28 Minutes, 16 Seconds and Still Holding: Tales of a Family Doc
In my last post I admitted that I had thrown in the towel. Rather than go to bat again for my patient whose medication had been denied by his new insurance company, I gave in and prescribed an alternative that might not work as well.
Well, today the guilt got me going so I re-read the two page denial letter. Again I found the words explaining the reasons for the denial, two of which amounted to advocating for unscientific medicine, even malpractice. And I found the additional sentence, buried about two thirds of the way down page two, which said that I could call the "800" number on the page to talk with the doctor who had reviewed the case and denied my prescription request.
There was no "800" number, but there was an "877". Same thing, I figured, so I called. Five minutes into the first hold, after the usual series of "if you are a virgo, push 1, an aquarius, push 2" I reached a human who asked me a series of questions about who I was, about my patient, his mother (really!), and then transferred me to another hold. Again a series of questions about my identity, a question (finally!) about the nature of my call, and (dashing my hopes), transfer again to another series of questions.
28 minutes, 16 seconds after dialing, the final question: Could I please leave my phone number and the best time for me to receive a call back from the culprit who denied my patient the medication which had controlled his symptoms for three years. It's now eight hours later, no call.
Little horror sotries like this are a daily occurance in primary care medicine. They waste my time, irritate my patients, and waste health care dollars. They are the product of our fragmented private health care system where health insurance companies spend fortunes designing "products" and marketing them to healthy patients while operating systems designed to deny care to those who become ill.
The wonderfully insightful Dr. Don McCanne commented yesterday as exerpted below on one of the health insurance industries latest products, a policy which doesn't actually provide any insurance but offers you the ability to buy one later at a price to be named later:
One of the many reasons that there is a push for comprehensive reform is that, in most states, individuals who have medical problems are denied the opportunity to purchase insurance on their own. This is one of the more serious flaws in insurance markets since this defeats the primary purpose of insurance - providing individuals with health care needs affordable access to health care.
Those crafting reform would address this problem by including guaranteed issue in their reform proposals. Insurers would be required to offer coverage to those with health care needs, but this would work only if it were coupled with an individual mandate for everyone to purchase coverage, otherwise premiums would skyrocket because of a concentration of high-cost individuals in the insurance risk pools.
There are still those who would prefer to see private sector solutions in the insurance marketplace. In this new product, UnitedHealth Continuity, the private insurance industry is demonstrating the thinking behind market solutions to our health insurance problems. A public sector approach would automatically include everyone forever, making health care a right. In a plan that only the innovative private marketplace sector could devise, the UnitedHealth Group, without providing any insurance benefit whatsoever, has created a way of selling us the the right to health care at some time in the future, but a right that you can purchase only if you are healthy and don't need care.
Besides the most obvious flaw of selling a right that everyone should have, there is another policy flaw in this proposal. Those who purchase this right and remain healthy would have a full range of insurance options and might well choose other options that may be more appropriate. Those who develop medical problems in the interim would have no choice but to enroll in this plan, only to find that premiums would be unaffordable because of the concentration of other high-cost individuals in the program.
Even with guaranteed issue, an individual mandate, and a regulated marketplace, the private insurance industry will continue to innovate to enhance the business success of their industry. With chants of "health care is a right" in the background, the insurance industry has provided us with yet another innovation in which they can sell to us our right without providing any service or product, merely the option to purchase coverage in the future.
Where have we seen derivatives pushed before? Is there any sense in keeping this industry in charge of our health care financing? Let's get a single payer national health program, where we can play by our rules, not theirs.
http://www.pnhp.org for the latest on single payer reform and to tell Obama what we need
http://change.gov/agenda/health_care_agenda/ <http://change.gov/agenda/health_care_agenda/>
Well, I've said it before, might as well say it again - all of this is just welfare for the insurance carriers unless we go single-payer.
Seriously - where is "Corporate America" on this? Where have they been? Are they really so consumed by "conservative" ideology that they can't see that national health is far and away their best hope towards regaining some measure of international competitiveness?
December 5, 2008 2:34 AM | Reply | Permalink
Corporate America, at least big corporate america is sitting on the sidelines waiting to see what may happen. With the Clinton health reforms they were willing to go along as they could see the economic benefits of providing national health insurance to all. They would probably also go along with Single Payer. The biggest problem is with the "small business" community, those largish businesses which do not provide much by way of health benefits to their employees. For an excellent, but somewhat depressing, historical-political analysis see Jacob Hacker's, The Divided Welfare State.
December 5, 2008 12:02 PM | Reply | Permalink
Yeah, I read about that nonsense! Probably will be sold by insurance agents, picking up their little piece of the pie! They'll have a spiel which will convince some poor suckers, who may go on paying for the thing long after we have a single payer system!
December 5, 2008 2:47 AM | Reply | Permalink
Single payer works. It's slower, and there are waiting lists -- but that's because more people in need get to use the system.
My aging mother has survived breast cancer, a heart attack, and Alzheimer's. Several hospital stays, and lots of followup medication.
But we live live in Canada, so her children haven't had to declare bankruptcy.
The objections the insurance industry raises to universal health care are self-serving BS.
Don't fall for it.
Same goes for the pharmaceutical giants.
Nationalize their greedy asses.
December 5, 2008 2:59 AM | Reply | Permalink
Our system is way slower, for the 47 million without insurance, especially.
December 5, 2008 12:03 PM | Reply | Permalink
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Dr Aaron . . .
This week I've been catching up on all your posts since your first one back in late November. Quite a read if a must say so.
I can readily see that you seem to be in support of a single-payer system.
Are you hip to this trip?
It's the John Conyers bill H.R.676.
United States National Health Insurance Act
I was wondering if you've read the actual bill? You can find all the links at that site.
I personally think it's long overdue. Like since Truman's time. But what do I know, I'm just a wooden duck.
I will check back and see if you've replied.
I truly appreciate your time and effort to bring to light here at the Café the daily struggles of both you as a provider and those who you care for deeply.
Oh ... And thanks for that information you provided about the 18th and Potero Urban Agricultural Project at your link over here. I left a reply there.
~OGD~
December 5, 2008 3:07 AM | Reply | Permalink
Lost time on the consumer end as well. I injured my spine last winter when I landed a drop/waterfall badly in my kayak while boating in Mexico. I spent over 5 hours trying to ascertain whether my insurance provider was going to cover the prescribed MRI. The vast majority of that time was spent in telephone hold purgatory. The 5 phone calls produced 2 opinions that the MRI would not be covered, and 2 that indicated it would as well as one that didn't know and would get back to me. Total elapsed time till I knew the answer, (I was covered)), was about a week and a half. Factoring lost productivity on the consumer end as well as that of insurance and healthcare providers should convince anyone the cost of our current system is unacceptable.
Regarding UHCs insurance scam: Reminds me of a street hustlers shell game. One hand offers the probability of finding the prize, while the other has all ready removed it from the table.
December 5, 2008 4:37 AM | Reply | Permalink
Your experience is why I chose a catastrophic policy at the point when my husband stopped working (turned out he had a hole in his heart, but what did we know?) 9 years ago. I figured it would be better to have a cheaper policy that made us pay a whole lot up front if we needed hospital care or surgery than wait around or fight rounds and be restricted by having to ask. Thus, when I twisted my ankle in the Canadian rockies (in a car wash... amusing story!) we went to a tiny hospital about 20 miles away and there in a tiny ER I got lovely care by paying up front with my credit card. It was a little over $500, maybe as much as $650 including the x-rays and time with the doc! And it didn't involve any wait time!
Single Payer. Single Payer. Single Payer.
Glad your healing is coming along. I know you mentioned the wrist brace you're wearing after they took off the cast. But the spine..... good luck with that!
This is all deliberately designed to make doctors and patients give up! They know exactly who Doctor Aaron is and who is patient is. And they're giving him the run-around for that reason!
December 5, 2008 10:34 AM | Reply | Permalink
Delays/denials of claims are most assuredly designed to discourage us from pursuing them thereby improving the bottom line on the insurers quarterly statement at the expense of public and personal health. I'm about to go to a catastrophic coverage plan myself, due to a loss of coverage from a job change. Due to a pre-existing condition my monthly premium is about to go up to $1755/month from $256/month. Ouch! My insurance company can't wait to drop me from its list of subscribers. Let's say it again in unison: SINGLE PAYER!
p.s. My spine is actually OK.
December 5, 2008 11:27 AM | Reply | Permalink
Glad the spine is ok. But that is a huge jump! That is what is unconscionable about our system! And that is catastrophic! (yes, the premium alone is catatrophic!)
Chanting: SINGLE PAYER! Somebody, please write up the tune. Do a video! Where are the creative folks who did all those Obama videos???
December 5, 2008 12:20 PM | Reply | Permalink
I'm right there with you! Single payer is the only way to go. It is the only way to share the risk and therefore have affordable (even cheaper premiums) with no one there to siphon off money for doing absolutely nothing.
For those who think it is too abrupt, why not decrease the age of Medicare qualification year-by-year until everyone can get into it? The issue of mandates could be solved the same way the enrollment aspect of the medication part was solved: "Join now, or pay huge bucks when you do"
Those who can't afford it would get the same help from the gov't that they do now.
Now, why wouldn't this go through right away? Hmmmmmm....I guess it's because Congress already has a single payer system for itself that you and I pay for. It is gold-plated and never ends. If they did truly single-payer for the whole country they would have to be a part of it.
There is our answer boys and girls, and if the Dems don't force this question in the next 4 years it is over.
December 5, 2008 2:57 PM | Reply | Permalink
Congress doesn't actually have a single payer for themelf. What they have is actually a supremely wasteful system in which the government spends money to offer them a variety of choices of private health plans. They do have the best of private health care and it's fully paid by their employer, us. But they are still enveloped in a system in which 35% of the premiums paid is wasted on corporate bureaucracy and profits.
Like us, they would benfit from an improved Medicare For All.
December 5, 2008 5:00 PM | Reply | Permalink
Let's look at the 35%.
How do we extract that? There are businesses and jobs depending on it, on the cash flow etc. I'm in favor of trimming the fat, but I'm not at all clear on how to do it. In a way it's a cancer on the health care system, but in another way each cancer cell is a job/person ultimately. What is the political surgery which is needed here? Where do we start the incision, and does it warrant some kind of palliative (or distractive) anesthetic?
After surgery, does the patient get reduced costs at about 35% or so, or do costs remain about constant so that about 35% more people can get decent health care for the same total cost? Or what? Obviously I'm being loose with 35, but you get the idea.
December 5, 2008 9:40 PM | Reply | Permalink
by the way. 24 hours later. Still holding.
December 5, 2008 5:09 PM | Reply | Permalink