There is a cancer spreading across the practice of medicine in the United States.
It is an insidious disease, and it is spreading at a rapid rate.
The disease is called insurance, and it is destroying health care and the practice of medicine in our country. We need to rise as a country and declare a national emergency, for Americans certainly deserve better than we are getting now.
Let me explain my outrage.
Over the course of the past four months, I have been battling a skin condition that often leads to hives. I have visited numerous doctors and have been shuttled from one doctor to another—all according to the rules of insurance, not by the science of medicine nor by the doctors and their staffs who practice it.
It started one morning last fall when I woke up and found myself covered in hives from the waist up. I called my doctor, but he wasn’t in that day. I went to the emergency room in Luling (my company insurance is not accepted by Gonzales Hospital. It was accepted there a year ago, but our company changed insurance from a PPO to an HMO and that coverage is not accepted at Gonzales. Unfortunately, that means the employees of the Inquirer are shut out from using our local hospital here in Gonzales. It is not the hospital’s fault—it is mandated by the insurance companies) and had to sit in the waiting room for an hour while they processed the insurance approval.
I was seen by two different doctors, given a shot, then shown the door. I immediately went to my doctor’s office to set up an appointment to try and figure out what was causing the hives, and again had to sit for almost 45 minutes while they processed the insurance information. Then they set the appointment.
A week later I went to see the doctor, and after discussing allergies and what not, he decided I needed to go see a dermatologist. I agreed and asked him for a recommendation. He gave me a couple of names and I left his office. When I got to the newspaper, I called both offices and was told the same thing: you need to have your doctor refer an insurance approved dermatologist before we can see you. I balked at this revelation but I was basically told to bend over and kiss my own keister.
So it was back to my doctor’s office via a phone call to get a referral from my primary health care provider. When I called the office, I was told they would work with the insurance company to get me a referral. It took over a week before the referral was agreed upon by the insurance company, and I was then told I could set up an appointment. I called the dermatologist I was referred to under my insurance plan and was informed that it would be three weeks at the earliest before they could see me. I told them what I was going through, but they just shrugged and said, “blame it on the insurance company!”
Blame it on the insurance company? Well heck yes, but the tail is wagging the dog here. This isn’t the practice of medicine—it is about the insurance companies’ total control of how our health system operates. It is out of control and it is out of our hands, and the hands of the medical providers. They want to get paid and deserve to be paid. Yet the decisions on health care and the practice of medicine doesn’t even enter the equation until an insurance company signs off on it first.
Back to my tale of woe. So three weeks go by, and the hives come back. I finally got in to see the dermatologist. She listened to my story for 60 seconds, wrote me two prescriptions, and then told me to change my shampoo, laundry detergent, soap etc. “Come back and see me in two weeks,” I was told.
For a few days there was welcome relief. Then the hives came back. I went back to see the dermatologist and told her what had happened and what I was going through. “Well, there is nothing more I can do for you,” she said. “You’ll have to go to an allergist to find out what is bothering you.”
I thought about it and inquired if she had a recommendation for a good allergist. “I can’t answer that,” she cooed. “You’ll have to go back to your primary health provider and have him recommend one. We can’t do that here under insurance rules.”
Really? Back to my primary care doctor again? That was my only option under the rules of insurance.
So it’s back to my original doc—two weeks later. Now the calendar is getting into mid-November, and the end of the year is rapidly approaching. I tell my doc we need to get the appointment with the allergist as quickly as possible for two reasons: first to find out what is causing my skin ailment and how to resolve it and two, I had already met my deductible for 2019 and didn’t want to start all over in 2020.
So, after 10 days go by, I get a call from his office referring me to an allergist and was given a phone number to call. I called the allergist’s office to set up an appointment, but they couldn’t do it because they had not seen the insurance letter approving the referral from my primary care doctor.
At this point, I am frustrated, furious and suffering. Another week goes by and they finally get the letter. The office calls me and sets up an appointment at one of their satellite offices in early December. Then five days later I get another call from the allergist’s office that says because they were sending me to a satellite office, my primary doctor had to get a referral for the doctor in the satellite office before they could see me.
Are you fricking kidding me? So it’s back to my primary doc, and he sends another referral letter from the insurance company. I call the new doctor’s office and I am told he can’t see me until January because he was off the last two weeks of the year.
At this point, I thought I was at rock bottom. No relief, no meds, and no cure. What an abomination.
Finally, I go see the allergist after the first of the year. I show up at the office and I’m hoping this will be the day when they figure out what I am allergic to. The office receptionist took my paperwork when I arrived, looked it over, and then said with a smile: “That will be $1,405 please.”
“What? Are you kidding me? Why do I have to pay that much today? You are going to bill me, right?” is all I could gasp.
“No, you have to pay that for the test,” she replied. “Your insurance company says you have not met the deductible for 2020 yet.”
I was outraged, and you should be too. This is how the practice of medicine is being run in this country—and it’s not being run by health care physicians. It’s being run by big insurance companies who are making hundreds of millions of dollars at the expense of our health—and wallets. It is outrageous that we as Americans have to go through this ridiculousness every time we need help from a health care provider. It’s even more insane that we as a country accept this and do not rise up and protest.
This isn’t about Obama Care, socialized medicine or anything like that. It is about the quality of health care we receive and the timeliness in which we receive it.
I don’t deserve this, nor do any of you who are reading this. But it’s got to change, and soon.
I would like to know what you think on this subject. Drop me a note or email me at email@example.com. Let’s start the discussion and how we can bring attention to this crisis and how we begin the process to effect change.
In the meantime, I’ll be scratching away.