Mission Statement

My mission although I didn't sign up for, is to endure all those crazy incidents you hear about from friends and coworkers. You know, those ones about the person who spent 15 hours in the waiting room at some hospital emergency ward. Or, even better, the one where this person sold health care policies only to find themself fighting for their life with the healthcare company just months before had been singing their praises. How's that for irony. Well, we all know the sob stories. I'll try to keep those to a minimum, and only when absolutely necessary for a point, but this is about all those crazy inconveniences that the healthcare industry as a whole puts the average person though on a daily, no hourly, basis, without thought, care or much consideration whatsoever. It's shameful. Why is my time and effort worth so little, especially when I'm paying you to provide a service to me. Why then is it necessary to fight tooth and nail just to get what I paid for? Is anybody listening? Well I certainly am listening, and screaming at the top of my lungs to anyone who'll listen to me. We need a grass roots campaign started like yesterday. We need someone whose on our side of the argument for once. Help out with your own stories and comments. Or, just try to keep me from going to far up on my soapbox. I truly hope I can help someone, open people's eyes to the craziness, and maybe make some small change in how heathcare treats us!

Tuesday, August 10, 2010

Excuse the missed weeks

Please excuse the missed weeks that I have not been posting.  I have recently lost a close friend to liver and kidney failure and was very much invovled in procuring adequate care until his passing on 8/8/10.  I am certain to have many things to say about his care and final care in general.  However, for now, please allow me the time to grieve in private. 

Saturday, July 17, 2010

Who's In Charge, Part Four

Who's in charge when I'm billed incorrectly?

First you should contact the billing department of the Practice, Hospital, or other entity that billed you incorrectly.  Then follow-up all phone conversations with a written summary of the conversation, and send it to whomever you spoke with.  If you cannot get resolution from the initial contact, then I suggest asking to speak with the Supervisor, and/or person in charge of the Billing Dept.

I would also ask for a complete, itemized billing, for all services provided, whether they are services covered by your insurance company or not.  I would then contact the insurance company's benefit coordinator, and ask for an explanation of benefits as it pertains to this particular billing.  In a lot of cases, the insurance company will direct to you to contact the Physician's Group to handle billing inquiries and problems.  They generally don't get  involved until there is an unresolvable situation.

After that, I would recommend that you contact of their Physicians, Hospitals, Radiological groups, etc., that provide the same services you received, and ask for their rates for services if provided by them, including use of your insurance and the capitated or contracted pricing.   If there is any difference in the rates charged by two or more entities, then bring it to the attention of both the company that originally billed you, and your insurance company or physicians group.  Ask if you can negotiate the rates down to equal what the other companies are charging, and offer to pay in full at the lower rate, today.

If they don't cooperate, you may have to issue a complaint to the company, the physician's group, the insurance company, any local advocacy groups, plus any known associations they may be governed by.

Ask for and thoroughly read all pamphlets and handouts for dealing with complaints and /or negotiations.  Usually they are handled through binding arbitration.  At any rate, they are required to provide you with step by step instructions on how to file a complaint, and whom to send it to.

Depending on the amount of monies involved, you may want tot contact the Department of Corporations, Health Care Division.  They are very slow to respond, but they are very thorough in their investigations.

Additionally, this is one of the few times I would recommend bringing in the Media.  Almost every T.V.  station has some form of consumer watchdog to assist people in dealing with multi-layered corporations.  Take advantage of their assistance and guidance.

The most important thing is to be persistent.  Do Not leave everything up to someone else.  Follow up with every person involved and keep meticulous notes regarding all conversations, phone calls, etc., including names, dates, times, a brief summary of what was discussed, along with any and all copies of correspondence from or to you regarding this matter.  Not letting things fall through the cracks is vitally important right now.  Stay on top of all correspondences, and return all calls as soon as possible!

Reread all correspondences with dates and deadlines.  This is very important.  Do not let a deadline lapse, or you could automatically lose your case.  If there is any discrepancies regarding days and/or dates, ask for clarification in writing.  Ask that any letters be rewritten to clarify the error.  I almost lost my case over a supposed "typo".  So don't be fooled by their tactics -- always keep your notes and records current.  Meet all deadlines.  And don't accept anything is final until you've reached the final binding arbitration.

These companies are large and can easily afford to jerk you around.   And they will.  They will repeatedly ask for the same information and swear they never received it.  I strongly recommend that all correspondence be sent certified.  That way, you have a signed receipt for everything sent, including tracking numbers.  It's a lot more difficult to say they didn't receive something when you have their signature and the date saying they did!  Keep all receipts attached to your copies of the correspondence, etc., sent.  Keep a chronological file or notebook with all information from beginning to current.

I know that it seems an awful lot of wasted time, space and money.  But believe me it will be beneficial in the end.  However, having said that, if you're fighting over $10 - $20 , you may want to consider all the time, money, and effort you'll put into fighting.  While I believe in fighting on principle, you do have lots of things you could better spend your time and money on.  So, please at least consider whether the fight is really worth the effort or not. 

Trying to keep track of your health care when things are handled properly can be a full time job.  Especially for those of us whom are trying to say ahead on the health wheel of life, it can be a daunting and overwhelming job!   So, when something out of the ordinary needs extra attention, or something wasn't dealt with properly to begin with, you've put yourself behind the eight ball to keep up with all the phone calls, and correspondence necessary to correct the problem.  For instance -- I had a balance billing problem from a capitated plan item.

If this was only once out of every 10-20 times I get billed, I wouldn't complain so much.  But, it's gotten so bad that I pay my PCP by carbon check and still ask for a receipt.  Even then, I am still regularly billed by the bookkeeper for payments I've already paid.  It's quite frustrating to have to always be the one person who provides all the evidence either way.  If I pay, I paid.  Copies of cancelled checks should be sufficient.  If  I haven't paid because I wasn't billed correctly, well shouldn't I deserve all the same courtesies?  Just move on!  But no, that's too simple.  I have to make several calls to different people to clarify the issue.  Then when  they don't agree, then I have to appeal their ununanimous decision in writing!  And, just to be fair, there's a time limit for appeals.  So no taking your time.  You either appeal now or forget it. 

But it's not just health care anymore that has this attitude.  Try to talk with your local Tax assessor about a billing error where you've been over assessed, plus never actually received a bill to begin with.  Talk about being stuck up to your neck in red tape, plus a tax code bible you have to read through to find a reason for them to consider listening to an appeal, to begin with.  It doesn't make any difference if they screwed up or not, they assume it will eventually be corrected, and until then you have no recourse, unless you can find a loop hole in their code book.  Just what I've always wanted, to read up on Tax Code Assessments!  Yippee!
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Friday, July 9, 2010

Who's In Charge, Part Three

Who's in charge when I have a legitimate complaint that's being ignored?

First, we'll need to know who or what you're complaining about!  If your complaint has to do with an employee of your PCP, Specialist, Hospital, Clinic, or other professional services, then I'd direct my complaint directly to the Personnel Manager and the highest ranking staff member available.  I would also follow-up my complaint in writing to all parties you've previously discussed the situation with.  Keep clear and concise notes regarding the dates, times, and places, as well as names, position/title of all persons involved, and any witnesses, including other patients.  Additionally, keep notes regarding anyone you discuss the matter with, their response and any actions taken or promised.  Along with the dates, times and locations, plus names and titles/positions within the firm/practice, etc.   This applies to any and all complaints.  Keep those notes!  Without them you'll be sunk before you ever start!

The lead Doctor(s) should also receive a copy of your written complaint, outlining all offenses, your attempts to resolve the matter, the persons with whom you spoke to and their actions or promises for action.  Include any attempts or actions taken along with those promised, but not put into action, along with any results or failures associated with said actions. 

Give them a time frame in which to respond and rectify the problem(s) before seeking further actions.  10 days to two weeks should be sufficient.  Make certain to send all correspondence certified, so you'll have a record that it was received, with attached copies and notes.  Keep a chronological file of everything!  From initial complaint actions, until full resolution!

If after the allotted time period has passed, and no action has been taken or any response or outline of action to rectify the situation, then I would proceed further.

If the complaint is directed toward the Doctor, the head of the Hospital or a particular Dept., then the highest ranking person available at that location would be a good place to start.  I would still  contact the Personnel Manager and try to follow-up with anyone whom might have authority over the Doctor  or person you've a complaint against.

There are also the State Medical Boards and State Medical Associations, as well as Federal Medical Boards and Federal Medical Associations for you to direct your complaints to, however, I would use caution and discretion before involving either the State or Federal levels until you feel you have exhausted all other means of resolving the matter and have no other resources left to contact.

Remember to keep your complaint clear and concise.  Give the offending person one final opportunity to rectify the situation, while letting them know your next step will be to contact the State or Federal Medical Boards and Associations.  Generally, just the threat of contacting them will bring about a response and typically some form of a resolution.  But, if not, at least now they know how serious you are with your complaint.

Always include your local Health Care Advocacy groups in all complaints, whether large or small.  It is their duty to keep records of the number of complaints against each individual Doctor, their staff members, and their practice.  All this information is available for public record and can be easily accessed.  Consider it a blemish on the reputation of each Doctor and their practice.  Enough of them will cause them some patients and eventually effect their wallets.

If you still can't find resolution, then by all means contact the State and Federal levels of the Medical Boards and Associations.  Send them a letter outlining your complaint, all attempts you've made to resolve it, plus copies of any and all correspondence between you and the offending parties, in chronological order.  Keep your feelings to a minimum -- just state the facts as clearly and without emotion, as possible.  Keep to the truth and try not to add opinions rather than facts.  Be concise, yet keep it brief and to the point.

After that you'll just have to wait until they respond.  You may wish to contact only the State, first.  See  what they do or how they respond.  Then, if you're still not satisfied, you can proceed with contacting the Federal Boards and Associations with your complaint.  Either way, you'll receive at minimum some type of an investigation and written response.

I don't recommend bringing in the media.  They tend to muck -up the problem and use their own version of the truth to slant it towards how they or their readers/viewer see it.  Besides, they can create more problems that they're worth.  The very last thing you want is to have them, the media, catch you off guard, making a statement that can be taken out of context and makes you seem foolish.  Or worse yet, causes you a legal battle down the road.  There is a very fine line between complaint and slander, so keep to the facts and mind that your temper stays in check.

Try to accept that the inevitable may be less than what you deserve.  But this is how life works.  It isn't always fair, and truthfully, there are very few reasons to keep someone from pursuing their chosen career.  So, accept that the final decision of the State or Feds may be less than desired, and realize while they may only placate you, the person you've lodged the complaint against is probably going to be on the receiving end of some fairly stern warnings and reprimands, that you won't ever hear about!

The truth is, mostly what goes around, comes around.  I know it seems trite, but it also happens to be very true.  People generally pay for their arrogance and disrespect in spades.  It may be that you'll have to accept that they'll get theirs, what's coming and due for them, in the end, and accept that on faith.  And, besides, who knows, may be you've hastened that end a little bit yourself!
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Tuesday, June 29, 2010

Who's in charge? Part Two

Who's in charge when I don't agree with my Doctor or my options?

The easiest answer would be, you are.  You're the person in charge of your own destiny, whether it be medical or otherwise. 

Where to start depends on a lot of other considerations.  Number one is, what exactly are you in disagreement about?  If it's an opinion regarding specific care or treatment, it can usually be resolved by getting other opinions.   Also, doing research on the success and failure rates for a particular treatment may help convince those with opposing opinions.

If you still can't resolve the issues, then I'd consider checking into support groups.  A lot of patients become a part of these support groups because they've stood in your shoes, filled with the same confusion and mistrust.  That no one can understand what it's like from your prospective.  But, you'd be wrong.  There are lots of people whose life story so eerily resembles your own, you'd be shocked that it's not your own.

Try not to wage a personal campaign against your Doctor.  Even in this day and era, there are still many things Doctor's don't fully understand.

In my own personal experience, I've had to explain my medical condition, it's symptoms, effects, and standard treatments so often that I find it strange when I don't have to.  My PCP didn't quite understand the complications and intricacies of my pain condition.  It's a very complex and complicated disease, affecting each person a bit differently, although most symptoms are similar.

For instance, my condition make me very susceptible to changes in the barometric pressure.  Increases cause my skin to feel as though I'm in a vise grip; like wearing a wetsuit that's 5 sizes too small!  Decreases cause my skin to feel too loose.  As though I'm melting into a puddle.  Either way, they make the pain of my condition overwhelming, yet there is nothing that can be done to treat it.

My biggest frustration was getting my PCP to understand that this affected so much more in my life.  More pain means less ability to move and reduced desire to do anything, including basic care.  I don't like taking pain medications, and I try to limit them to the minimum needed to get me through the day.  I don't want to become another statistical pain patient that becomes a drug addict.  I know that sounds harsh, but it is too often too true.  Abuse of pain killers is becoming the fastest addictive substance out there.  But that's for another blog.  I don't want to become one of those statistics, so I limit my pain medications.  I try to minimize my medications as best I can, but there are some days I can't fight the good fight.  This is where the PCP and I come to a great divide of opinions.

That is, until five (5) years later, when he was diagnosed with the exact same condition as mine.  Now he has an entirely different opinion about how I choose to control my pain.

Of course, we can't all be that fortunate.  It's not very likely your Doctor will suddenly understand you or your disease fully, or experience your life as you live it from one day to the next.  Nor is it likely you'll have my luck and find a Doctor with your exact condition to treat you.

There are Doctors who specialize in care for specific conditions.  A quick search on the Internet will guide you toward them.  But sometimes it's not possible to get to a Doctor who specializes in the particular field you need.  So, spend time talking with your contacts from the support groups.  Print out articles that you find for your Doctor.  Help to educate them as best you can.

Also, you can contact your Insurance Company and/or Physician's Group for referrals to other Doctors, Specialists, etc., to help manage your condition.  Additionally, there is always the health care advocacy groups.  They ask lots of questions and delve deep into your health records, but they can be very knowledgeable and helpful.

The best course of action may be just to change your PCP or Doctor.  But, you're very likely to find yourself in the same predicament.  My experience has often shown that you can learn more with a clear mind and a calm demeanor.  Try to understand why your Doctor wants you to follow a particular path of treatment or care.  Try placing yourself into their care and give their opinions and suggestions at least a minimal try.   Then, at least they can't say you are continually uncooperative or uninterested in any type of care or treatment.

Who knows, maybe they know something you don't, or hadn't considered.  Maybe they prefer you to start out slowly with baby steps and see how well you respond to the least invasive treatments, first.  Then they can gradually up the ante and move you toward more aggressive treatments.   This isn't necessarily a bad thing.  And while I know it seems like mostly wasted time.  I have discovered that Doctors can glean a lot of useful information from treatments that don't work, as well as those that do.  Perhaps, sometimes, even more from failures. 

It's the same with life.  You can't learn anything by being right all the time.  And so it is with health care.  A great deal of trial and error.  Sometimes the long way around may be what's best for you in the end.

But, only you can decide that for yourself.  You need to talk with your Doctor.  Make them understand your concerns and reservations.  Talk to them about your planned approach for care and treatment.  It's very possible that you can reach some sort of compromise that honors both opinions and covers an even broader spectrum of treatments and care.  Until you can be reasonable and speak plainly with information and research to back you up, then you're probably wasting both your time and efforts. 

Become as knowledgeable about your disease and/or illness as possible.  Education is vital to understanding what step comes next.  Until you're there, put your trust in your Doctor's care.  That is until they give you reason to not trust them.

When you have concerns or just don't understand, or are afraid --  talk to your Doctor!  Let them know all the things that bother you, that concern or worry you.  Because until you do, they are in the dark and without communication you're doomed to be frustrated and unhappy with any and all care you receive.   Communication with any Doctor about even the smallest concern can make a huge difference in your overall care.  But, until you voice them, the Doctor has no idea you're concerned or just worried.

So, find someone you feel comfortable with.  Try to follow their advice, but most importantly, talk to them about everything regarding your concerns and opinions.  Let them know how you feel about their suggested treatments, your worries, and options you'd like to consider.  Remember, letting them and yourself become a team will be the best form of treatment you'll ever receive!

Tuesday, June 22, 2010

Who's in Charge? Part One

Who's in charge is a very loaded question, and one that would take an entire lifetime to fully answer, especially as it pertains to health care.  So,  I decided to touch on the top five (5) questions I usually get about "who's in charge?"
  1. Who's in charge when I need help and answers, but I can't get them?
  2. Who's in charge when I don't agree with my Doctor or my options?
  3. Who's in charge when I have a legitimate complaint that's being ignored?
  4. Who's in charge when I'm being billed incorrectly?
  5. Who's in charge when I get denied?
We'll start with number one (1) this week, and follow with a series over the next 4 weeks answering as best I can all five (5) important questions.

Who's in charge when I need help and answers, but can't get them?

First, I'd start at the source.  Ask your Doctor.  Tell him/her what it is that you need help or answers to?  I've found most Doctors to be very intelligent, patient, and full of unexpected guidance when looking for answers.  Remember, most Doctors have heard and seen just about everything.  Plus, contrary to popular belief, they are human and do experience problems very similar to our own.  If the Doctor doesn't have the answers themselves, I wouldn't be surprised if they at least didn't offer sound advice as to how to find the answers you seek.  If not, keep your head up, there are several more places for answers, depending on the specific question.  Let's assume that you need answers regarding specific medical treatment.  Well, then your PCP should be a wealth of information, or they should have some idea about who would.  Let's say they recommend that you consult with a Specialist.  This is a good start, but don't get too overconfident.  Specialists are like opinions, and believe me, they each have their own, unshakable opinion about what is and isn't the perfect thing for you!   So, you meet with a Specialist, and they either give you the answers you want, or they add to the confusion, giving you more questions than answers.  Shake it off and return to your PCP for another referral to a different Specialist.  Explain why you felt that you and the Special you saw, seemed to have differing opinions, and you would prefer an alternate opinion before deciding  what to do.  Be determined.  You are entitled to secondary opinions, especially when it involves any type of surgery or invasive treatment.  You can also, while you're waiting to see this second Specialist, use the Internet to do some research.  You should have formed some specific questions by now, after consulting with two different Doctors on the subject.  Look for websites that are technical in terms about your specific situation or condition.   But, also search for support groups having any relationship with your specific condition.  These are average people from around the globe who have had or are dealing with the same problems you're facing.  They sometimes can be your greatest resource guide.  A lot of times, these people have stood exactly in your shoes, with lots of questions, and very few answers that aren't technical and unsympathetic toward your plight.  These people understand that you not only need answers, you need reassurance that you're not alone.  That there are others who've been where you are now and somehow they got though all of it. 

Now while I strongly recommend listening to the advice and experiences of others, especially if they have or they are experiencing the same issues you're trying to deal with yourself.  However, please use caution before wholeheartedly heeding someone else's advice, alone.  This is the same as only looking at one side of a coin.  There may be something vital and important on the other side.  I would take the advice given as a starting point.   Use their previous experiences and failures to guide you in the direction that's right for you, personally.  This way, combined with your technical research, you can go see the second Specialist with a better understanding of what lies ahead.  And, can now formulate questions of what's still bothering you.

If however, after all this, you are still unsure or can't get the answers you need.  Then I would begin contacting other resources.  For instance, maybe after all your research and talking with the Doctors, you've come to a conclusion on which treatment, etc., to pursue, however, you still have questions about where to go?, which Doctor to use?, how much will you have to payout of your own pocket?,  Will you stay at the hospital or will this be outpatient care?, or What about after care and/or physical therapy?

These questions should be directed to the insurance company and/or the physician's group.  Both phone numbers for customer care or service should be listed on the reverse side of your insurance card.  If not, they PCP's office staff can find the phone numbers for you.  Just ask. 

When contacting either the insurance company and/or the physician's group, ask for customer service, or a benefit coordinator.  Tell them you need a specialist for an explanation of your benefits.  They should be able to answer all your questions or direct you to whomever can.  Keep asking any and all questions until you are satisfied.   Even if that means several calls over several days.  It's better to know the answers up front, rather than be shocked with the bills arrive.  Additionally, the Insurance company and/or Physician's group may require you to have certain tests and/or other treatments before you can proceed with surgeries or more expensive treatments, etc.  They may also request recommendations from several Doctors and send you to see more Specialists for testing and opinions.  Try to relax, and understand this is part of the process.  However, don't allow yourself to be treated without care or concern for your condition or well being.  If you are in pain and all the poking and prodding makes it worse, then demand to be given medication to help you cope and control your pain.  If you feel no one is listening, then by all means stop them and make them listen.

If you still feel you're not being treated fairly or with respect or concern, then I would contact the local health care advocacy group.  They are usually local by city or state and are part of a government run oversight.  However, they do a lot of good.  Generally, they are staffed by knowledgeable volunteers and others paid for their expertise.  They can be a wealth of information and help.  Just keep in mind, they are partly government run and therefore not always easy to get through to on the first few tries, and they do require lots of information from you before they'll proceed in assisting you.  They may also have their own suggestions as to how to deal with your situation  -- and I mean writing letters!, more specifically.  So, call them, but be prepared for lots of advice, phone numbers, local support groups, other advocacy centers, addresses, etc.

Another place to contact, if you're truly still desperate for answers is the Dept. of Corporations, Health care division.  They deal with HMO's, PPO's, and other health insurance groups.  They take their time responding, and generally you'll be required to put your complaint or problem in writing from beginning to present.

Also, if you are covered by Medicare, or a Medicare provided insurance, then you can also contact them for general assistance, however, they will most likely refer you back to the Insurance company or Physician's group or another advocacy group.  But, again they may have some helpful information.

In any case, asking questions can only be helpful.  There are no stupid questions and every one's entitled to know the full story, especially when it pertains to your own body and the care of that body.  You cannot make an informed decision or consent without being first fully informed to your own satisfaction.  Do not allow the Doctors, the Insurance companies, etc., to bully you into making decisions without understanding why.  While I realize some situations warrant urgency, I still believe you can be fully informed within a matter of minutes when one so chooses to do so.  I've been in several urgent situations where I've had to make a choice with very little understanding.  But, as I've also learned, if you continue to ask questions and voice your real concerns, most Doctors and staff do feel compelled to answer them as best they can.  Unfortunately, only you can determine when you know enough to make an informed and educated choice.  So, until you're there, stick to your guns and get those answers!

Monday, June 14, 2010

How Sick?


Please remember the following entry is the personal opinion of the writer.  No medical advice should be construed as fact.  Always follow professional medical advice when seeking medical attention.  The writer has no medical training or expertise, other than their own personal experiences as a patient.  You should always consult trained and accredited medical personnel for any and all medical situations.

                                                                     How Sick?

Of course, the age old question in dealing with Doctor, etc., is just simply how sick am I, and when does it warrant further investigation?  I don't know about everyone else, so we'll use my barometer to measure:

  •  If you're too sick to go to work, school, etc., you're probably sick enough to stay home and in bed.

  •   If, however, you're running a high temperature, have nausea, diarrhea, or a blinding headache, then you should at the very least consider going to see your Primary Care Physician.                                  

  • If you feel too sick to drive, or make any decisions, I'd recommend an Urgent Care facility.

  • If you can't make heads or tails about what to do, I'd consider visiting the Emergency Room.
Now, I realize these are oversimplified instances and each person should determine their own comfort level when seeking medical treatment, but a lot of the time, things aren't quite so easy to decide.

Usually for myself, if I can make sound choices about my care, then I keep to my home or see my PCP. Especially if "it" doesn't seem to want to leave.  If, however, I start wondering aloud and not making much sense, then I tend to believe I'm a lot sicker than I'd realized.  That's when I consider the Urgent Care facility. 

Not always, but occasionally, I've gone to see the PCP and have been sent on to the Urgent Care or Emergency Room.  But mostly, I try to keep my choices clear and direct.  If something seems broken, such as an arm or toe, or if I need stitches for a deep cut --- those are obvious Urgent Care visits.  But, if I also hit my head, plus I believe I've broken a bone, well then I'm headed straight to the Emergency Room asap!

These are basics.  Everyone has their point of a slip -up vs a disaster.   The really difficult test comes when you're not sure what's happening!  For instance:  you have an upset stomach with a little pain.  Now what?   Well, first, I'd call the PCP's office and ask them what they'd recommend.  Unfortunately, as we've already discovered and discussed, a great many times your attempts to call a PCP go unheeded or ignored altogether. 

If it's something completely new, and doesn't appear to have any reasons for it, I'd at least go to an Urgent Care facility.  It may waste a great deal of time, but you never know when it could be serious.  If you can't decide, a bit of waiting and some Internet research may be very helpful.  Who knows, maybe the potato salad didn't agree with you today, or after the third day in a row.  Or, it could be the virus plaguing all your co-workers.

The truth is you'll never know all the right choices ahead of time.  Only in hindsight can we make error free choices.   So, what to do?  Ask yourself some basic questions, and be honest!:

  1. Does it hurt bad enough to warrant being poked and prodded?

  2. Is this worse than anything you've ever had before?

  3. Does this seem different from the countless times you've been sick before?

  4. Do you feel you need a Doctor's opinion?

  5. Are you worried or overly concerned about how you feel?

  6. Does your spouse, significant other, or friends feel you should see medical attention?

  7. If someone else had the exact same symptoms, what would you advise them to do?

  8. Are you only putting off a visit to the Urgent Care facility or Emergency Room or PCP's office, because of the amount of time you'd be waiting?

  9. What's the worst that could happen if you go see a Doctor?

  10. What's the worst that could happen if you don't go see a Doctor?

  11. Can you tolerate the symptoms comfortably until tomorrow, or when you can get an appointment with your PCP?

  12. Is there anything you can do to relieve or alleviate your symptoms right now?

If you answered all these questions truthfully and honestly, and without any guilt, then you should have a pretty good idea about what to do.  I find, for the most part, common sense, and knowing yourself well, is the best barometer in determining when something needs further attention.  If you're truly uncertain, then a dose of caution is usually the best course of action.

Just remember, your health is a life and death matter!  No amount of joking or glossing it over can change that one fact.  So, keep that in mind the next time you wonder whether you're wasting every one's time and efforts.  Even the smallest molehill can become a mountain, left to it's own devices!  Besides, just consider it as a small repayment towards all the hours you've wasted waiting for the Doctor to get around to you.

Wednesday, June 9, 2010

Is anybody listening?

Another truly irritating fact in dealing with health care is everyone talking, having their own opinions, while nobody seems to be listening to what anyone else is saying.  Is anybody truly listening?

Take for instance the case of my family member --  They scheduled an appointment to discuss with the Doctor that they were finally willing to have the recommended surgery form the previous year.  The request came with another hopeful scheduling request, so that a visiting family member could be there to help out during recovery.  The response to that request wasn't met with to much enthusiasm.  Stating that 2-3 weeks was impossible!  Now the most ironic thing is that the appointment took almost 5 weeks to schedule, which would have given them sufficient time to perform all pre-operation tests, plus the operation.   Here is where the rubber and road meet to no effect.   Now the next step as required by the doctor, is to have an MRI scheduled and done before any thought of surgery could be considered.  So, paperwork was sent to the insurance company for authorization.  It was processed and approved by May 18th; sent to the patient on May 22nd; and received by the patient on May 26th.  With the holiday weekend looming, the patient waited until the following week to call for an appointment.  When they did call the approved testing facility, they were told it could not be scheduled as they had not received the instructions from the Primary Care Physician's office. 

After six (6) phone calls to five (5) different people:  the doctor's assistant, the referral dept. clerk, the scheduling clerk (all at the PCP's office) and  the MRI scheduling clerk and office manager (at the MRI facility), I was only able to leave six (6) separate messages regarding this situation.  This is a typical problem where someone dropped the ball in doing their paperwork, creating a log-jam for everyone else.  But the real travesty is when you're trying to get it corrected or dealt with, and they don't listen.

Trying to find the right person, department, and/or the right placed to call for help seems daunting.   But, help is out there, it just takes a lot of working the phones, asking questions, and not giving up!

In the particular case described, the representatives from the Doctor's office, instead of listening to what the problem actually is, quickly take offense toward the patient and them pointing out that they haven't done their job properly. I personally don't care whose right, wrong or purple --  just fix the problem, please!  Additionally, the MRI facility could have just as easily made the appointment and called the PCP's office for the needed information, themselves.  Not only were they not listening, they were stating very clearly that is was not their job.  How petty we've become when dealing with health care.

The simple truth is there isn't enough time to get your point across when you're at the doctor's office, and when you're not, you can't get anyone to talk to you.  Most questions and problems could be very easily dealt with if the parties involved would just check their personalities and insecurities at the door.  Most people don't try to point out other's faults.  It's impolite and ill mannered.  The majority of us don't care enough to correct a stranger, so why should we care to point out anything?  The truth is they just want to get from point A to point B with as little problem as possible.  Unfortunately, the insurance company and Doctor's groups say the PCP has to be involved along every step of the way.  So, until they say it's OK for you to go to point B, you're stuck waiting at point A.

So, what to do?  Keep calling.  Keep talking.  Keep trying to get your point across to the Doctor's staff.  Eventually you'll get somewhere.  Even if it just because they're tired of hearing from you.  In any case, in my particular situation, the log became very quickly unjammed when I suggested  to the MRI scheduling clerk that they try to contact the PCP, as I obviously was not getting any results from my attempts to get the situation corrected.  (There is more than one way to skin a cat..)  Within 20 minutes, I not only had an appointment scheduled, but scheduled for the following day!  Plus receiving a phone call from the Doctor/PCP's office to verify that all was well and taken care of.

It's just that simple.  All it takes is one person to listen to the problem and react with proper action, to make all the problems disappear!  Just think how much simpler our lives would be if everyone stopped long enough to listen to the problem at hand and just fix it!