Seeing the doctor

Today I will be seeing a doctor to establish care and receive my annual medicare wellness exam. One of the challenges of moving in 2020 and again in 2021 has been that of establishing care with doctors. The primary care physician is the key to the other doctors I will eventually need to see, including a dermatologist. I asked around and took care in selecting a medical practice because the primary care physician is so important in the overall process of obtaining health care.

I spent about 45 minutes on hold in my initial contact with the practice, when I called to make an appointment. The soonest appointment I could obtain was three months in the future. Then I spent another half hour on hold when I called back because the paperwork they sent me to fill out contained an error in the time and date of my appointment. That paperwork had ten pages of forms to fill out. One of those forms contained two pages of general financial policies of the medical practice. In essence what they said is that I would be asked to authorize them to provide any medical services they deemed necessary and that I understood that if my insurance company refused to pay for those services, I would be personally responsible for all charges.

I know that medical practices are serious about that financial policy. For example, I know a person who was transported to a hospital unconscious after an accident. That hospital transferred the patient to a trauma center while the patient was still unconscious. After successful treatment the patient was released to complete recovery at home. While at home the patient was informed that a lien had been placed on their home by the trauma center because the insurance company had refused to pay for the treatment at the specialty hospital because it was not pre-authorized. It is impossible to obtain a pre-authorization when you are unconscious.

Inability to pay for medical services is a leading cause of personal bankruptcy in the United States. It is a leading cause of homelessness in our country.

Imagine for a moment that you are searching for a repair shop to change the oil on your car. Now imagine that when you get to the shop they ask you to sign a form that says you authorize them to make any repairs they want to your vehicle. Furthermore the form informs you that they will not provide you with any estimate of what the cost will be or any explanation of the reason for the charges. The charges will have no relationship to the amount of time required to make the repairs and no relationship to the cost of the parts provided. Then imagine that you are informed that if the company provides any repairs not covered by warranty, you will have to pay and that they can not only seize the vehicle for payment, but also all of your assets, including your bank accounts, your retirement savings, and your home. And to add insult to injury, know that we intend to charge your warranty provider a price that is a fraction of what we will charge you if they don’t pay. We negotiate with warranty providers, but not with individuals.

You’d probably refuse to sign the form, find another repair shop, and tell all of your friends about the scam. You might even report the scam repair shop to the better business bureau.

Then, imagine that there was no other way to get the oil changed in your car.

And, just to make matters more fun, I have received a text message, a voice mail and an email from the medical practice where I will be seen today that state, “If you have fever & cough or suspected coronavirus exposure please reschedule your appointment.” In other words, if you have any actual symptoms, or suspect that you might have been exposed to an illness, the practice does not want to see you. Sick people are not welcome at a doctor’s office.

Imagine if you got a call from the oil change shop that said, “If your car is making any unusual noises or has any warning lights on the dashboard, please reschedule your appointment.”

When we lived in South Dakota we had long-standing relationships with excellent health care providers. We had received care from the same dental practice for 25 years. Our family physician had treated our parents. Still, when Susan was in the hospital for treatment of atrial fibrillation, she was administered a medication that caused her heart to stop. Fortunately, the rapid response team was able to revive her and she was able to fully recover. But there was a 24-hour period during which her care was charged at a rate approaching $10,000 per hour. That’s right: a quarter of a million dollars for an overnight in the intensive care unit. Fortunately for us, the insurance company negotiated a settlement at a greatly reduced price. She is healthy and has had no lasting health issues from the experience.

Because of that experience, however, we already know that it will take more than six months after this move before we can get her cardiology and monitoring services transferred to the county where we live. And if one of us had been exposed to Covid, the process would take a lot longer.

Not long ago, in an informal conversation, a person asked rhetorically, “Why don’t people trust doctors and hospitals for information about vaccines? Instead they turn to the most obscure sources of false information and believe untrue things about the disease and the vaccines.” I didn’t say much at the time, but I wonder how many people there are who are convinced that medical practices are financial scam operators who cannot be trusted. I wonder how many people have given up trying to obtain basic medical services from recognized providers and have turned to a combination of self care and alternative medicine.

Fortunately, I’m not sick. I have good insurance. I have few financial assets. I am patient. As a result, I get to see a doctor today. I’ll take in all of the papers so that they can set up my “paperless” medical records. Prospects are fairly good that I will get to see a dermatologist sometime in the next year. And I’ll still have to allow a minimum of a half hour each time I need to place a phone call to the doctor’s office. I sure hope I don't get sick.

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