He'll be writing lists or making notes and then the next thing he knows, his pen drops and there's a mark across the page. But he just picks it up, straightens his things, and keeps going.


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