Tuesday, September 2, 2008

Beware Cheerful Women Who Answer the Phone

Just got off the phone with Keith's doctor's office. We've been trying to follow doctor's orders and get an appointment with a hematologist because Keith developed anemia while in the hospital as a result of the drop in red blood cell production that can occur in cases of chronic illness. It all sounds pretty serious to us, so we're committed to jumping through the hoops necessary to make it happen. Trouble is, the hoops are moving, and on fire.

The hematologist that Keith saw in the hospital is not in his Humana/Medicare provider network. When we called for an appointment, the cheerful woman on the phone told us that the first $10,000 in expenses was our responsibility. Naturally, our next call was to Humana/Medicare to find a provider in the network.

Humana/Medicare gave us the names of several doctors in network, we chose the ones closest to Keith's primary physician and called for an appointment. The cheerful woman who answered the phone asked that we have Keith's records sent over before any appointment could be set, once she had those records she would call us to schedule the appointment. We immediately called Keith's primary physician with the request and were told it would be taken care of the next day.

About a week later, we realized that there had been no phone call so we followed up with Keith's doctor who assured us that the files had been transferred. We then called the hematologist's office who told us the person in charge of that was out, they'd check and call back.

Another week passes.

Another call to Keith's primary physician's office, more reassurances, ball back in the hematologist's court.

Another week passes.

I spoke with Keith's primary physician today and he said he'd check on it. A few minutes later his office manager called and said the doctors we had selected did not accept Humana/Medicare insurance. I called her back, told her that we got those recommendations directly from Humana/Medicare. She hesitated for a moment and, as if she was telling me a state secret, said that those two doctors were joining the practice of the original hematologist who saw Keith in the hospital. (Thus forcing us back in the position of having to pay the first $10,000 in expenses if we chose to make an appointment with them.)

I was appalled. If we had been told a month ago that these doctors were not going to be accessible to do the job, we could have made an appointment with another of the in-network doctors. In my estimation, they had knowingly continued to delay the appointment citing paperwork and blaming anyone who wasn't on the phone so that this merger could occur and they wouldn't have to deal with Medicare patients like Keith.

Fortunately, Keith is of hardy stock and is hardly wasting away from anemia. However, if this need was so urgent in the hospital that he was given direct hemoglobin and iron transfusions to strengthen his red blood cell count, why the hell was this appointment given no urgency here in the 'real world'? How are we expected to trust our doctors when the most urgent question is "how are you going to pay for this?" when "this" can't even be proven to be a problem that we as patients should give any urgency to at all? We are fortunate in that Keith & I are very resourceful, able to ask questions, and find alternatives. However, as Keith, who is a great poker player says, it's hard to win the game with the deck stacked (and re-stacked) against you.

It has been just about a month and we still haven't gotten an appointment set. So, the ring cycle begins again, and we will
begin calling the next bunch of doctors and trying to get them to care. One thing I am sure of is that a cheerful woman will answer the phone

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