Glutton for Punishment?

Note:  Thanks to my friend, Frume Sarah, I recently signed up at “the red dress club” and now receive regular writing prompts twice each week.  The first one—“gluttony”—arrived in my inbox earlier this week.

Dear Medical Insurance Provider:

It’s really very simple, and yet you just don’t seem to be able to get it right. 

On March 9, you issued a $100 check to me as payment for services that I’d received from an out-of-network provider.  Trouble was, you factored into your calculations a $25 co-pay that I (rightly) hadn’t paid.  (Remember, this was an out-of-network provider and thus there was no co-pay.)  And so I called you and listened to cheesy music until it was my turn.  When you finally got on the phone, thank goodness, you understood what I was telling you, apologized for the error and submitted the claim for reprocessing.  About a week later, a check for the additional balance due me arrived in the mail.

On April 18, you issued a $360 check to me as payment for services that I’d received from an in-network provider.  This time the trouble was that—as is the practice with such providers—I’d paid the requisite $25 co-pay and expected that the doctor’s office would bill you.  When I called to tell you that a check had been issued to me in error, you told me to sign it over to the provider.  If I did that, however, he or she could conceivably be paid twice.  And so the uncashed check sits in my ever-growing “Medical Insurance” file.  One day, I’m sure you’ll figure out the error and come looking for that money, and I’ll just return the check to you.

Yesterday, you emailed an Explanation of Benefits to me that detailed payments due me for services that I’d received from a (different) out-of-network provider.  Like the first time, though, you again factored into your calculations a $25 co-pay that I, once again rightly, hadn’t paid.  And so once again, I called you, listened to cheesy music until you came on the line and, thankfully, understood what I was telling you, apologized for the error and submitted the claim for reprocessing.  With any luck, when the payment arrives in the mail, it will be for the correct amount.  Needless to say, I’m not too terribly optimistic that it will be.

So, Medical Insurance Provider, let me fill you in on how it’s done.

When I see a provider who is in your network, I’ll pay a $25 co-pay, the provider will bill you and you’ll pay him or her a predetermined negotiated rate—generally less than what he or she charges—for the service provided to me.

When I see a provider who is out of your network, I’ll submit a claim for the full amount, you’ll tell me that the usual and customary charge for that particular service is some amount less than what I was charged and then, if I’m lucky, you will, without factoring in a co-pay that I didn’t lay out, issue a check for 80 percent of the lesser amount.

I hope this information is helpful to you, Medical Insurance Provider, and that henceforth you’ll use these guidelines when processing my claims.  Thank you for your careful consideration of this matter.

Sincerely yours,
JanetheWriter

R

Small Jewish World?

Last week, three hours into a four-hour wait in pre-op, I posted this status update on Facebook:

Still waiting... hungry...tired...grumpy. :(
Then, the chaplain, Sister Elaine, came by. :)

The first comment on my update came from a rabbi and cyclist friend in Toronto:

Hey - I actually knew a wonderful Chaplain named Sister Elaine at MSK when I did an internship in Hospital Chaplaincy many years ago...she had white curly hair. I wonder if that is the same Sister Elaine?! She was AWESOME!!!!!! (This was in 1988-89).

No doubt, it was the same Sister Elaine:

‎@Sharon -- it is totally the same Sister Elaine. She was great!

To which Sharon responded:   

That is awesome! If you see her again, tell her I said "Hello!" I was there for a year my last year of rabbinical school! xo ♥

Although I did not see her again during my stay, I certainly will remember her kindness for a long time to come.

Thanks, Sister Elaine.

*   *   *

So, is this a small Jewish world story?  Discuss.

Whose Blood is It Anyway?

Photo:  University of Utah, Health Sciences Library

This morning on my way into the office, I stopped in at a Quest Diagnostics Lab to have blood drawn.  (Next week it’s back on the medical merry-go-round for me.)  Thankfully, the place was empty and even without an appointment I was in and out in about three minutes. 

It occurred to me on the walk to work, though, that aside from printing my name on the clipboard at the front window, verifying my address, and signing and printing my name on a form where the phlebotomist pointed, he had no way of knowing that I was truly the person I claimed to be. 

Although I would not ever consider doing it, the whole episode did make me wonder what (aside from the moral imperative to do the right thing) would prevent me from sending a marathon-running, 20-something who is genetically predisposed to low cholesterol to provide “my” blood? 

I’m just sayin’…

My Doctor Failed Me

I was interested to see the Cases column in yesterday’s New York Times, and especially glad to read the last line: “The answers are with the patients, and we must remember the unquantifiable value of asking the right questions.”

In fact, that article, coupled with my own recent up-close-and-personal experience in the medical world prompted me to write (although I probably will not send) this letter to my (soon to be former) internist:

Dear Dr. I-Used-to-Think-You-Were-a-Really-Good-Doc,

I’m writing to ask that you please forward my medical records to my new internist as I am leaving your practice effective immediately. Although we’ve been through a lot together in the last five or six years--ongoing control of essential hypertension, diagnosis and treatment of a lingering viral infection, antibody titres necessary for grad school enrollment, a Z-Pak or two for upper respiratory infections, and, just about two years ago, a four-day hospital stay via the emergency room that resulted in gallbladder surgery—it’s time for me to move on.

Why, you ask? Well, let me tell you.

Until now, we’ve had what I would consider to be a positive doctor-patient relationship and you’ve been, from my perspective, accessible, competent, compassionate and caring, qualities that are harder and harder to find in an internist. Back in January, however, during a routine visit in which you checked my cholesterol and blood pressure, I told you—with great difficulty—that I was increasingly stressed out and having trouble dealing with it.

Your response? Try to get more exercise and see if that helps. Anxious to feel better, I did start an early morning treadmill routine and found that, indeed, I was better able to handle the challenges of balancing work and school throughout the spring…until plantar fasciitis forced me off the exercise equipment for a few weeks during the summer.

By last month, with Biennial just days away and amidst mounting pressure from both work and school, I again told you during a routine visit that I was not handling stress well and that more and more I felt it was negatively affecting my ability to function effectively. Your response this time? An electrocardiogram (which was totally normal) and the suggestion that I “just need to get through this.” That day, I left your office more stressed than ever and, although I was unable even to envision life after Biennial, hoping that things somehow would be better once I returned from Toronto.

Unfortunately they were not, which only furthered my resolve to find an answer. Earlier this week, therefore, I saw my ob/gyn, a doctor I had previously seen only for routine care and with whom I do not have the longstanding relationship I have with you. And yet, to my great relief, she listened, asked good questions, answered mine, ordered a lot of blood work and (pending the results) offered a seemingly plausible diagnosis. In this particular instance, she also prescribed medication that, once it kicks in, will, she assured me, help me feel better.

Now that I’ve had a chance to read up on the diagnosis she provided, I’m compiling a new laundry list of questions for when I see her again in a few weeks. At the top of that list will be this one, very important question: Can you recommend a new internist?

I regret that our relationship has ended this way, but the bottom line is this: when I needed and asked for your help, you disregarded my concern, you blew me off, you just weren't there for me. I only hope that you’ll be there for the rest of your patients.

Sincerely,
JanetheWriter