Thursday, April 17, 2014

Obamacare and Me: Help me. Please. Somebody.

Episode Two:  Doctorama, or,  How I Learned to Stop Worrying and Love Big Government

In our last episode: The insurance plan I liked and wanted to keep was canceled.   I applied for a new government Exchange policy, and as I was doing so, I learned I had a tumor on my kidney.  After receiving a series of conflicting government messages and chat line advice (“Your enrollment is complete.   Your enrollment is not complete.  Wait for your insurance company to contact you.  Don’t wait for your insurance company to contact you”)  I flipped a coin, chose a course of action, and wound up with a confirmed Exchange plan in the nick of time.  Both sets of doctors confirmed they were authorized providers with my new company.

In late December, tests and procedures approved under my old policy confirmed that I had a cancerous mass on my kidney, which had spread to my bladder (yeah, I know.  Eeeewwwww.  I felt the same way.  If you’re curious about the precise type, it was Transitional Cell Carcinoma—a smoker’s cancer.  I don’t smoke.  Never have.  The doctor had a hard time believing me.   I’m not sure he believes me now.)  In early January, I went in for an outpatient procedure under my new policy to remove the bladder cancer, which fortunately had not advanced very far and could be taken out with little collateral damage.  The scoping procedure and the follow up surgery are astonishingly uncomfortable.  I won’t go into the details but suffice it to say that no incisions are involved.  (Use your imagination.  Are you squirming yet?)   The kidney removal could not be done on an outpatient basis, however, and would require a hospital stay.   This second, more complicated surgery was scheduled for the final week of January.

Late in the afternoon on the day preceding the surgery, I got a call.  A very nice case manager with my insurance company told me that neither doctor was an approved provider with their plan.  My vision dimmed and my head swam.  For a moment, I didn’t know whether to flip, flop, fly, or go fishing.  But before I could begin shouting, have a heart attack, or run screaming into the afternoon, she hastened to assure me that the next day’s surgery had been approved anyway under a “continuity of care” principle.  I could have my operation and one follow up visit.  But that was it.  After that, I’d have to choose new doctors.   And by the way, she said, it was an open question as to whether the previous surgery I’d had—the outpatient procedure—would be paid for.  She told me she really couldn’t guess, but said that if the claim were to be rejected, I should appeal.  (Eventually, the company did pay those bills.)   I pointed out that I had looked up my primary care physician on the company’s website before signing up, and that both doctors’ offices had assured me they were on the plan as approved providers.  She was quite apologetic.  As it turns out, the Exchange plans the company offered were not in the same system as their other policies, and had different provider lists.  Who knew?  Not me.  Not my doctors.  The lady admitted that confusion reigned all around, and apologized again.   But I wasn’t angry.  How could I be?  Reading between the lines, this case manager had fought personally to see that my surgery would go forward, and had won a major victory on my behalf.  These were not, after all, bad people from a John Grisham novel.  They were just confused people.

The next day, I had my operation.   A good time was had by none.   There were complications.  And it  was a damned good thing I was in the hands of a world-renowned surgeon.  He told me later that the kidney was so enlarged that it had completely wrapped itself around the renal artery, requiring great skill to separate it without killing the patient (that would be me).   I then spent eight very long days waiting for the biopsies of surrounding tissues to come back.  Finally, they did—and the findings were negative.  No evidence of any spread.   The news capped a six week period of not knowing whether my time left on planet Earth would be measured in days, weeks, months, or years.  Throughout all this, my lovely wife remained very stoic.  I’m not sure how to take that.

By the end of February, two things were clear. One, I was going to live long enough to have to pay my bills.  And two, it was imperative that I keep my highly skilled doctor, as I would almost certainly be needing follow-up surgeries (bladder cancer almost always comes back).  I started making calls.  A little investigation showed that none of my doctors was on any of the plans offered on the government-run Marketplace Exchange website.  But after talking with my existing company, I found it would be possible, in theory, to dump my Exchange plan and replace it with a non-Exchange plan offered by the same company—as long as I did so before the close of business on March 31, when open enrollment would end.  In late February, I chose a comparable plan, confirmed (this time verbally with a company rep) that both my doctors were on it, and filed the appropriate paperwork.

When I’d applied for insurance on the Exchange in December, I’d received an immediate approval.  Not this time.  Three weeks after applying, I still hadn’t heard a thing.  I hit the phones.   After spending some time getting bounced around from agent to agent, I finally found someone who said she couldn’t help me directly, but could put in a word with the enrollment department on my behalf.  I was not allowed, however, to speak with enrollment staffers myself.   The call ended without a solution.   However, within the hour—1 pm Friday March 21—I received an e-mail informing me that my application had been approved.  The message stated quite specifically, however, that I should not cancel my existing plan until I had received my membership materials.  It was still a week and a half to end of open enrollment.  I was good.

Or so I thought.

When the last day of open enrollment arrived,  I still did not have my membership papers in hand.  I had received no snail mail, no emails.  The premium for my old policy was now due.  I checked and found out that the credit card I had submitted with my application for the new one had not been charged.  This raised questions.  Was my new policy in effect, or not?  Could I cancel my old one, or not?  If not, must I then immediately pay the April premium for the old policy?  If I did pay the April premium, which would be past due in one more day, would both policies then be in effect?  If so, would I be able to get a refund for the old one?  Was there something wrong with the credit card number that I submitted for the new plan?   So, I hit the phones just after 9:30 AM.  Here is what followed:

9:38:  I call the toll-free help number listed on my March 21 email, and get a voicemail inviting me to leave a detailed message.   I disconnect.

9:40:  I call the other number listed on the email, which is not toll free.  A woman answers the phone.  Her greeting is garbled but I do not recognize the company name that she mentions.   I identify the company I'm trying to call and ask her if I've reached the right number.  She allows as how she is with the company, but says I've reached a department that is only for inquiries about broker commissions.  I double check to make sure I have dialed the number I had intended to dial, the one listed on the email, and I see that I have.  I point this out to her, but she insists that I have not called the correct number.  She gives me a third number to call.

9:43:  I call the third number.   I am on hold for 1 hour and 12 minutes.  Finally, a man answers the phone.  I explain in detail who I am and what I need.  He apologizes, tells me I have called the wrong number, and offers to transfer me to what he says will be the correct one.  I explain that I have already been on hold for nearly an hour and a quarter, and that I had been transferred to him by another person in his company who'd assured me this would be the right number.  He apologizes but repeats that he can't help me and will need to transfer me.  I agree to let him do so.

11:00:  I am transferred to my fourth number of the day and am on hold for only 7 minutes, after which a lady comes on the line.  I repeat my detailed explanation of who I am and what I am trying to accomplish.   She looks up my account, and is able to confirm for me what I already knew, that my replacement policy application was approved.  But she says she needs to put me on hold to research my other questions.  At 11:15 she comes back on the line and tells me that she cannot answer my questions, but will transfer me to someone who can.  At this point I believe I hear her tell me (but I could be mistaken) that she will stay on the line to make sure the call goes through.  She transfers me to a number that answers with hold music, and she does not stay on the line.  Now utterly abandoned, I am bereft of joy.  With a crushed spirit, I begin to consider harming myself and others.  Preferably others.

1:15 PM:  As of this time, I had been on hold at this fifth number for two full hours.  The time spent was not completely devoid of entertainment value, however, because the hold messages were quite interesting.   First, a recorded voice would say, "We apologize for the delay.  Your call is important to us.  The next available representative will be with you shortly."   This would be followed by a clip of music that ran about ten seconds.  Some of the music clips contained snippets of voice-over audio apparently intended as health tips.   Some tips contain only a sentence fragment, such as:  “—Until children reach one year of age and weigh 20 pounds.”  I think the rest of the message, had it played out, would have said, “At which point, this call will be answered.”  A few messages did contain a complete thought, like this one:  “Walking can help you manage stress and soothe your feelings.  For your safety select a good pair of walking shoes that support your arches and heels.   And always remember to check with your doctor before starting a walking program.”  That useful tidbit was followed by a minute of dead silence, and then another message stating, "We apologize for the delay.  We know your time is valuable and we appreciate your patience.   Please continue to hold and we will be with you soon."  And the cycle repeated.  And repeated.   After two hours of this, my mood had lightened sufficiently to where I was no longer thinking about harming myself.  But others were not yet out of the woods.

1:30 PM:  Elvis was still dead, my cell phone was nearly so, and I wasn’t feeling so hot myself.  After nearly four hours on the phone, 95% of which was spent on hold, I gave up to go to lunch.  And as I stepped into the garage, a disturbing thought crossed my mind.  If a city bus were to smack into my Mustang while I was on my burger run, or if I were to keel at the wheel from a stress-induced heart attack or stroke, would I be covered?   The fast food joint I had in mind wasn’t so far away.  It occurred to me that I could walk.  I’d heard somewhere that walking could help manage stress and soothe feelings.  And I did happen to have a pair of walking shoes—good ones that supported my arches and heels.  But I had not checked with my doctor to see if a walking program would be appropriate for me so soon after surgery.   And then it hit me:  at this point, with no answers and with open enrollment ticking to a close, I didn’t know who my doctor was.  Or if I even had one.

As of this posting, two and a half weeks later, I’m still not absolutely sure.   


You can find the entire series of blog posts on my medical journey on this page:  My Medical Travails:  Adventures in the Toilet Zone.  And of course, I invite you to check out my author's page, where you can learn about my novels, see critic and reader reviews, download sample chapters, and find purchase links:

© 2014 by Forrest Carr.  All rights reserved.

No comments:

Post a Comment