Grumpy Granny on Health Care

Pulling Teeth, Or, Not Having Information About My Condition

2009-09-04T09:00:00.000-07:00

A disclaimer: my dentist is wonderful. By "pulling teeth" I'm referring to the fact that obtaining information has been as difficult as this dental procedure.

One of the things one reads about the Mayo Clinic is how eager they are to inform and educate their patients. In New York, at least at the facility I use which is also world famous, there is a very different culture.

Here's the chronology. It's not a pretty picture.
On July 23rd I am diagnosed with phlebitis in my right leg. The HSS screening pre-op doctor ordered a sonogram only of the leg whose knee was scheduled for replacement on July 29. Surgery canceled although it seemed that the surgeon would have happily waited a couple of weeks and gone ahead.
July 28: appointment with the "Vascular Guy" recommended by the screening doctor. He does not believe the diagnosis of deep vein thrombosis by the HSS radiologist and orders a new sonogram, this time of both legs.
August 4: sonogram confirms that I have superficial phlebitis -- in both legs. Edgardo, the technician, distinguishes himself by wiping the gel from his hands on my robe (which I'm wearing!) and recommending that I use this very robe which he has used as his towel to wipe off the gel from my own legs. After a minute or two of "euuhhh" reaction, I find some towels provided for this purpose and avail my self of them. Have not reported Edgardo. Now get this: the diagnosis was provided by the head technician, not the doctor. He recommends that I now wear compression stockings on both legs. He is also very vague about whether or not I will hear anything from "Vascular Guy."
As far as I know, no further communication of the diagnosis -- or anything else -- has been made to my PCP (a.k.a "Doctor")-- to this day.
Week beginning Monday, August 10, Doctor informs me that he/she can't give me any idea of treatment, future monitoring or anything else because the "Vascular Guy" has gone on a two-week vacation. Since when don't primary care physicians know about the care and treatment of this fairly common condition?
On August 24 Doctor goes on vacation so I am still wondering, one month later, what the follow up will be. I try twice to call the "Vascular Guy" but the temp replacing the practice secretary does not forward the messages. During the second call she allows as how I should call when the secretary returns on August 31.
August 31: Doctor returns from vacation. still haven't heard heard whether Doctor has spoken with "Vascular Guy" re: my continued care -- by September 3
September 2 "Vascular Guy's" PA returns my call and provides some information about how to wear the stockings and that because the clots are close to the knee, that I should wear the thigh high style (as it were).
Naturally I have done web research on phlebitis but I am still in complete ignorance of "Vascular Guy's" follow up plan -- if any.

The Bureacracy Involved in Getting Presciption Support Stockings

2009-09-03T20:35:00.000-07:00

Anyone who claims that there is no byzantine medical care bureaucracy already ruling every aspect of our health care has probably never had ongoing medical issues beyond routine exams.

In answer to those who say a public option will limit choices, let me point out that I cannot acquire compression stockings for my phlebitis at the facility recommended by my physician's office. Instead I must purchase them from an agency in Aetna's network if I would like to be reimbursed for this covered expense. So, already, I am forced to use a particular vendor who may or may not meet the standards preferred by my physician. Neither I nor my physician has much of a choice in this matter.

When I called Aetna I was advised that although 90% of the cost is supposed to be covered, both my physician and I should read Aetna's 10-page policy bulletin on the subject and be ruled by it. In other words, Aetna, an insurance company, not a medical provider, (just in case you weren't paying attention) will ultimately decide what sort and how many stockings I may have. When I can finally reach a live person at the approved vendor, (whom I have called three times since yesterday to no avail, by the way,) besides the fax # for the prescription, I must learn what information, such as diagnosis code and produce code the vascular surgeon's office must provide. And, anything else.

Anyone who may be worrying about the potention future threat of a government bureaucracy ruling health care is way behind the times. This structure already exists and is thriving. It reminds one of Gogol's tsarist Russian bureaucrats. Some days I think that even the Postal Service would be better. That is, until I have the opportunity to visit the Cathedral branch... What about the IRS? Just kidding.

David Plotz of Slate Is Right -- It Should Be Called Insurance REFORM

2009-08-19T20:23:00.000-07:00

He's right -- that's the key. It's not health care reform so much as regulating insurance. So,folks, let's call it "Insurance Reform". Now that the the pharmacological industry is pretending to play along with Obama, having made a sweetheart deal at the voter's expense, let's work on really getting this right. Then, perhaps we can fix the pharmacological issues.

If only the Senators weren't in the sway of all these corporate interests....

Doctors Making Money

2009-08-18T07:48:00.000-07:00

Unfortunately, I've alienated my new primary care physician. After looking around for a couple of years and trying out some other pcps, I settled on a highly-recommended physician. Doctor(I don't want to use a name or pronoun so I will use "D" instead) has great credentials and we made a family decision that I would use an out-of-network pcp. D is smart and interested in the total care of the patient.

However, I seem inadvertently to have come across a major Achilles heel. When I began my warfarin/coumadin therapy a few weeks ago D exhorted me to come in for a blood test a.s.a.p. I explained that my insurance company would only reimburse me if I went to a contracted lab. D insisted I use the practice's lab and told me that the charge was only $30 for the test. D said that it would be so much faster and efficient for D -- and me, too. So, I traipsed across town to the office and was shocked to discover that the INR test was actually $62, $30 for the blood test plus $32 for the venipuncture (sticking the needle in to retrieve the blood). Naturally, for the second INR test that week I went to Quest, the lab with a contract with Aetna. Which turned out to be a lovely surprise, actually, as Quest has adopted an appointment system and I had to wait exactly 5 whole minutes, even without an appointment. But, that's beside my point.

My point is that for about 10 minutes of my first office visit since the phlebitis diagnosis (which turns out to be superficial but in both legs) and the cancellation of knee replacement surgery, D quite adamantly berated me about not using the practice's dedicated lab. D said D couldn't practice good medicine (I kid you not) under these circumstances. I was close to tears, feeling rather overwhelmed with my then still-undiagnosed but potentially serious deep vein thrombosis.(Neither D nor I had yet received the official sonogram results of the day before!) D claimed that D's practice of medicine was compromised without immediate INR readings. Waiting 24 to 48 hours just was not acceptable. D told me D wished the practice could afford (note the irony here) the machine that instantly finds the INR levels with a pin prick because -- get this -- there weren't enough patients on warfarin/coumadin to make it affordable it for D!

This is a good example of at least three problems with our present system and doctors trying to make money. Should doctors be allowed run their own profit-making labs and radiology centers force their patients to use them? What about the unnecessary and inefficient duplication of services in an urban setting? Are patients likely to get the best service in a small radiology unit at a private practice or in a larger facility with more traffic and thus (one hopes), more experience?

My share of the Quest test is $.61, by the way.

Now Obama is Scrapping "The Public Option"?

2009-08-17T12:20:00.000-07:00

I've just written my senators, congressman and the White House protesting the apparent scrapping of the so-called "public option" for health care. This morning Jerry Nadler was on NPR and for once someone was explaining what is really going on. It was refreshing to hear it said out loud because it's something a lot of the electorate already understands.

Obama, Clintonesque middle-grounder that he often is, seems to be willing to sell out to the financial power excercised by the insurance, pharmaceutical and other health industries over our Senate. Obama is whimping out again. And, he'll lose a lot of support.

This is very depressing.

Who's Kidding Whom: We NOW Have Limited Access to Medical Care

2009-08-13T14:03:00.000-07:00

Admittedly, the New York medical care market is different from other areas, or so I'm told. More and more doctors are refusing any insurance. It seems as though only newly minted, old hands or not-so-highly-rated doctors are the only ones accepting insurance in this market. When the pro-insurance scare mongers claim we will have limited access and choice if any of the present reform plans are passed, what planet are they living on? Don't they know what's going on.

Since about late April my right wrist has been aching -- and it's getting worse. I followed the recommended wait-and-see approach. But, it's now time to see what's going on. However, it turns out I can't go to either of the two doctors recommended by my primary care physician because neither one takes Aetna, my primary insurance. The web site for one doctor said he did take my plan bit when I called his office his receptionist said he no longer did. And, that's her insurance!

Today I tried to find a hand surgeon who would take Aetna. So, I had to look through Aetna's poorly-designed "DocFinder" and then call around until I found one who did AND was affiliated with the same hospital as my other doctors. (Call me silly, but isn't it nice when the doctors can consult with each other?) Only two of the hand surgeons at the Hospital for Special Surgery accept Aetna. Who can blame them, actually. And, the one I finally made the appointment with doesn't accept my secondary insurance. Luckily (haha) I've already met the out-of-pocket deductible for that plan so I'm okay.

I have an appointment in 11 days. That a waiting period, folks. I'm not complaining about that -- I'm hoping my wrist stops hurting by then and I can cancel the appointment. But, we DO have to wait in this country and most of us cannot go to any doctor we want to.

Being Billed For A "Free" Benefit

2009-08-11T11:20:00.001-07:00

Have you ever been billed for what is supposed to be covered? I received a bill from the hospital where I get my annual mammogram for $8.61. Not too terrible, right? I can afford that, I thought. However, I realized that my insurance plan (Oxford at that time) offered this for free. I think it's a state law, actually but never mind. I called the Women's Imaging Center and verified that they took Oxford. I called Oxford to verify that the service is free. All this takes time which I am lucky to be able to carve out of my work day.

I've faced this sort of issue before and despite numerous calls to all parties concerned continue not only to be billed but then to have the bill sent to a collection agency. Because this affects my credit, I am not too happy with the providers' and insurers' errors/oversights/carelessness.

I wrote a letter and enclosed photocopies of 1. the bill 2. Oxford's summary of benefits 3. my Oxford card. The letter included a cc to the state attorney general health bureau but I won't actually send that copy unless I need to.

In the 80's I was able to get around $1,000 that Blue Cross / Blue Shield of NJ had cheated my family out of. If everyone is shorted $10 here, $50 there, can you imagine what the profits are?

My So-Called "Health Insurance"

2009-08-11T11:07:00.000-07:00

The insurance plan at work is one of those you read about. You know -- the kind that provides totally inadequate coverage unless you are never ill and don't need surgery.

The new plan for for one person has a $2,000 in-network deductible, plus a $5,000 out-of-network deductible. I pay 20% of all in-network medical costs (and, I mean ALL) until I've spent $3,000 in out-of-pocket expenses. $500 is deducted annually for this very poor coverage from my paycheck.

Did I mention that I work for a wealthy not-for-profit organization and this was the best they could do? It seems the insurance companies demanded about a 24% increase from small and/or not-for-profit enterprises -- those with under 100 employees. With fewer benefits, to add insult to injury. My employer didn't have a choice, running on an endowment which has been affected by the market downturn.

I am lucky to be covered by two insurance programs, one through my employer and one through my spouse. If I didn't have secondary insurance, I could easily expect to spend $7,500 on medical expenses this year. That is considerably more than 10% of my gross income. Why not $8,000 -- you probably did the math, right? My employer realized that this enormously increased burden would be very hard on most of the workers and established a $500 per person health insurance account.

My daughter, who works in HR, told me that in her company our kind of plan would be the third (read: worst) tier coverage, meant for young and very healthy people.

But, as I mentioned, I am extremely lucky because my spouse was a civil service employee and still has excellent health benefits. As it is I'm finding the increased cost a challenge but know how fortunate I am.

We need to organize a real, powerful march on Washington with demonstrations all over the country. I’m willing to help.

Why is Anyone Afraid of Government Involvement in Health Care When We're Already In the Hands of the Insurance Companies' Nightmare Bureaucracy?

2009-08-06T08:18:00.000-07:00

On August 5, 2009 I had another experience with the insanity and sheer depravity of the greed and profit driven insurance industry. That morning I'd called my pharmacy to refill a Warfarin (a.k.a. Coumadin) prescription because on, August 6, I planned to leave town, not to return until late Sunday night, August 9. Since the pharmacy is closed on Sunday, I needed to refill it then.

Warfarin was prescribed for DVT (deep vein thrombosis) and superficial phlebitis.

Aetna denied the refill, claiming that according to their records I had enough Warfarin until August 15 and, furthermore, would not be permitted to refill my prescription until August 7 (when I would be out of town and without a prescription in hand from my doctor!). I called Aetna to explain the circumstances and was directed to their "Pharmacy Care Division”. A clerk explained I wasn’t even eligible for a “vacation exemption”. The person denying the refill assured me she was “only following the rules”. When asked, she admitted she isn't a medical professional.
Here are the details:
Prescription dispensed 7/23/09:
Label on prescription states: TAKE FIVE TABLETS ONCE A DAY OR AS DIRECTED
The protocol is that patients have blood drawn periodically and the doctor adjusts the Warfarin dose according to the INR levels in the blood.
Dosages directed by doctors: 5 mg for the first six days; on July 29, the doctor increased the dosage to 6 mgs/day.
Counting the Pills in the 100 pill bottle
Beginning July 23 I took 5 mgs for 6 days and 6mgs for 11 days for a total of 96 1 mg pills. On Sunday, August 9, Therefore, I would have had only 4 mgs left. (Note, it is dangerous to change Warfarin levels abruptly.)

Even if my dosage had remained at 5 mg/day, there would have been only enough Warfarin to last through August 11 although Aetna’s clerks claimed I had enough for 5 mgs/day through August 15!

I explained that Warfarin is
1. not a street drug
2. not something that is pleasant or wonderful to take and entails many limitations
3. the protocol is that the attending medical person adjusts dosages according to INR levels obtained through blood work – a fact noted on the prescription label
4. Warfarin levels have to be carefully managed
5. It can be a matter of life or death because clots can kill or cause great damage

Finally, after 20 minutes of arguing and waiting on the phone, the refill was permitted.

What are we going to do about giving these unqualified clerks such power to rule our medical care? Sure, they’re only following order....when did we hear THAT excuse in history?