Sometimes I think I need the affective equivalent of the Mac OS spinning pinwheel or the Windows hourglass to use when I am in one of those situations that taxes my resources way way way beyond their capacity.  A message that says “This person has become unresponsive.  Do you want to wait or force quit?”  Or in the case of yesterday’s dealings with the insurance company and my primary care’s office/billing coordinator, “A fatal error has occurred.  Out of patience.  Shutting down.”

It would spare me the pain of having to try to explain what I’m trying to explain while also trying to explain my processing.  Which I will do.  At length.  Because, to continue the computer analogy, I have a somewhat quirky operating system courtesy of my very dysfunctional upbringing.  I’m like the old Dell in the corner, the one with all that memory but which has an old crappy processor and is running Windows Vista.  Sure, I have some really cool programs but if you tax my resources by opening up too many browser windows running all kinds of flash, I have nothing left for the simple operations like switching tasks appropriately or, oh I don’t know, being able to handle your choice to insert some clip art into a Word document.

Yesterday was a very taxing day.  It’s been a taxing week, with a long prodrome.  This week, I had a conference way out in the Western part of Northeast State that my boss, when she was feeling pissy with me back in March, basically insisted I go to.  Then Wednesday through Friday is another conference, which I am presenting a nearly 2 hour workshop/lecture at.  And next week is another conference.  On top of all of this, I have a few fires that keep popping up at work…last minute “OMG” type stuff that has to get done or at least considerably started now now now.  Oh and all the normal stuff that I do for my job too.  I am doing all of this juggling on between 850 and 1100 calories a day – 1100 is a GOOD day and is only accomplished with significant time, effort, and on days when I’m out of the house, extra weight because wherever I am going, I have to bring my own food or run the very high risk that I will have nothing at all to eat.

This does not make for a happy, well adjusted set of responses to stressors.

So when my health insurance company called me after part one of the week’s three day conference to tell me that oh they changed their minds (again) and I  can’t see my primary care as a primary care because my doctor’s office either can’t or refuses to bill as a primary care for me, I was not in an ideal position to handle that.

I’ve been dealing with this particular issue for months.  I have several pages of typed notes.  And among all of it, the one person I have NOT been able to connect with is my doctor’s billing/office manager.  I left her a message a few weeks ago asking, as recommended by the insurance company, if she can tell me whether my primary care CAN bill as a primary care with this insurance company. She called back….oh it was a few days later I’m sure, and left a message that did not at all answer my question.  She answered a different question, the one the insurance company always starts with, and which I know from miserable experience that you have to press the largely not very with it people who you first get on the phone when you call Big Crappy insurance to get them to even understand what you are asking.

Here’s the background on the plan and the conundrum.

  • My plan has two tiers.  There’s what we can call the basic network of providers and a preferred network of providers.  All of them are in Big Crappy Big Shot insurance network, just some are also in Big Ass Teaching Hospital Preferred Network too – this distinction makes the two tiers of coverage/billing/copay.
  • If you see a specialist in Big Crappy Big Shot network who is also in Big Ass Teaching Hospital network, you pay $15 as a copay.
  • If you see a specialist who is just in Big Crappy Big Shot network but NOT at or affiliated with Big Ass Teaching Hospital, you pay $40.
  • Moreover, the plan I have does not REQUIRE a primary care, but it does allow it.  A primary care in Big Crappy Big Shot network can bill as such and can therefore charge a $15 copay for primary care visits.  And, trivially (from a logic perspective) a primary care in Big Crappy network who is also in Big Ass Teaching Hospital network can charge a $15 copay because even if they are billing as a specialist and not a primary care, it’s only going to be $15.

Ok.  Got it?

So my doctor is in the Big Crappy Big Shot network and is not in the Big Ass Teaching Hospital network.  I consider him my primary care, he considers himself as my primary care, and he is who I see for my primary care.  He does have a double specialty but in my state with the primary care shortage, the doc who you see for primary care can have a specialty that is not traditionally one of the primary care specialties.  I double checked this with Big Crappy Big Shot healthplan in one of the very early phone calls.  So, I should, theoretically, be able to see my guy as a primary care and have him bill both the insurance company and me as an in Big Crappy network primary care.  I.e. I should have a $15 copay.  And yet it keeps coming to me as a $40 copay, suggesting that he is billing as a non-preferred specialist.

A reasonable question here is does my doctor not have a primary care contract/privileges with this insurance company or is there just some mistake in how it is getting processed in the billing cycle.  What the insurance company keeps thinking I am asking and which I have to break through every single time we talk about it is “what is my copay to see a specialist who is in Big Crappy but not in Big Ass Teaching Hospital network for a specialist visit?”  Why the fat frickity frick would I be asking that?  That is easily answered.  It is very clear.  I would not spend hours trying to clear that up.

The insurance company tells me that the bills coming in from my primary care visits to this doctor are coming in from this doc’s office coded for specialist.  Hence the $40 copay.  “Ok, well, can they bill for him as a primary care in your plan?” I ask…and I have to ask it alot since I’ve been through three rounds of laying this all out, then getting to the point where I can ask that question, then told they have to research it and call me back, then called back with an answer that either isn’t an answer or, as I said, isn’t an answer to that question.  Yesterday, I spoke with someone at Big Crappy who generally gets the issue and who I have to spend far less time setting it up for.  She tells me that I should call the doc’s office and find out if they just don’t bill as a primary care.  “Does he have a primary care contract with you?” I ask.  She doesn’t know, provider services would but I can’t call them.  My doctor’s office should know this, she tells me.

So back to the doctor’s office and the billing manager.  I left this question for her a few weeks ago.  She called me back a little while after I left that initial message.  Instead of answering my question about whether my doc can bill as a primary care in Big Crappy Big Shot insurance, she says in the voicemail she left: “Your insurance doesn’t require you to have a primary care.  The reason for the $40 copay is that if you see  a specialist who is not in the preferred network, it’s $40 because you have a tiered plan.”  Ah, so she answered the dumb question.  I did not blame her for the dumbness, because I know that the folks at Big Crappy will assume that any question about copays is THAT question about copays.  I call her back that day and I get her voicemail.  I was on a short break at a conference (yes, another), and so I had to speak quickly and concisely.  I thanked her for calling them and explained that unfortunately Big Crappy didn’t answer the question I actually had, which was etc. and yadda yadda and whatnot.  I wait.  She did not call me back.  This takes us to yesterday.  Yesterday, the Big Crappy people follow up again telling me that all of my bills from the doc in question are being submitted from his office as specialist visits, not primary care and that I need to ask the primary care’s office about whether he can bill as a primary care with them.  Big Crappy tells me that the doctor or his billing manager should know this and if they don’t, they can call provider services.  Big Crappy insurance gives me the provider services number too.

So I call the office manager yesterday.  I leave another message.  I sound brittle, because I’m trying really hard not to sound as infuriated and frustrated and just plain EXHAUSTED as I am.  I realize as I am leaving this message that maybe the reason why she hasn’t replied to my clarified question that I left her a few weeks ago is that she might have been on vacation or out.  I call the main number and ask.  “Oh she’s been in and out.  I’ll tell her you called.” the secretary tells me.  “Uh, ok.” I say, realizing then that this means the billing coordinator has just been blowing me off, probably assuming she answered my question and not interested in re-answering it or explaining it.  So I add “can you let her know that I did get her message but I did have a follow up question and that’s what I’m calling about?”  Yes, says the secretary.

The office manager calls me and from the start, she’s got a chip on her shoulder.  I try very very very hard to work with her, but it is clear that she feels that she has put in more than enough time on this.  As she is explaining it though, it’s clear that she’s still answering the wrong question.  So I try to let her know, and believe me, I try gently, that I appreciate the effort but that I think the insurance company didn’t understand the question.  She says that my doctor can be a primary care with my plan, but that with my plan, I don’t NEED to have a primary care, and that she only has one provider number for my doctor.  I say that I know that I don’t have to have a primary care, but I can have one…and say “the problem is, there’s a difference between ‘need’ and ‘can’ here…” and I was going to finish that sentence with “that the insurance company seems to overlook when they are answering questions about primary care for this plan” but she cut me off (about the 5th time she interrupted) and said “Oh well I’m sorry that my understanding of the English language is so bad that I apparently don’t know the difference.”

Boy, that escalated quickly.

There is just no need for that sort of shitty attitude.  I don’t tell her this (5 years ago, I would have).  I say “It sounds like you are offended, and I think you think I was insulting you – is that accurate?  Are you offended?”  “Yes” she said sulkily.  “It really wasn’t my intention.  I don’t think that you don’t understand the difference, I think the insurance company is playing games with words here, and I just need some help breaking through that.”

I think I deserve a fucking medal for being so god damned nice about her shitty attitude.  And mind you, this is on a grand total of about 200 calories at that point for the whole day.

So I’m still processing this shit.  I just really don’t know how to proceed or where to file this away in my brain so that it doesn’t alternately piss me off and distress me greatly.  I need my primary care to be a part of my team, on my side to help me manage elements of living with an evolving, chronic illness.  It’s already tough enough that the systemic barriers between doctors’ offices and health care networks, on top of the historic culture of medicine, actively prevent collaboration between care providers.  Add to it leaving the patient out to hang on dealing with the insurance company and billing and you’ve got something that is just so unbelievably toxic.  While I process, I think I need to hang up the “fatal error” sign, spin the pinwheel, and just let people know that all of my resources are otherwise engaged so please don’t ask me to open up another tab in facebook or you’re gonna get blue screened.

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  1. Oh, this IS so toxic. Great post. I think you do deserve an award for dealing with that woman as I had to deal with some stupid billing error and got the same attitude and just threw it back at her. When we’re sick like this, our threshold for BS is just gone. I can relate so much to all of this–even the work part as I was still working f/t the 1st 1.5 yrs and dealing with this crap and appts. at 7 am and was the walking dead (while barfing from the pain all day). I really don’t know how much more I can take of the US healthcare system at this point, or how you can keep dealing with it + workings f/t. The rudeness/confusion/prior-auths./etc. are everywhere and I am so fed up (hence, being volatile–lol). Why can’t we just have what the damn W. Europeans have and the rest of the modern world (minus Canada)??? It’s so easy! It works! No one is going broke over there! They don’t even complain about healthcare. Imagine that!

    Do you ever wonder how the healthcare system got this way. I know it wasn’t like this when I was younger. I think if the gov’t won’t fix it, despite trying, then they should provide liaisons for the chronically ill/disabled to deal with the stupid insurance companies and all their nonsensical rules and regulations! Right. I seriously think I will have a total nervous breakdown one day–like one call to them or a damn billing dep’t will be the straw that broke the camel’s back and then it’s off to the cuckoo’s nest.

    Hang in there (put up the hourglass). You don’t need any of this and I so get it…

    • Thanks for the reply, I needed some nice words and encouragement. I know exactly what you mean about the straw. My husband and I call that “the camel straw”. I do think one of these days that is going to do it for me. It came pretty close on Wednesday.

      A liaison would be great!

      Yeah, I don’t know exactly how it got like this. I’m too young to know what navigating it was like before the early 90s, my parents handled stuff then. I think docs will tell you it was the advent of managed care that did it, or started it. I suspect it’s that layered on top of medical culture, which invalidates the patient and which elevates the doctor and by proxy his or her staff to god-like status. I truly believe one of the big underlying points of conflict in my interaction with this woman was that she didn’t think I had a right to even be asking the questions I was asking.

      • Glad I could be a source of support (at the very least). I think you’re right about how the system fell apart and as we’re close in age, I don’t recall much before the ’90s either, but my step-father retired in his late 50s b/c he had a successful practice and could just quit it all and was sick of the system and the crazy malpractice insurance (he’s the OB/GYN). So, that’s how I know things were once different.

        I don’t think we (as patients) are really ever allowed to ask questions in general! I swear that’s why my corneal specialist is such a snot with me. Don’t question the doctor–OMG! Ditto for the staff or the big ass insurance companies. You need to find some acronym for them.

        Well, I wonder if we can still blog from the cuckoo nest? My counselor will probably send me there the next time I irk them. Oh, my other dream (aside from the liaison one) is some place where chronically ill people could go, like TB patients back in the day, and you don’t have to stress about anything. I imagine sitting on a comfy lounge chair on a large lawn (what’s lawn?) and being waited on hand and foot (and getting lots of free PT). Bet that will come down the pipeline, too. Lol! Maybe it’s hidden in the Affordable Care Act and the right-wingers missed it.
        A 🙂

      • I remember ex husband’s purchase of insurance too….crazy expensive and that was the late 90s. I’m sure it’s just gone up since then.

        I’m convinced that as baby boomers hit the “body falling to pieces” mark in numbers (we’re not quite there yet) there will be some really big changes in how people with chronic illnesses are treated. Right now, chronic care and elder care suck massively – but these are not people who are used to being passive. They are an activist generation, and I imagine that they will be quite a bit more vocal when they start entering this system in big numbers.

        Yeah, I suspect I may end up in a bit of a “time out” too. I’m going to see a counselor who is supposed to help me connect with someone for long term therapy…but most of the sort of basic to intermediate level counselor types do not handle someone like me well.

      • I think you’re right about the boomers when they actually get sick. My dad would be the most volatile patient ever, but he goes to all his specialists for fun and life-extending purposes as you know. He did get a bad staph infection when I was a kid and ended up in the hospital and I heard that they wrote “incorrigible patient” on his chart to warn the docs and nurses. I vaguely remember visiting him and he was a neurotic mess, per usual. Lol! I should have a sign around my neck that says what they wrote.

        Well, I do hope you eventually get to the right counselor. There probably is someone out there w/a lot of experience who thinks outside of the box and can understand it all. Fingers crossed!

  1. Blending in | Final Trick

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