Modern medical practice and infrastructure is one giant clusterfuck.

The BBQ Pit
21

A huge concern I have is accuracy of charting.

My health insurance company has a spot on their website where you log in and they keep a list of all of your appointments, diagnoses, etc. So you can track your chart. Handy.

So I logged in one day and discovered that, back in February, I went in to see the Doc about pain and numbness in my hands and fingers. Several tests and ruled-out diagnoses later, she decides it’s just carpal tunnel, which, btw, she is not treating or doing anything about. She’s all about me losing three pounds and sees me every three months to track my progress. :rolleyes:

Anyway, I’m logged in and I see that the diagnosis for the initial February appointment was listed on my chart as Kashin-Beck disease. WTF is that, I wondered. So I Googled it. Kashin-Beck is a disorder that Chinese children get from eating moldy rice and causes deformity in the hands. It was pretty clear that I am not a Chinese child, nor have I eaten moldy rice, ever. I print out the Wikipedia page and take that in to my next appointment and played stupid.

“Um, yeah, I saw this diagnosis in my file that my health insurance company keeps and I wanted to confirm it with you. How are we planning to treat this Kashin-Beck Disease? Can I be cured?” :smiley:

Doc blinks a couple times, re-checks my chart on her computer and realizes the medical billing person entered the wrong diagnosis code. She said she would have them fix it.

Fast forward a couple months and a diagnosis has been added to my chart that says, basically, “Random pain in hands.” So no carpal tunnel diagnosis on paper, though that’s what the Doc said to me. I’m an editor and obviously need my hands and fine motor skills to make my living, but cannot get treatment from my Primary doc, who seems averse to even documenting the actual diagnosis on paper for some reason I can’t quite figure. But the Kashin-Beck Disease diagnosis is STILL on my insurance company’s file.

So that means if I lose my job and after COBRA runs out, I will be uninsurable because of a “preexisting condition” that I never had and never heard of. But it appears on my chart, so no private insurance company will ever take me without first taking my left leg, my right arm, and my first born… every single month. Nevermind the asthma and high cholesterol.

This makes me question any other medical charts I’ve ever had, which I’ve lost track of because of changing jobs or my employer changing insurance carriers. I wonder what other mistakes are on my charts and I wonder how frequently this sort of thing happens. Most people never see their actual charts, nevermind do we see the diagnosis codes the billers enter and submit to the insurance companies. My advice to all of you is ask to see your charts, and verify that the diagnoses therein are actually what you’ve experienced. Not that I’m entirely sure you can do anything about it if you catch a mistake. I suspect I will be living with Kashin-Beck disease for the rest of my life, whether I have it or not.

22

Far more often both of these sentences mean, “I don’t know what’s wrong with you, but I feel like I have to do something.”

Here’s why modern medical offices are such a clusterfuck: a single doctor with his own practice needs, at a minimum, a nurse, a receptionist, and someone to do billing (which requires special and arcane training). That’s not counting someone to clean the office and it assumes he can properly manage the business himself. It’s hard to pay all of those people and stay in business.

You can’t really cut those corners, so the next step is to consolidate. So two or three docs try to share a receptionist, nurse, and biller, or billing gets farmed out (which isn’t much cheaper). But it’s hard to have just one person doing all that for two docs–what happens when she goes on vacation? So what you end up with is a big bunch of docs, three or four nurses, two or three front desk people, and a billing “department”.

It’s next to impossible to assign specific doctors to specific staffers (for various reasons), so in essence every staff member becomes responsible for every patient. And there might be 200 patients a day in a big busy clinic.

The phone is another matter entirely. In every clinic I’ve ever worked in (which have all been pretty big), the phone doesn’t stop ringing all day. In my old clinic we had two people doing nothing but answer the phone and messages were still being left constantly; if they stopped to listen and respond to a message two more got left in the meantime. Phone trees don’t even help that much. I don’t know a good way to handle it except to hire a shitload of people to man the phones, but since so many people are calling for what amounts to medical advice you can’t let just anybody do it.

Running a medical clinic sucks. This is why I choose to be employed.

23

?
When I am done with my GYN I go to the front desk and make my appointment for the next year. Your GYN has a stupidly inefficient office … One year about 3 years ago, I got a letter from mine telling me that my original appointment gyn was leaving the practice for a move out of the area, named my new gyn and offered me the chance to change to a different gyn in the practice, gave me the new address for my old gyn and the option to cancel my appointment and move to a different practice.

24

Sorry, the referral to a specialst sent me to a GYN oncologist for a 4 cm mass on an ovary. I have a history with cancer. That was NOT a ‘My buddy needs some cash’. The time before that was to a surgical endocrinologist to remove a cancerous parathyroid gland that was telling my body to move all my calcium into my bloodstream. The time before that was for a tumor that went from pea sized to pingpong ball size in 30 days.

25

My Primary’s office seems to only answer phones on days ending in “t” for about an hour and a half each day. If you manage to call during the magical, moving-target window, you’ll get to speak to a human. I presume they collect voice mail and it’s somebody’s job to listen to all the voice mails and call people back, so they only open their phone lines a couple hours a day.

Would it be asking too much if doctors’ offices used more technology to assist them? For example, I think it would be cool if – after I’ve established a chart – I could go online and request an appointment through some sort of web-based Outlook app and basically book my own times. I bet, after the initial outlay of programming/start up costs, it would be a lot cheaper and would take care of a LOT of phone traffic. What do you think about that idea?

Also, what did you think about my chart story? I’m interested in what you think the percentage of billing/diagnosis code errors are floating around out there, something I’d imagine most patients never think to check or verify. I certainly didn’t until I was diagnosed as a sick Chinese child. :cool:

26

Dogzilla, you might want to sit down, honey. Your father and I have something to tell you.

27

Blue Cross just raised my rates again, 2nd time this year. It’s going to go over $800 a month for the 2 of us. Our budget is such that the bill gets paid toward the end of the month so until the day we pay the bill I’m unable to purchase prescriptions at the insured price (insurance status shows as ‘inactive’ til it’s paid). So I rely on the $4 scripts, samples from my dr, and one free script from the drug company. My dr visits and tests are covered retroactively.

On the other hand, I am so very blessed in my physicians. They are fantastic and they speak to each other. Some of them even have gone to school together. They discuss my health care amongst each other as needed, and I have the good health to show for it. I am a ten year cancer survivor. Both my mom and my brother died from cancer, I’m shocked and pleased to still be here.

28

:smiley:

29

Preexisting conditions don’t work that way. You cannot get treatment for anything attributed to the condition, but other conditions, like hay fever, for example, would be treated. Your preexisting condition would remain uncovered for a period of time under the new policy, after which point it wuold be eligible again. Since you’ve never had that condition, it should not cause you to worry.

Also, if you lose your job and Cobra runs out, as long as you are not uninsured for more than 30 days, you will not be considered to have a “break in coverage” and prexisting condition clauses will not apply. Please do not panic.

30

I don’t think I’m understanding you. So, let’s break it down real simple; talk to me like I’m 2.

  • My chart says I have a disease that I do not. This is largely irrelevant unless I go shopping for private insurance. If I kept up my COBRA and find a new employer, I know about the Certificates of Continuous Coverage (HIPAA Certs, they are referred to) and any new employer’s carrier would cover me, no preexisting condition problems. I get that.

  • But. If my COBRA runs out and I *still *don’t have a job, I have to go shop for private health insurance, as if I have any money to pay for it. (Nevermind that this hypothetical stops right there because if I’m unemployed, I won’t be having any $800+ a month for health insurance. That’s if I’m lucky and get cheap rates.)
    Joe Blow’s Private Healthcare insurance company looks at my records and says, “Ah, you are a sick Chinese child. And you have high cholesterol and asthma. You are high risk. No insurance for you! Or you can have it at a mere $2000 per month.”

I do, in fact, have high cholesterol and asthma. You are saying that neither of those would be treated until I reach some arbitrary point of eligibility again? Good hell. Hope I don’t die from an asthma attack in the middle of the night in the mean time!

I assure you, if I lose my job, I most certainly will have a break in coverage because A) I would never be able to afford COBRA on $0 income and I would never be able to afford private insurance on $0 income. (I am single. There is no spouse with a salary to be my safety net. I lose my job, I’m Screwed.)

But. Just pretending I had a few thousand dollars to burn, you’re telling me that Joe Blow’s Private Healthcare insurance company will cover me, sick Chinese child-disease and all?IF they do, and that would be a big-ass IF, then I’m thinking the premiums would be so cost-prohibitive that it would end up making more sense to stay unemployed and try to get Medicaid.

The stories I’ve been reading and hearing on the intertubes indicate that most private healthcare insurance companies will pretty much seize any excuse not to cover, including pointing to diseases you never had and classifying you as high risk.

31

In the conservative morality, this is all your fault, because you did not plan ahead. Responsible people never get into jams like this, because they have prepared for any eventuality. Ergo, if you find yourself on the wrong side of circumstances, it’s your own damn fault, and you deserve whatever happens to you. What’s more, if anybody offers to help you, they are just enabling your lack of responsibility by infantilizing you and creating a dependence on others, thus making your problems worse. So your suffering is for your own good, you see.

32

Dogzilla,

I am not 100% certain on exactly how it works when you transition to private insurance, however, most states have an “insurer of last resort” which will cover you if everyone else declines to cover you. My understanding, though, is that if you don’t have a break in coverage, you will be covered fully, with no preexisting condition clauses. It’s part of the Health Insurance Poratbility and Accountability Act, I beleive (HIPAA).

This is a lot of what-ifs, however. You are eligibile to remain on COBRA for 18 months, and Iw ould sincerely hope that you have a new job by then.

As for exactly what ailments can be considered preexisting, I am not sure. I do know a friend of mine had asthma excluded (and this exclusion is only for a limited time, say 90 days or so) way back when, so that may still be a legitimate target.

I do agree with the general premise that the way we do insirance in this country is just a mess. Doctor’s offices and hospitals have to have dedicated staff members working dilligently on getting the appropriate reimbursements from insurance companies, and they take forever to pay because they can, etc. I don’t like the idea of the government running my insurance, but I don’t like the system we currently have, either.

33

Yep, and the liberal mentality is that you should never ever have anything bad happen to you, ever, unless you’re intolerant or happen to beleive in evolution, or something. And the taxpayers, especially the rich, should just buy insurance and limosines rides to work for everyone, because that really wouldn’t cost all that much anyhow, especially if the government runs the limo service.

Or, how about you shut the fuck up about “the conservative mentality,” and I’ll stop making shit up about your ideology.

34

The problem is affording either COBRA OR any other insurance that would cover all of the conditions.

Now, if you have insurance that considers a condition you don’t and won’t have “pre-existing” then you’re not out much since you won’t have any claims that will be denied. But the insurance bill itself might be (I’m no insurance expert) higher to start with because they won’t (as far as I understand it) jack up your insurance once your pre-existing term is over.

So, we’ll put it in real terms.

Dogzilla goes to Insurance Company A. They give her a quote of $400/month. If she didn’t have asthma and high cholesterol, it would be $350/month even though at the beginning of the policy they wouldn’t cover the bills for asthma and high cholesterol anyway. When they do start covering those, they are still charging $400/month (unless it’s been long enough for the rate to go up).

So, if she has yet another “disease” on her chart, that disease might get figured in to her policy even though it’s not going to be costing the insurance company anything, because the insurance company would assume that eventually they’ll have to pay out a claim on moldy rice syndrome.

35

Exactly, jsgoddess, thank you. Now that was a good point that I should be planning ahead and have a nice, phat nest egg stashed away and nit be carrying bad debt. Let’s say, for the sake of argument, that I have $100,000 in cash savings that I could tap into. People are already running out of unemployment because the job market is so dead right now. I still have to cover my mortgage, utilities, groceries, etc. Assuming all that, and assuming no other financial emergencies, how long would my funds last for COBRA and then for private insurance?

My point is that even people who are more responsible than I am are still in a very precarious position. And I don’t know many average middle or lower class income people who have that kind of nest egg stashed away. AFAIC, most of us are one bad car accident or one cancer diagnosis away from financial disaster, if not total ruin. The most responsible minimum wage worker in this country is still going to be in big trouble. I wonder how much homelessness is caused by our healthcare system? Most, if not all, industrialized countries have some sort of public healthcare system. I don’t understand the outrage against reform and the lack thereof for it.

36

Not quite an answer to your question, but The National Coalition on Health Care says:
[ul]
[li]A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance. (cite: Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009.) [/li][*]According to another published article, about 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs. (cite: Robertson, C.T., et al. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures,” Health Matrix, 2008.)[/ul]

37

[quote=“The_Devil_s_Grandmother, post:36, topic:508521”]

Not quite an answer to your question, but The National Coalition on Health Care says:
[ul]
[li]A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance. (cite: Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009.) [/li][li]According to another published article, about 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs. (cite: Robertson, C.T., et al. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures,” Health Matrix, 2008.)[/ul][/li][/QUOTE]

Thanks!

So, according to FearItself’s “conservative morality” (I don’t know what that term means because I don’t understand what morality has to do with the attitude expressed in that post), those 1.5 million people must be really irresponsible and they lost their homes because of lack of planning. Is that right?

38

Those people have all done something that has caused Jesus to remove his protection from them.
That something is called sin, and their misfortune is in fact God’s judgement upon them.

39

So what was the point of the atonement then? :confused: If the Christian belief is that Jesus died on the cross to atone for all of our sins, why then would it be necessary to smite the sinners with a health disaster, foreclosure, bankruptcy, whathaveyou?

If a beautiful, perfect, sinless little baby is born with a terrible congenital deformity and requires millions of dollars in surgery to save its life, then that baby had it comin’ because it was a filthy sinner? :dubious: And health insurance companies should be/are the arbiters of judgment in deciding who is a sinner and who isn’t, right? So they should refuse to pay for those life saving surgeries on these moral grounds, do I have this right?

:rolleyes:

40

Squink’s summation is biblically wrong and popularly right.
I think I may have been whooshed by both of you, but I’m ok with that.