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.
Update:
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: www.forrestcarr.com.
© 2014 by Forrest Carr. All rights reserved.
No comments:
Post a Comment