Tag Archives: insurance

Don’t waste my time! (On “patient autonomy” and health insurance)

If there’s one thing that makes my blood boil, it’s having my time wasted. I only have so much, and I waste enough of it myself that I really can’t afford to lose any to others’ incompetence.

Unfortunately, one of many frustrations that come with a chronic illness is wasted time. Managing celiac disease takes a fairly large toll on your time in the form of food research and preparation—though that’s, arguably, time valuably spent rather than wasted. Far more annoying, really, is dealing with doctors.

I, for example, have an HMO (health maintenance organization) insurance plan. The main difference between that and a PPO (preferred provider organization) plan is having to be referred by a primary care physician (PCP) in order to see a specialist. Even a specialist specializing in the chronic condition I will have for the rest of my life.

Researchers have actually felt the need—and gotten funding—to study the benefits of long-term follow-up care for celiac disease patients. Turns out (surprise!) it’s good for us. (See, e.g., this article in the Canada Journal of Gastroenterology.)

Judging from that, for the rest of my life, or at least the next few years, I should see a celiac disease specialist now and again. So can’t I just have a standing referral?

No.

Instead, before I can see my gastroenterologist to try to find out why I still feel crappy after over a year of being as carefully gluten-free as can be, I have to:

  1. call my PCP’s office
  2. wait on hold
  3. talk with a receptionist who seems determined not to understand what I’m asking for or help me to get it
  4. wait nearly a week for a return phone call
  5. follow up myself
  6. learn they need me to supply the doctor’s ID number (whether they were planning to ever, oh, call me for that information, or why they couldn’t ask me for it the first time I called, I do not know)
  7. tell them the ID number
  8. be advised to see my primary care doctor about whether I need to see the specialist
  9. snap that I have a chronic condition that my doctor already knows about
  10. feel bad for losing my temper
  11. agree to wait several days more for them to put through the referral
  12. and then and only then, finally, make the appointment with the specialist I already saw a year ago, who we all know I need to see.

I understand Oxford wants me to get referrals rather than run around willy-nilly to specialists and expect insurance to pay for it. They don’t trust me to know who to see, and why should they? Most people are idiots, and I haven’t proven to them that I’m not.

But wouldn’t it be nice if I could?

Look, I’ve been SAT tutoring for a while now, and if there’s one thing SAT tutoring will do, it’s turn everyone involved off of standardized tests. But some tests are necessary proving grounds or barriers to entry. No one wants people behind the wheel who haven’t passed a driving test, right?

So what if there were a test for basic medical common sense? Since “the prevailing ethical mantra in medicine” is supposedly patient autonomy (scoff), we could call it the PAT (Patient Autonomy Test). Those who passed could be trusted to refer themselves to specialists.

Insurance companies should be on board with this—after all, if I wind up needing to see a specialist, they lose money by making me see another doctor first to get the go-ahead. With the PAT, we all save money (and time).

Questions might include:

What kind of doctor should you see if you have a lifelong disease primarily affecting your gastrointestinal tract?

a) a gastroenterologist
b) a podiatrist
c) a cardiologist
d) none of the above

In your opinion, specialists and specialized medical tests and procedures are:

a) fun toys to enjoy at a whim
b) resources to turn to under specific, necessary circumstances
c) both

Are you:

a) a child
b) an adult capable of rational thought
c) a complete idiot
d) really struggling with these test questions

A quick reading comprehension portion on a passage describing recommended follow-up care for a specific condition could come next. And then a section on triangles, because—as my SAT students could tell you—that’s stuff we all really need to know.

bubbling an answer on standardized test with pencil

Don’t make any stray marks, now.
Photo © biologycorner | Flickr

What time wasters get your blood pressure up? And do you daydream about patient autonomy, too?

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On time management

To-do lists are great. In fact, 96 percent of people who keep them say their lives are better with to-do lists. (Go figure.) I think I’m part of that 96 percent, but I’m certainly among the 50 percent who write down tasks they’ve already done just to be able to cross them off. I can’t help it; it’s thrilling.

Herewith, then, my most recent list.

Today I:

checked2Looked up my latest symptoms on WebMD

checked2Learned more than I remotely wanted to know about “pulsatile tinnitus

checked2Cross-examined self for evidence of hypochondria

checked2Decided symptoms actually exist

checked2Complained about symptoms

checked2Blogged about symptoms

checked2Tweeted about symptoms

checked2Googled autoimmune diseases associated with celiac diseases

checked2Remembered a few other symptoms and Googled those, too

checked2Tried to determine whether my hair is thinning

checked2Decided it’s too soon to tell

checked2Worried anyway

checked2Searched insurance database for PCP in my new neighborhood

checked2Got discouraged with system and switched to Google

checked2Bemoaned lack of reliable Yelplike system for finding new doctors

checked2Got discouraged again and gave up for the day

Tomorrow I’ll:

unchecked box

Actually do something about it.

Despite appearances, this post was not sponsored by Google. Do you spend more hours Googling things than solving them? If not, how do you manage your time (and self-care)? Do you keep a to-do list? Check anything good off lately?

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Stress Test

By now, I think just about everyone I know has shared this New Yorker comic with me:

david-sipress-it-s-a-simple-stress-test-i-do-your-blood-work-send-it-to-the-lab-and-nOkay, fine, it was only about five people, but I still find that significant. Of all the New Yorker comics that exist and of all the neurotic people that could jump to mind upon seeing them, this comic puts my friends and family in mind of me.

Fair.

Recently, I watched the movie Romantics Anonymous (Les émotifs anonymes) with a friend. (The movie is very sweet, and French, and available on Netflix, so if you’re into romances about socially anxious people and chocolate, check it out.) In it, a character claimed that the three most stressful situations in life are moving, weddings, and exams.

My friend wondered, “Are exams really that stressful?”

I said, “Maybe he means medical exams.”

She replied, “You would say that.”

Also fair.

Recently I underwent a new medical exam of my own, and alongside it my usual trio of Stressing, Obsessing, and Second-guessing (yes, that’s SOS for short).

In advance: I stressed over whether I was following the preparation diet properly. I went online the day before—never wise—and found prep instructions from other doctors that included instructions mine hadn’t, all of which it was too late to implement. I stressed over how my change in routine for the day of the test would affect me for the rest of the week. I stressed over getting another diagnosis. I stressed over not getting another diagnosis.

On the day of: I stressed about whether my doctor’s office was properly handling the referral and billing process for my insurance (with good reason, turns out). I stressed about whether I was blowing the right way into the breath tester thingamabob. I stressed about the fact that midway into the test the receptionist realized she’d overlooked a detail about my insurance.

Properly dealing with this detail, I learned, would involve time travel. I stressed about not knowing how to time travel.

For the rest of the week: I continued to stress about the insurance, making phone calls to two different doctor’s offices and to the insurance company and not knowing what to say once I got on the phone with any of them.

To one, I said, helplessly, “I feel like the middleman here; I don’t know what I’m talking about,” to which she replied, “You are the middleman. You’re the patient!” I also said, to the same receptionist, “I’m only twenty-three!” Poor thing, she had no idea she was in for an impromptu counseling session, but she handled it well. Maybe twenty-three isn’t that young, considering in some places and times I’d have several children by now and be managing a household. Be that as it may, it’s true: I had no idea what I was doing. And it was stressful.

When I got the results: I compared my chart to others online and stressed over whether my doctor had gotten the diagnosis right. Those graphs don’t look the same! I thought. The peaks aren’t right! I stressed about taking a potentially unnecessary antibiotic. I stressed about my insurance’s prescription coverage. I read studies, second-guessed my doctor’s choice of antibiotic, then worried that I wouldn’t hear back from the pharmaceutical company before the weekend to learn whether my new tablets were gluten-free.

Now: The test is over! All I have left to stress about is whether I’m taking my antibiotics with enough time before and after meals and between doses and with enough water and without lying down within the next 10 minutes—why is that?—and without forgetting a dose. I’ve woken up several mornings convinced I’d forgotten to take it the day before (no wonder I’m having nightmares).

Oh, and if all that’s not enough and I feel myself entering stress withdrawal, I can always stress about whether or not any of this will do me any good.

Or about how stressed I am.

Tell me how you deal with stress, and your thoughts on the top three most stressful situations in life. Do you too Stress, Obsess, and Second-guess?

If you’re looking for more on medical stress tests, the fine ladies behind Breaking Up With Captain Crunch and Sassy Celiac have both written hilariously about their colonoscopies—fun!

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