How Did This Happen?

(c) 2010 Christiana Lambert

Keep hoping to run out of rants about our medical and/or insurance experiences, but apparently will have to save that goal for 2014—ha, ha. (That’s a gallows laugh for those of you who might have presumed I meant that at all lightheartedly.)

Late Friday night I kept asking myself, “How did this happen?”

One minute we’re having what we hope is a routine appointment for abdominal pain at the doctor’s office on a Friday afternoon at 1:30 and the next we’re on what seems like some sort of an odyssey—that wasn’t supposed to have nearly so many confrontations with all those mythical monsters of old, you know: insurances snafus, appointment scheduling problems, rude ER doctors, and the familiar vague diagnosis.

Raise your hand if you’ve ever been thrown into what could be an emergency appendectomy, but just turns out to be a lot of trauma and money for little information and little relief. Lucky for my daughter, this was her second such experience in ten years. We were all sitting there with her going, “Wait. Haven’t we been here before?” The only thing we can say that has improved was that she no longer had to drink some horrible contrast fluid for the non-diagnosis—this time she got it by IV. And for everyone who wants to blame any of this on recent changes in health care, the only major difference from 2004 is that then we had co-pays and now we have (high) deductibles—which we have had since before the outcome of the 2008 presidential election was decided.

Last time, however, the pain really did start on a weekend and require emergency care.

This time—not so much—which is especially infuriating in this era of much, much higher costs.

This time what was supposed to happen was she would get the preliminary bloodwork done (which she did) on her way home to wait for a call from radiology for information on a daytime appointment. What we didn’t expect was a phone call from the doctor’s office saying she didn’t show up covered on our insurance plan so they couldn’t get authorization. Never mind that she’s been on this particular insurance plan since July 2010 when my husband’s employer changed insurers and that she has had claims paid in this current plan year that began in July 2013. Never mind that my access into the subscriber information showed nothing amiss.

Now it became our responsibility to talk with the insurance company. First I had to attempt to bypass the phone tree gatekeeper, though. Seriously, how could I tell the computer what I was calling about in a short statement? Current subscriber denied improperly? Is that really in the artificial intelligence settings?

After my call got through to a representative—who said I was the second caller she’d had that day with a similar complaint but stated my daughter was indeed active in their records—I had to call the doctor’s office with the information from the insurance company on how they should call the insurance company. Got that? But first I had to fight to get through the doctor’s phone gatekeeper to prove that I was indeed returning an urgent call from the medical assistant.

You know what the assistant told me when he called back? Yes, she does have insurance, and, no, she didn’t need authorization in the first place.

At that point the radiology company searched all its locations and found that none would stay open long enough to get the contrast into our daughter in time for a CT scan. They could see her on Monday—except the doctor was afraid our daughter’s appendix might be ready to rupture.

Our daughter begged us not to spend the money and effort on the ER and wait for Monday. She is tired of expensive diagnoses and had little faith that this journey would be worth the urgency.

These are those health care moments where the system lets you take all the risks—your money or your life sort of decisions.

It would have been so much better if anyone had listened to us when we described why we were at the ER. No, she was not self-reporting as the paperwork says. She was there because the clock ran out on Friday afternoon—through no fault of anyone in our family. The doctor said she needed that CT scan because of where she felt the pain and how long it had been there.

The only people who really listened in that place were the nurse who brought us to the room and the admissions/financial representative who knew just how much we were going to pay for the initial snafus, even if our daughter did need an appendectomy. In fact, they were the only people who could read her name correctly.

Four-and-a-half hours later, the ER doctor pronounced her with a temporary medical condition—yes, the one listed on her paperwork from 2004—and then left us with paperwork that diagnosed her only with unspecified abdominal pain, mentioning nothing of the term he must have flung out hoping we would not remember. He wouldn’t address why something that’s supposed to last a week would still be ongoing after at least four weeks. The patient in number 19 was not an emergency appendectomy, but simply chronic, unresolved pain. Take some Tylenol and call your doctor on Monday.

Haven’t we been here before? Only this time, this particular odyssey is going to cost so much more. Let’s start with the fact that an authorization wasn’t even required even though she was insured all along and then continue with the fact that an ER is no place for someone whose condition may indeed be chronic. I don’t blame the doctor for erring on the side of caution, but I do blame the confederacy of dunces that followed—and, yet, is there any recourse for us? We could have gotten the same results at 4:00 on a Friday afternoon without all the drama and extra expense.

Somehow I don’t think we should be the only people this Monday asking, “How did this happen?”