Who Will Pay?
I am on the phone, a ragged stack of medical bills before me. As usual, I am on hold. In February I had a severe bout of diverticulitis. It is October now. I am feeling fine. No, I take that back, my colon may be fine; but my mind is definitely hurting. The very thing that was supposed to assist me in getting well is driving me crazy. It’s called-oh, you guessed-an HMO. Whatever their glossy ads say, they have not got it right. I have experienced first hand their getting it wrong.
I belong to an HMO. I feel like it owns me. The six months that have passed since I was ill have been six months of intermittent dementia. Doctors’ offices have called me, patiently. The hospital has called me, patiently. They know what this is all about, and they are no more pleased than I. It’s about who will pay.
When I was growing up, my town had one doctor. For better or worse, we all went to him. Turns out it was for the better. With his help we mostly stayed healthy. He charged a reasonable fee for that. Those who could pay, did. Those who needed to, bartered. There were those who could do neither. The doctor lived a comfortable life, better than most. He had come to terms with the fact that he would not always get paid. It came with the territory. Hospitals were like that, too.
Enter insurance companies, those bloated behemoths Gerry Spence says make justice difficult in our courts. They have added a new dimension to their time-honored ploy of holding up settlements for generations.
Now it is about “holding up” health care. Holding up as in “delay”, but also as in “highway robbery”. And I use that word care advisedly. Let me explain how care works. First, you receive a ton of booklets and forms to read, filled with legaleeze and insureeze. By the time you have finished you will have vague symptoms of unease. There are too many “Don’ts” and “Non-Benefits”. In my HMO, they pretend to cover mental illness, but the list of exceptions is greater than the conditions included. So, as the HMO’s convoluted system gradually gets to you, the HMO rests assured that they will not have to pay those who will “care” for you. You will be tucked away in some institution where most assuredly you will not get it together to fill out the necessary forms for the financial help you need. In other words, the money you’ll need to file a law suit against your HMO.
But back to the beginning. Perhaps you didn’t bother to read all the stuff they sent you. Bad move. These documents constitute your new bible. You will need to pray regularly for understanding, and hopefully not your acceptance of their “will be done.”
After about six hours of reading you will probably dig out of this mire of data that you must pick a doctor. First, find the list of permissables, and good luck to you. This, it turns out, includes some fifty practitioners, forty-five of whom are not taking new patients. Of the other five only three are still alive. Those three have no practice (double entendre), having just graduated, or worse, barely escaped having their license revoked for malpractice.
But here’s something. Your former doctor is listed as one of the forty-five. But now, you must have permission to go to her/him. To do so you must complete an historical record of your family’s health, signed and sealed by a Dedimus Justice.
A year later, having received approval (and miraculously having staved off any illness till then) you can actually go to your doctor when necessary. This is the only time things will be clear for you. But by now you have decided HMO means Hell Management Organization.
Eventually when you visit the doctor there will be a flood of HMO notes to be processed, beyond the usual ones on your condition. Add another half hour for which you will pay. Need a specialist’s referral? More forms. And you, who may be feeling ready to drop, must crawl, if necessary, to deliver those papers to the formidable functionary of the HMO. In addition, you must call your HMO’s home office in the big city to let them know there will be a referral. If you or your doctor forget to do any of these steps, punishment ensues. “There will be no more of this casual dropping in on a specialist anytime you feel like it,” says the snarling voice on the other end of the phone when you call to explain. Yes, and no money, either.
If you were too sick to make the call, in a coma, or lying in the road with a broken leg, for instance, your HMO cares not one wit. When will you learn to comply?
Besides the endless time spent on the phone, (listening to canned music, recorded messages, “Press one, press *, etc.,) besides the endless call-backs, the stacks of paper to sort and file, there will be more warnings, threats, false promises, temper tantrums. Your own and theirs. Your blood pressure rises. You are lucky you don’t “stroke out” right there on the phone.
The new managed care systems employ dozens of phone operatives cum “counselors” who listen to you when you are snagged one more time, confused, annoyed, snapping angry, or weeping. It’s a hard job. The HMO worker must be strong to the point of bull-headed, unsentimental yet soothing. They must ooze empathy but never, never give in. When desperate they will even flirt. It’s not phone sex, but it’s very weird.
This whole thing is crazy-making for them and for you. There is a high turnover rate in these jobs, and after a few months of service some are undoubtedly sent to a rest home where someone else will counsel them. If Lady Luck is willing they will eventually return to work. If, however, they have lost it, they will end up with a roommate like you who recognizes their voice from the past, and … well…it’s anybody’s guess who will pay.
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