My irregular musings on city life, politics, baseball, roller derby, and whatever happens to be getting my goat today.

Thursday, September 10, 2009

Sprain - Part 2

Right on cue, the big evil corporation that "provides" me with health insurance has decided to screw me over. It's as if someone out there (probably an evil web-based insurance company AI) heard me typing
And anyway, while it will be great to have a public insurance option to cover the uninsured, I have no intention of ever using it for myself while I can get employer-subsidized private health care.
and thought to themselves, "hey, it sounds like we're not doing enough to make this guy suffer." So within 24 hours I get a call from the physical therapist's office.

Tuesday morning I had my initial PT session with a friendly therapist named Jamie. Basically, she repeated the stress tests the Sports Medicine Genie performed last week (Does this hurt? How about this? Okay, how about this?), then attempted to yank my arm all the way out of its socket. Oddly enough, that part felt pretty good once I got used to it, since it apparently took the pressure off my bursitis for a moment. Seriously, as in "my bursitis is acting up." When did i get so old?Afterwards, she gave me some odd activities to do at home, including dangling a can of soup from my limp arm and making circles in the air with it, and pulling on a giant rubber band, and scheduled me for several more weeks worth of appointments.

Today they called and said my insurance company had told them that I didn't have a primary care physician on file, and that therefore my referral from my primary care physician was not on file. Since this made no damn sense at all, I called my insurance company. After spending ten minutes or so in voice mail hell, I reached a fairly rude woman in Plano, Texas who told me that my primary care physician was in their other HMO network, but not in my HMO network. I asked why they were mentioning this now, since I've been on this plan for nearly two years and have gone to the doctor several times within that span. She said - seriously - that they have a computer program which randomly selects claims for . . . I wasn't taking notes, but I think the term she used was adjudication. She said that most claims were paid automatically, but a certain number were randomly selected to be scrutinized and my number came up. Now that they've actually looked at the file, they have noticed for the first time that my primary care physician is not someone in their network, and now I have to pick a new one. Since my doctor is not my doctor according to the insurance company, her referral to the physical therapist is not valid. In fact, she said none of the claims should have been paid in the past, but we would just "start over going forward."

This is, on top of everything else, clearly a lie. I mean, they way my doctor got to be assigned as my primary physician was, I picked this plan out of three offered by my employer, I looked up my doctor on the insurance company's Web site, then called the insurance company's registration number and dialed in the ID number I found next to my doctor's name on the insurance company's Web site. So clearly, at one point my doctor was part of my network and subsequently she has been dropped. But according to Texas lady we have always been at war with Eastasia. . .

What I suspect happened is that the insurance company was happy to ignore me as long as my premiums kept getting paid and I didn't need any particularly expensive care. Once I was injured, they went through my records looking for a reason to delay or deny care, hoping if they caused me enough trouble I would go away.

So Annoying Texas Woman told me to get a new doctor and ask them to give me a new referral to the physical therapist. This, of course, is never going to happen. None of the doctors offices I spoke to today refer to the clinic I went to on Tuesday, they all refer only to specialist within their own hospital networks. Evidently some kind of elaborate kickback scheme is in place where by specialists bribe medical practices to refer to them, possibly the doctors are part owners of the firms etc. Anyway I will have to go to an appointment with a new primary physician next week, who will probably refer me to a new Sports Medicine specialist within his own network, who will then repeat the same examination again (Does this hurt? How about this? Okay, how about this?), and then, a couple weeks later I will start physical therapy again at a new, less conveniently located clinic. So several people will get paid unnecessarily, and the insurance company won't end up saving any money by harassing me.

Of course, my shoulder will continue to hurt like a bitch in the meantime, but nobody in the medical industrial complex seems too concerned about that. Some "centrist" politicians have raised concerns that if health care reform passes with a public insurance plan attached, this will be "unfair" competition that may drive private health insurers out of business. To me, that seems like a feature, not a bug. I mean, do people seriously think adding Annoying Texas Woman to the unemployment rolls is a reason not to do reform? Again I will direct your attention to this:
In Japan, waiting times are so short that most patients don't bother to make an
appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic
clinic at Keio University Hospital to schedule a consultation about my aching
shoulder. "Why don't you just drop by?" the receptionist said. That same
afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an
operation. "When could we do it?" I asked. The doctor checked his computer and
said, "Tomorrow would be pretty difficult. Perhaps some day next week?"
America has "the best health care system in the world?" Whoever told you that is your enemy.

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