Healthcare can be a pain in the ass.
This is the first post from one of the site’s new contributors. Josh is a personal trainer and actor living in NYC. In addition to being one of my best friends, he’s one of the most frugal and sensible people I know. Since he writes well and I trust him to do a good job, I’m always asking him to write content for the blog. When something happens that makes him angry, he calls me and takes me up on it. That’s his way of being a media watchdog. - Ed.
Healthcare. Groan. Most of us have been bombarded with “news” about healthcare recently that lacks any substance. I for one am as tired of watered down, promises of miracle fixes as I am of the ridiculous, unsupported scare tactics of the other side. I want to share a personal story about my experience with my health insurance company, Blue Cross Blue Shield, and then give you some accessible resources that explain why we are in this mess and what can be done to help us out of it.
My story is a unique one in the healthcare discussion. Rather than being a life-or-death-Canadian-border-jumping-page-turner, my story involves the mundane realities of our normal healthcare needs. I was bit by a dog at 5:25PM. My skin was broken in several places, but I wasn’t going to need stitches. My first call was to a vet, who instructed me of the dangers of bacterial infections from dog bites and said I needed to get it taken care of that evening and not wait until the morning. My next call was to my doctor, whose office was closed. My third call was to my insurance company, whose office was also closed. My first annoyance: the local vet stays open later than both my insurance company and my doctor.
My bite was clearly not an emergency, so I went to the medical clinic around the block to see if I could be seen. This clinic informed me that insurance companies will not pay for tetanus shots (I later learned this was false…the first of many misinformed statements of the evening) and that I would have to pay out of pocket. I don’t pay a premium every month to then also pay for care. I went another two blocks to another medical clinic who said they could see me. Victory! Then I was informed that I couldn’t be seen because I needed a referral from my primary care physician. Defeat. I explained that my doctor’s office was closed. They asked that I get clearance form my insurance agent. I explained they were closed. They said then there was nothing they could do for me.
“Can I bring a referral tomorrow?”
“Nope. That’s what everyone says and no one does.”
“I’ll leave my credit card and driver’s license as collateral.”
“Nope.”
They recommended I go to an emergency room, where I would have to be seen. But I wasn’t having an emergency. This is what drives up costs. I went to the emergency room this summer after waking up during an allergic reaction, unable to breathe. They gave me a shot of adrenaline and some Benadryll and charged my insurance over $2,000. Although I have no regrets about that visit (not being able to breathe is scary), I knew there must be another option for my minor needs of a tetanus shot and some antibiotics. I refused to be another person who raises everyone’s premiums unnecessarily.
I remembered I could change my general practitioner at my whim online, and I asked if I could use their computer to do so. I could see eight from my perch at the window. I would change it to the doctor practicing here (the one they told me to change it to) and therefore wouldn’t need a referral. “No,” came the one word reply. I didn’t have enough time to make it to a computer and get back to the clinic before it closed at 8:00. My iphone didn’t support the website, so I couldn’t do it on that. I called my girlfriend. She, after much effort, managed to change it. I had her email me my confirmation. Victory! I strolled up to window with iphone in hand.
“Here. I changed it.”
“We need a hard copy.”
“Can you print it out on your computer?”
“Nope.”
Defeat.
Seeing my temples redden, the woman at the window leveled with me. “Insurance companies suck. If they can find a reason to not pay us, they will.” But the thing is, this doctor office sucked to. How hard is it to print out an email confirmation? Everyone was so angry at everyone else that no one would make any common sense concessions to streamline the arduous, expensive process.
At this point, I had been at this clinic for over two hours and the bacteria from the bite was getting a head start. Remember, the bite hadn’t even been cleaned out yet. I made a call to a friend who lived nearby and had a car. He printed out the confirmation and brought it to me. I slammed it on the counter.
The woman said, “Sorry, the doctor is on his way out the door.”
“What?!?!?!?!? Stop him!”
“Wait, Dr., you have another patient.”
He turned and looked me in the eye before he begrudgingly went back into his office.
I asked the woman if I should follow him, but before she could answer, he retuned and said, “Do you want to be seen or not? Hurry up…it’s now or never.”
I had a strange unflinching courage from my 2 and a half hour stint in the waiting room and I replied, “Don’t talk to me like that. I’ve been waiting forever to get clearance to be seen because I didn’t have a referral.”
He launched into a huge diatribe, “I hate insurance! What does your general practitioner have anything to do with me treating a dog bite? Is he a bite specialist? It’s infuriating.”
I suddenly liked Dr. Asshole. We were on the same team now.
“I know,” I replied.
Then he saw the bite. “Oh, that’s bad. That can easily get infected.”
I gritted my teeth from quipping something that would ruin our new-found friendship. He ordered the nurse to give me a shot, clean the bite, and gave me a prescription for antibiotics, and then he disappeared. The whole meeting took less than a minute. That’s what I waited all night for? That’s what my insurance company wanted my general practitioner to okay before agreeing to pay for? That was the precious meeting the lady at the window was trying so desperately to protect?
My fury didn’t end there. As I was leaving they said I needed to schedule a check-up with Dr. Asshole. I refused. He was an asshole.
The woman said, “Well, you have to schedule an appointment with your new general practitioner so the insurance company will pay for this appointment.”
“I don’t need to see a doctor for anything.”
“You don’t need a physical?”
“No. I got one 5 months ago.”
“Well, just stop by and say hi so we can bill your insurance company for that appointment so they will accept payment for this appointment.”
“But I just saw him.”
“No, he isn’t in today, you saw Dr. Asshole, his partner.”
“Why didn’t you tell me to change my general practitioner to him and not Dr. Asshole?”
“He doesn’t accept your insurance.”
“But Dr. Asshole, who practices in the same office, does?”
“Yes.”
I was outraged at the waste, the senseless red tape piling up the bills. I begrudgingly agreed but called Blue Cross Blue Shield the next day (when they were open). They informed me that an additional appointment was unnecessary, and Dr. Guy-I-Never-Met could write a referral for Dr. Asshole. I almost screamed “IF I NEVER MET HIM, THEN WHAT QUALIFIES HIM TO WRITE A REFERRAL ON MY BEHALF?!?!?!?!?,” but instead I said, “Thank you, you have been very helpful.”
I then called and canceled the appointment.
Clearly the system is broken. One step in the right direction is that most people are willing to admit that now, although even now some still don’t. There are so many insurance companies and they create different rules and the doctor’s offices sometimes can’t even keep them straight. There are wasted appointments. There are forced trips to the ER when no other options are available. I saw all this first had from a minor dog bite. In this specific case, I don’t see why there’s not a law, or policy if that term scares you, that allows things like tetanus shots to be administered by any clinic or doctor’s office, and the patient’s insurance will pay a set fee regardless of where it was done. The same for throat cultures and other simple treatments. That seems like an easy way to cut some costs. Hell, maybe it is one of the 2000 plus pages of one of the current bills. Maybe I’m missing something, but the cries of death panels and abortions are too loud for me to hear the details about what is actually happening. Let’s start a meaningful discussion. Please share your stories, opinions, and comments.
Also, If you want incredible information on how we got were we are and how we can get out of it, listen to these two This American Life episodes. They are truly fascinating.
Thanks for reading.
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As the girlfriend who had to spend a half an hour at work looking up how to change his general practitioner, only to learn it did nothing can vouch for the frustration of this particular episode.
Wow, what an amazing story. My experience with an amergency visit to the dentist was the opposite (I called up, they said come in, I filed out paperwork, and it turned out to be less than I expected).
It makes me angry to think how much money is wasted with all this junk. Making you schedule a second appointment that you didn’t need? Come on. I have a friend who just started working for an accounting firm that has lots of government contracts. He says that so much time is wasted in the office that he’s now mad about paying taxes. The government pays for him to sit and watch other people not work, and somehow that’s ok.