Thursday, October 28, 2010

Insurance Will Cover It (Part II)

 I'm going to assume a certain knowledge of the facts for this post.

The bills have stopped pouring in.  I've been filling in the credit card information in the little boxes printed on the back of the invoices and using the return envelopes with the little glassine windows and some of the Heifer International return address labels and my self-stick Forever Stamps.... all feeling vaguely 20th Century in this era of on-line banking.  I can't remember the last time I wrote a check for anything.  

While the bills have stopped flooding the mailbox, the phone has been busily ringing.  Amidst the political robo-calls and surveys with obvious built-in biases today I received a call on behalf of the Billing Department of The Hospital.  Okay.... this bill has been in my house for 6 days.  Two of those days were Saturday and Sunday and for 3 of those days I was out of town.  They couldn't really think that the payment was overdue, could they?  And what did on behalf of mean, anyway?  Had they sent the bill to collections already?  

"Before we go any further, let me ask you something, Sir.  Are you in The Hospital's Billing Department?"  Yes, he was and he was only wondering if there might be a supplemental insurance policy which we had forgotten to provide during our visit to the ER and how was I planning to pay the remainder? 

Once I climbed off the ceiling, I was able to listen and hear him say that he was in no way trying to collect the bill at that moment (thought he'd take my credit card if I wanted to be done with it right then - which I did) but was only trying to help.  If I'd overlooked an insurance policy that might help me with the bill, he'd be glad to file the paperwork.  I took a deep breath - he was a very nice kid and it was obviously the script from which he was forced to read that was making me nutty - and I remembered the demographics in the ER that night.  We were the youngest people by a decade or so.  I was frantic and distracted; I can only imagine what I'll be like when I'm 80 and dealing with children pretending to be doctors and nurses who breeze in and breeze out without identifying themselves or asking permission to stick tubes and needles in the writhing patient.  I forgave the young man, said that there were no other insurances we could dun, and then was surprised to hear him ask me to detail my complaints about the care we'd received.  He typed, I talked.

Attitude, information systems glitches - these could be laid at the door of The Hospital and lay them there I did.  But as our conversation went on I had an epiphany.  We really hadn't needed the ER at all.  The primary care physician needed to see an x-ray and then, perhaps a CAT scan.  The fact that the urologist had done both two days before meant nothing.  Those results were in another office, owned by another practice and it was after 3pm and anyway they wanted their own and on and on. 

Had I thought to ask why we were being sent to the ER (I thought he was so sick that he needed immediate hospital based care because his symptoms were worsening and it might not be pneumonia) I hope I that I also would have had the presence of mind to make further inquiries regarding the use of the existing x-rays.  If the urologist was able to diagnose pneumonia when his area of expertise is somewhat lower in the human anatomy, then why wouldn't any competent radiologist be able to do the same?  If the pictures were available on-line (and why weren't they or couldn't they be made available that way since the urologist read them on his computer?) why couldn't a radiologist and the doctor in whose office we were sitting confer and diagnose and prescribe and send us home directly?  We used resources and spent time and money unnecessarily.  

If there's a better argument for streamlining the sharing of information I'd like to hear it.  For now, I'm sticking with this experience.

Given that there's a bias toward tried and true in our doctor's office (one of the many reasons we're leaving his practice) it's not surprising that this smooth flow of data does not exist.  The fact that he was willing to expose the patient to invasive rays rather than making an effort to obtain the test results directly makes us just a little nutty, now that we can look at it in retrospect. But still.... sending us to the Emergency Room? We were in his office, which exists in a kind of surreal zone of medical practitioners and the laboratories which support them; 3 miles of professional condominium suites and hospital units and lots and lots of x-ray and scanning machines spread in equal distances north and south of his suite.  Why didn't we go to one of those out-patient places?

I am glad that the patient was treated with IV antibiotics that night, but I wonder if he recovered $11,000 faster than he would have had the tests been read and the medicine prescribed that afternoon?  My hunch is - probably not.

So where does the responsibility for this debacle lie?  I'm referring to the enormous waste of time and energy utilized to diagnose a problem which didn't require the facilities of a hospital based emergency room.  Should I have questioned the suggestion that he go to the ER?  I don't think that I would want to be remembered as the woman who interfered with proper medical care.  On the other hand, would it have been inappropriate to wonder aloud about the reasoning behind the decision? 

Should there be a triage station outside the ER?  Broken bones and stopped hearts would go to the front of the line, but perhaps there ought to be a not-really-that-sick bay for those who are mistakenly sent to their doors.  What is the hospital's responsibility in this situation?  Do they need to do more outreach to the physicians in town, reminding them that other resources exist?  Or would that interfere with the hospital's bottom line? 

I realize that I am woefully ignorant about many things which attach themselves to this incident.  Are Emergency Rooms centers of profit or loss for a hospital?  Are the physicians employees or private contractors?  How did I let things spiral so far out of control?  One thing I know for certain - there has to be a greater level of trust than currently exists between the physician and this particular patient.  So much of what went on was frightening and fast and we were floundering because we didn't know what was going on, nor why.  I think that it's time to make the switch to G'ma's gerontologist - that 30-something Birkenstock wearing Blackberry toting 21st century caregiver.  That is one piece of this puzzle over which I have some control.
More will follow in this series - including a further dissection of the bill itself.

No comments:

Post a Comment

Talk back to me! Word Verification is gone!