Healthy Arrogance?

Those of you who have read my stuff for any length of time know of my ongoing frustration with the medical industry. I need to blow off some more steam about it. This is not a political post, though. While it is my belief that if the government gets involved in health care any more than it already is, they’ll screw it up even more, I’m not going to get into that here. The present state of affairs in provider-patient relationships at issue here, not how it got to where it is.

Why do we accept being pushed around by the health care industry? Others providing services to us could never get away with the arrogance and lack of basic business courtesy. (Well, except for home repair and remodeling contractors. They don’t seem to give a damn, either.) I believe that our system promotes this type of behavior. For most Americans, health insurance comes from the employer, who pays most of the premium. Doctors and hospitals bill the insurance company, not us as individuals. Thus, in many cases, health care providers view the insurance companies and the government (in the case of Medicare patients) as the customer, and patients as transport devices for the all-important insurance or Medicare card (check out Medicare Benefits). This is not true of all practices, but it is certainly an easy rut to slip into for many of them.

With that buildup, you have to be thinking that I have been annoyed beyond the breaking point by some egregious sin committed by a doctor or treatment facility. Well, two things got on my nerves this week. Taken individually, or perhaps even together, they seem like the type of minor annoyances that most of us routinely accommodate — just because that’s the way it is. Again, I ask, why do we tolerate it?

I have a couple of diagnostic tests set up over the course of the next week or so. Each was at a different facility, and both were scheduled by my physician’s office with my involvement and concurrence.

I scheduled the first one, an EMG, for October 12, a week from today. This was scheduled back on September 23. At that time, they put me on the cancellation list for today, and made a firm appointment for October 12. I normally don’t do that “cancellation list” stuff, because it is more a convenience for the doctor and the facility than it is for me. If someone cancels, they will have a backup just so they don’t lose any revenue for that time slot. I recognize that idle equipment and staff mean money down the drain, but that’s not my problem. Essentially, I have to block that day and not schedule anything else, while they have the option of plugging me in (literally, in this case) if their need arises. Of course, if nothing “opens up”, they have no interest in calling me to let me know that I can release the time. If they do call me to slot me in, it is usually at the last minute, after I had already given up on them.

Moving right along, today was the “cancellation list” day, and I had heard squat from them until about 11:30 today, when they finally called. My voice mail answered the call on my pain-in-the-ass line, the number that I give out to people I don’t want to call me. (My doctor’s office has my cell phone number, but they are forbidden to hand it out without my permission.) The call had nothing to do with today — it couldn’t have, because I would have had to show up at 8:00 AM. Instead, it politely informed me that the neurologist wouldn’t be there next Monday, so I would have to reschedule. This is the same old arrogant medical industry crap that caused me to fire my periodontist a few years ago. (Read my rant about him.) If you want to learn my opinions on periodontists and how I select the one which is best for me click here to investigate. My options were to reschedule a week later to the 19th, when the big doc would be there, or set it up with another neurologist. I felt that if my internist asked for a specific neurologist, which he did, I should insist upon him being the one who does the job. However, scheduling an “emergency” extra day at homecoming weekend at Wake Forest or whatever the hell it is that is so important that he cannot keep his commitments to his patients is enough to make me want to dump this guy already. Some first impression!

Nevertheless, I returned the call to “Debbie”, and after being subjected to a lengthy outgoing announcement and an interminable series of menu options, I arrived at her voice mailbox. I left a message stating that I would reschedule for the 19th, but I also wanted to know what caused me to be rescheduled. Of course, Debbie works for the diagnostic facility and she has no control over doctors, which I recognized in my harangue. I just wanted to let her know that this type of unilateralism is what drives patients nuts. Perhaps she will mention it to the big doc, but probably not, because she’s a lowly scheduler and probably wouldn’t get the time of day from him. However, Debbie either isn’t very efficient or she, like the rest of them, doesn’t really care about being efficient. My call to her at 1:00 PM has not yet been returned at 3:30 PM.

The other diagnostic, a thyroid scan is still scheduled for Thursday this week, as far as I know. However, I’ve already received two “courtesy calls” from the diagnostic facility leaving messages on my pain-in-the-ass line just saying I should call them back and reference a certain number. I know exactly what these “courtesy calls” are all about and I don’t intend to return them. I’ve dealt with this facility, run by one of the two large hospital systems in this area, for a long time. Several years ago, before another test, I actually did answer one of these “courtesy calls.” Some courtesy. It was actually a request to pay in advance for a procedure that was to take place several days hence. Well, friend, it is bad enough that I have to pay for these tests on the way in, but now you want money well in advance? No chance that will happen. When I spoke with the hapless individual on the other end of the line that time, after being told what was the purpose of the call, I asked just what the hell about an advance collection call could be considered a “courtesy.” The response was that “some people enjoy the courtesy of not having to deal with payment on the day of the procedure.” I would be one of them, alright, but I would prefer to get a bill afterward, after I know that it didn’t get screwed up.

Things do get screwed up in this careless and arrogant medical industry from time to time. Recently, I had blood drawn at my doctor’s office. I came back for my follow-up appointment a week later, whereupon no one could find my test results. After much frantic searching and phone calls to the lab, they concluded that the lab lost the blood. I told my doctor’s office that I better not receive a bill for anything associated with this couple of visits. Of course, I did, in spite of my warning. They just don’t give a damn.

I’m in the same situation a lot of us are in these days. I am self-employed and can only get insurance through an employer, which in this case is me and my little Subchapter S company. I’m paying over $16,000 per year in medical premiums for a $4,000 annual deductible policy with a $5,000 out-of-pocket cap. There are no low co-pays for office visits or drugs. Everything is at network negotiated rates, and all comes out of my pocket until I reach the $4,000. From that point, I pay 20% of network negotiated fees until I reach the out-of-pocket cap. So, essentially, I’m paying for these services but the providers and their staffs still think they’re working for the insurance company. It gets worse when I reach Medicare age, because then I not only have doctors and staffs disregarding my needs, but then also government. I’ve always had good service from my insurer (Aetna), which I should for what I’m laying out for decent coverage. However, I’m just sick and tired of the notion among providers that we patients are essentially just revenue sources who are to be slotted in and out in consideration of everyone’s priorities except ours. We need to start voting with our out-of-pocket dollars.

Physician, heal thyself!