By Danielle Ofri
New York Times
Midway through my first pregnancy, I was told that I needed an injection that is standard for an uncomplicated pregnancy. I assumed it would be simple to get approval from my insurance company.
“Thank you for calling,” the digital voice at my insurance company answered. “Please listen closely, as some of our options have changed.”
Tinny music churned out of the receiver while I sorted papers on my desk and paid the cable bill. I pulled out a step ladder to change the battery in my smoke detector, when the music suddenly stopped. There was the unmistakable ring of a real phone and I straightened up in preparation.“Thank you for calling,” came the recorded response. “Please listen closely, as some of our options have changed.”
Nearly an hour after I’d started, I finally procured an actual human being. I was then forwarded to a “care coordinator,” then to a “case specialist.” I had to plead my case to four different people before I achieved the holy grail of a pre-approval.
All this for a standard medication for a healthy pregnancy? What about my patients who are truly sick? What about those with limited education, or who don’t speak English well? How do they navigate this system?
I suspect that many give up in frustration. I’m not much of a conspiracy theorist, but if someone suggested that the byzantine insurance system were set up to deliberately discourage patients from making claims, I wouldn’t argue.
After my ordeal with the insurance company, I wanted to breathe a sigh of relief. Unfortunately, I had another onerous task ahead of me. My otherwise law-abiding black Lab mutt had somehow misplaced the New York City dog license that usually jingled with the other tags on her collar. The thought of navigating the municipal labyrinth of New York City governance filled me with a dread, but I stolidly dialed the health department’s veterinary services office. I laid out my tax returns, figuring I might complete them while on hold.
The phone rang once. “Hello?” I was so stunned and unprepared for a human voice that it took me a minute to react. I stumbled as I sheepishly explained my dog’s indiscretion with her license tag.“Oh, just jot down her license number on a piece of paper and send it in with a dollar.”
“Yes, just put a dollar in the envelope and you should get the replacement tag within two to three weeks.”I replaced the phone back on its base, in a state of shock. Could it be that simple? Could this entire encounter have only taken one minute? And was it really going to cost only $1?
When I reflect back on my years as a doctor and my years as a dog owner, I realize that everything has been easier when it came to my dog. I can call and talk to my vet. I can get an appointment the same week. I can buy the medicines and get the blood tests — at a reasonable price — right in the vet’s office.
My own patients have a far harder struggle in every respect. My foray into the insurance world as a patient exhausted me and pointed out everything that was wrong with our health care system. How is that the simplest routine medical matters have been made so complicated by our insurance companies? Why does every encounter require a veritable girding up for battle? And how many patients do not get the care they need simply because they are defeated by the bureaucracy?
There’s a lot we can learn from animals in many facets of life — Lord knows, a nice massage behind the ears could do a lot of us some good — but I am consistently impressed by how much smoother veterinary medicine runs. Of course it’s too simplistic to make a direct comparison, but I hope that in this ongoing health care reform we consider ways to make things easier for patients.
Standardized forms across insurance companies would be a major first step. Simplified, humane means for a patient to contact an insurance company would be another. Perhaps an independent commission could nab insurance companies that stonewall their patients (and those that stonewall the doctors, forcing them to fight for their reimbursement).
Getting sick is taxing enough; dealing with the insurance company shouldn’t have to be a battle. Perhaps we can take a few hints from veterinary medicine in terms of ease of access and civility. A bowl of biscuits on the counter wouldn’t hurt either. (From the New York Times,)