Here is a satire based on many years of living in the U.S. without affordable health care. I'm grateful for what I have gotten when in need. But most of the past 40 years I did without adequate health care, for the simple reason that I couldn't afford it.
Rather than write a chronicle of my own adventures with doctors and hospitals, the good, bad, and ugly, I'll just say that this story was greatly inspired by the experience of acquiring a serious iatrogenic disease conditon from a psychiatric drug (clonazepam) whose secondary side effects were never mentioned to me until it was almost too late. I'm almost recovered now, after twelve months gradually tapering off of it.
This drug is thought to be "mellow". It is, at first, but it is a devil's bargain if I ever saw one. Klonopin and similar drugs such as Xanax and Ativan are so powerful that in the pure state an amount weighing the same as a penny, (2.5 g.) could tranquilize five thousand people (0.0005 g. X 5,000 = 2.5 g.)
However, this story isn't about >that<, only inspired by it. This is about the health insurance/physician complex. <br> The frustration of not having any recourse for the harm I suffered from this drug seemed to coalesce into this little fantasy about "Bob" and his troubles.
Preface: The author knows almost nothing about the actual health insurance industry, having had so little direct experience with it. This story is meant as satire. Much good is done by doctors in cooperation with the health insurance industry, and this story does not mean to take away from that. The author is just bitter because he didn't have access to good care, and the reason was money. Money and health care should just get a divorce.
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THE DOCTOR WHO WAS SAVED UP
"It's Untreatable."
When Bob realized that what had been bothering him was Snaugger's Syndrome, he decided he ought to do something about it soon, because it itched terribly.
He called the office of Dr. W, who was the one of three doctors listed on his insurance plan, and set up an appointment.
He had to wait three months, during which time the awful itch never seemed to stop, not even for a minute.
When the day for his appointment with Dr. W finally came, Bob was very hopeful. He was confident that Dr. W would fix him up in a jiffy, which goes to show how little he knew of his true condition.
"Snaugger's, eh." Dr. W told Bob. "There are some things I could do."
"Can you cure it?", asked Bob.
"Can't. But anything's possible", said Dr. W. "We should do an MRI."
"My insurance won't pay for it", Bob told Dr. W.
"I can't blame them," replied the doctor. "It's untreatable."
"Untreatable!" Bob cried. "You mean-"
"You'll just have to get used to it, I'm afraid," Dr. W said. "I don't treat it."
"Oh," said Bob.
"You might get a second opinion," said Dr. W, with a tone in his voice that implied he thought second opinions were for sissies.
"Yes, I suppose I could," replied Bob.
"Not that another doctor is likely to tell you any different", said Dr. W, with a look of disapproval. "But you could check with Dr. X. You might be able to get him to look at you. I wouldn't get my hopes up, though."
==========================================
A Conversation with Dr. X's Receptionist.
Bob, feeling a little more depressed than usual, went home and called up Dr. X. The young woman who answered the phone said that Dr. X was booked up until late July of next year.
"Well, if Dr. X can't see me, what about Dr. Y?" Bob said. "Isn't he on the first floor there? He's on my list."
"List?" the young woman said.
"My insurance list. The approved doctors."
"Oh, yes sir. I know. We can refer you to Dr. Y., of course. There IS a small service charge. Now, while we have you on the phone, would you like to go ahead and make the appointment to see Dr. X? It would have to be August after next."
"No, no. that's fine", Bob said. "That too long to wait. I suppose I'll just call Dr. Y. I would think he could handle something like this."
"Yes", said the young woman. "Of course, all the doctors here are very capable. As a matter of fact, Dr. X was Dr. Y's favorite teacher. Our Dr. X taught Dr. Y everything he knows."
"Did he really?" said Bob. "Perhaps I should make that August appointment after all, just in case."
"Certainly," the young woman said brightly. "You can't be too careful."
"Well, thank you very much," Bob said. "Give my regards to Dr. X."
"I will, and we'll see you on, uh, August the seventeenth, 2010? Eleven A.M.?"
"That's right. I'll be there. Oh, one more question. Just curiosity. Do you know who Dr. X's teacher was?
"Dr. W." she replied.
"Oh." Bob said. "Are you sure?"
"Yes", she said. "He told me."
"Well, I was just curious," said Bob.
"Well, now you know!" the young woman chirped happily.
"Yes, I do." Bob said. "Goodbye."
"Good luck," she said, and hung up.
=========================================
Making an appointment with Dr. Y.
Next, Bob dialed Dr. Y's number. The receptionist, a young woman whose voice sounded very much like Dr. X's receptionist, answered the phone. "Team Family Associates Medical Group", she said.
"Is this Dr Y's office?"
"Oh yes. He's here. But he's with a patient. Can I give him a message?"
"I'd like to get in to see him, if I might," said Bob. "Dr. X referred him, I think." Bob wanted every leverage. "They might not have called just yet."
"That's all right. I believe you. Now, let me see. Dr. Y has a ten-forty-five A.M. on May...no... let me see... how about on Tuesday the seventh, at four-thirty? A week from today?" she asked.
"I'll take it," said Bob. He felt very fortunate.
====================================
Tuesday the Seventh.
Exactly a week later, Bob was at Dr. Y's office by a ten minutes past four. He sat down in a soft chair in the hushed waiting room and read Reader's Digest until four-thirty, but the doctor didn't come out. At four-fifty-five, he got up and walked to the front counter in order to ask the young woman- the same one he had talked on the phone with a week earlier- when Dr. Y would be getting around to him.
"Oh, I'm very sorry". "I thought someone had told you. I'm afraid Dr. Y has been called away for the rest of the day. You'll need to reschedule. What did you say the problem was?"
"I didn't", Bob replied. "But it's Snaugger's."
"Oh my", the young woman said, and gave him a sympathetic look.
"It's very troublesome", said Bob.
"I can imagine", said the young woman. "I'm sorry."
Silence.
"Do you think Dr. Y will be able to see me soon?" asked Bob.
"You did say Snaugger's, didn't you?" said the young woman.
"That's right," he said. "I was hoping that Dr. Y could-"
"Wait a minute," said the young woman, and she picked up her phone and tapped four buttons, then turned away, so that Bob couldn't hear what she was saying.
After about thirty seconds she turned back around and faced Bob. "That was Dr. Y. himself. I told him you have a concern about Snaugger's. He said to tell you that you will need to see a specialist."
"A specalist? what kind of specialist", asked Bob.
"A doctor who specializes in Snaugger's, I guess," said the young woman. "There must be someone."
"Can you suggest a specialist, then?" Bob said. "I really want to get this taken care of."
"I'm sorry, I can't", she said , and smiled. "I suggest you call your health insurance provider and have them recommend someone."
=============================
Bob hears from an old friend.
Bob went home again. The itch and inflammation was really troubling him a lot by now, and he had to rest for several hours while his nerves settled down.
He was just about to get up and make a sandwich when the phone rang. It was his old friend Jack. Bob hadn't talked to him in two years.
"Bob!", said Jack. "How are you, you old son of a gun? I was just in town for a business convention, and thought I'd drop by and see my old buddy."
"Well..." Bob said "I would, but I've got this darn itch flaring up again."
"Sounds like Snaugger's", Jack said. "I've seen that. It's tough."
"Tell me about it," said Bob."I can't even find a doctor to look at it."
"Well, old pal, this is your lucky day,", said Jack."My brother-in-law had it. He went to Dr. Z. Made him good as new."
"Dr. Z?" Bob said. "You mean the Dr. Z across town?"
"That's the one", said Jack. "My brother-in-law swears by him. Seems he's worked out a treatment that..."
"You're sure we are taking about the same disease?" Bob said.
"Snaugger's, yeah. I know all about it. When my brother-in-law had it, he never shut up. "It itches! I can't stand it", he'd say. I was like, 'I know, I know!', but Sis darn near took the kids and left him. Everyone was sick of hearing about it."
Silence.
As an afterthought, Jack said, "Well, anyway, finally Dr. Z cured him, so he shut up."
"That must have been a relief for everyone", said Bob.
"I can't say you're wrong about that", replied Jack.
==================================================
Calling Dr. Z.
Bob thought this was wonderful news, and called Dr. Z's office right away. The young woman who answered the phone reminded him of Dr. Y's receptionist. She took his name and his phone number, and then asked a few questions about his symptoms.
"They're bad enough," Bob told her. "Itching, sneezing-"
"That's it, all right," said the young woman. "My cousin had it."
"How is she?", asked Bob.
"She fell in the tub, and hit her head", said the young woman."But at least her Snaugger's doesn't bother her any more."
"You mean Dr. Z cured her."
"Oh, yes", she said proudly. "Dr. Z is very good."
"Well, please set up an appointment so I can get in to see him," said Bob.
"Just a minute", she said. "Hmmm... there may be a problem."
"A problem? What problem?" said Bob.
"I'm looking at your information. I'm afraid that Dr. Z doesn't accept ABC Healthcare."
"What!?" said Bob. "But Dr. Z is the only doctor I've been able to find who knows anything about curing Snaugger's!"
"Yes, he is", said the young woman. "He cured my cousin. Before the coma, I mean. And I am sure he would be glad to see you, but our office does not accept ABC."
"Oh hell", said Bob "What am I supposed to do now?"
"There is no reason to raise your voice and swear at me, sir", said the young woman. "I think I have gone out of my way to assist you. I just can't do anything about it. It's our office policy."
"All right," sighed Bob. "All right. I apologize."
"Never mind," she said. "My cousin was irritable, too, before Dr. Z cured her, so I'm used to it. I think that what you need to do is to call ABC directly, and have them tell you what to do."
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Saving Him Up.
Bob went home. He was getting more and more discouraged, and he was itching more than ever. "Stress," he thought. "Stress."
He found his health insurance card, and dialed the company's 800 number. A robot voice answered with "Hello. Your call is very important to us. Please hold."
Bob waited. There was music playing on the telephone. He couldn't quite make out what it was. It sounded like Percy Faith. There's....da da da da... a.. summer place...da da da da....
After thirty seconds the computer-generated voice came back on and said "If you are calling about a problem, please press one now. If you have a question about your bill, or would like to make a payment, press two. If you would like to receive information about our extended care plan, press three. If you would like to talk to a health care representative, please press pound."
He pressed the pound key. The Percy Faith music came on again, and then there were a few clicks, and a young woman came on the line and said "Thank you for calling ABC Healthcare. My name is Alison, how may I help you today?"
"At last", Bob said, " a person with a name. Alison, I have a problem I'd like Dr. Z. to examine, and-"
"Is Dr. Z on your list of approved doctors?", asked Alison.
"I'm not sure," Bob lied. "Well, actually, no, I don't think he is. I just have Doctors W, X, and Y."
There was dead air on the line for a few moments, and then she said "I'm looking at your policy, and your approved doctors are Dr. W-"
"That's correct. I've been to see Dr. W", said Bob. "He says he can't treat my conditon."
"or Dr. X-" .
"I tried, but Dr. X is booked up until-" Bob began.
"- or Dr. Y." Alison continued.
"I already called Dr. Y. His receptionist told me that Dr. Y said I needed to see a specialist."
"Oh, a specialist." Pause. "That's different."
"What do you mean?", said Bob. "What do you mean, different?"
"Your coverage does not extend to a specialist," replied Alison.
"I don't really need a specialist. I -"
"I thought you just told me that Dr. Y recommended that you see a specialist", said the woman.
"He did," said Bob. "Or rather, his receptionist did."
"Well", said Alison, "Shouldn't you see a specialist, then?"
"But you just told me that my insurance policy won't pay for a specialist."
"That's correct," Alison replied. "Of course, you can go to a specialist if you want to, and ask him to send us the bill, but it would have to be reviewed at the main office, and I honestly don't think that they would okay it."
"I don't know what to do", said Bob.
"I understand", she replied. "It's just that your policy doesn't include visits to a specialist. I'm very sorry."
Pause.
"Perhaps you could get an appointment with Dr. Z".
"Well, as a matter of fact, I would like to do just that. That's why I called. My friend Jack's brother-in-law-"
"Would you mind holding for just another minute?" said Alison. there was a click, and then the Percy Faith music came back on. The itching was really starting to drive him crazy.
Alison came back on the line and said "I just called Dr. Y's office. They say you need to see a specialist. They said they already told you that."
"Yes," Bob said. "That's why I called you."
"If you would check your policy, you can see that your coverage-"
"I know," Bob said. "It doesn't cover a specialist. That's why I mentioned Jack's brother-in-law. He had the same thing, and he went to Dr. Z."
"And was Dr. Z able to resolve his problem?", asked Alison.
"Yes", said Bob. Finally he was starting to get somewhere. "Dr. Z has a treatment for Snaugger's, and apparently it was succesful on the brother-in-law, and someone else's cousin, and so I thought -"
"-that you would see Dr. Z", Alison said. "The problem is that Dr. Z is not on your list of approved doctors."
"What can I do, then?", asked Bob.
"Well, certainly you should go see Dr. Z if he has an opening", said Alison. "Unfortunately,
it won't be covered."
"Because Dr. Z is not on my list", Bob said.
"That's correct", Alison replied. "In order to see Dr. Z, you must be a patient."
"How do I do that," Bob asked. "if he's not on my list of approved doctors?"
"Well, you can't." Alison said. "That's the whole point. Your policy doesn't cover it. Your best bet is to contact Dr. X when he comes back from vacation."
"But Dr. X is booked up until next year! I have an appointment with him then. I can't wait that long. And anyway, I need to see Dr. Z."
"But you're not Dr. Z's patient", said Alison. "I thought you knew that."
"I do know it. I want to become Dr. Z's patient, but his office told me they don't accept ABC."
"Of course they do. Dr. Z has an arrangement with ABC, but only for patients who have him on their list of approved doctors. You're not one of his patients."
"Is there any way I can get to see Dr. Z, even if I am not one of his patients?", asked Bob.
"I don't see how", said Alison. "If he was on the list of approved doctors on your policy, of course, that would be different."
"What if I just pay Dr. Z myself?", said Bob. "I need to see him to get this thing taken care of soon. It's just getting worse."
"Sir, if our insurance coverage isn't satisfactory, I can connect you with our billing office, and you can cancel it." Alison replied. "Although I don't see why you would want to do that, after being covered by us for... mmm... the past five years. Have you been satisfied with ABC Healthcare?"
"Well-" Bob began.
"-because, of course, you know there are other insurance providers that you might find would be more suited to your needs, if you're not happy with our company." She sounded a little put out.
"The policy's fine," Bob said. "I'm not complaining. I just need to get in to see Dr. Z, even if I have to pay for it myself."
"If you are going to pay for it yourself, why are you trying to get your insurance to pay it? Your policy doesn't cover visits to Dr. Z. He's a specialist."
"Well, why can't I go to Dr. Z, and just pay for it myself?" said Bob.
"Actually", said Alison, "ordinarily you could. But Dr. Z only sees approved patients, and the last I knew, he was not taking new patients."
"Does Dr. Z even have any patients?" Bob said. "It seems like no one but Jack's brother-in-law and Dr. Z's receptionist's cousin has ever gotten in."
"Of course he has patients," said Alison. "My aunt went to him, too. Dr. Z is one of ABC Healthcare's Gold doctors. When any of our clients need to see Dr. Z, all they need to do is make an appointment, and Dr Z's office will then send us the paperwork."
"But Dr. Z doesn't accept my ABC Healthcare insurance. I told you that." said Bob.
"Well, of course not, if you aren't one of his patients", said Alison. "I'm afraid I just can't help you."
Bob was itching terribly. "Stress", he thought. The itch always got worse when he felt stress. "Why can't you help me?" He was feeling as if he might start crying. "This thing is getting worse every day."
"I bet it is", said Alison. "My aunt was lucky to get it treated."
"Your aunt had Snaugger's?"
"For years", said Alison. "I don't even like to think about it."
"But then Dr. Z treated it?" said Bob.
"Yes", Alison replied. "She was itching, itching, itching, day and night. It was terrible." Alison frowned. "But Dr. Z completely cured her. Of course, my aunt was an approved patient. Our contract with Dr. Z requires that he only see approved patients."
"Let me get this straight", Bob said. "My policy doesn't cover seeing a specialist, Dr. Z won't accept my policy, ABC won't pay for it even if he would see me, which he won't, because I'm not a patient, and his contract with your insurance company means that he only sees patients who have an ABC policy that covers visits to a specialist."
"That pretty much covers it", said Alison. "I guess you will need to find a different doctor. Have you considered checking with Dr W again?"
"I don't think so", said Bob. Dr. W told me it is untreatable."
Alison replied, "Well, I don't see why he would tell you that. Perhaps he meant that you should see a specialist."
"No, it was Dr. Y who said I had to see a specialist." said Bob.
"And so that's when you decided to call Dr. Z", Alison replied.
"That's right", said Bob. "Dr. Z is the one I need to see, and I don't understand why I can't see him."
"That's what I just explained to you. Would you like me to go through it again?" said Alison.
"No, thank you." Bob replied.
Alison said, "Okay, then. Were you able to get the information you needed by calling us at ABC Healthcare today?"
"Well, yes; you've been, uh, very helpful. I just wish I knew why, since Dr. Z has very few patients, and since he is the only doctor who can treat my condition, I can't get in to see him, insurance or not."
Alison said, "Well, I've tried to explain everything to you. It's really just one of those things."
"One of those things", said Bob. "One of those things."
"Yes, just one of those things."
"I have no idea what to do next," he said.
"I don't either."
Long pause.
Then Alison spoke up and said, "Look... I shouldn't say this, but- I want to help. So I think you should know."
"Know?", asked Bob. "What are you talking about?"
"Well..." Alison replied, "Don't tell anyone, okay? But here's how it works. Dr. Z's contract with ABC has a quota."
"A quota", Bob said. "What kind of quota?"
"He has a quota, about the number of patient visits he is allowed to have. And, well, uh, he's full."
"He's full?" Bob said.
"Yes", said Alison. "Completely full."
"And he's not accepting any more patients.", said Bob.
"That's it", Alison replied. "No new patients, unless you have insurance."
"I have insurance", said Bob. "With ABC."
"But not to see Dr. Z", Alison said. "He's not on your list. And he's full."
"How can he be full when he hardly has any patients?" Bob asked. "It doesn't make sense. It doesn't make any sense at all. He's the only doctor who can treat my condition, but I can't get in to see him because he doesn't accept my insurance, I can't get in to see him because I'm not one of his patients, I can't get in to see him because my policy doesn't cover visits to a specialist, and I can't get in to see him because he isn't on my policy's list of approved doctors."
"Now you understand", said Alison. "You see how it is about Dr. Z. And anyway, what you should know is that we're saving him up."
Bob thought he hadn't heard her correctly. "You're- did you just say, you're 'saving him up'?" said Bob.
"Yes. We're saving him up." said Alison.
"Saving him up for what?" asked Bob.
"In case we need him.", she replied.
"Even though he has hardly any patients, you're saving him up?"
"Yes, sir. That is our policy, to have a doctor in reserve for times when there is an unexpected increased client load. We're saving him up."
"So I can't get my problem treated by Dr. Z, ever?" Bob said.
"Well, I never say never", Alison replied. "I am just saying, right now Dr. Z's schedule is full, and beyond that, we're saving him up."
"Saving him up", Bob said, more to himself than to Alison. "Saving him up."
"Didn't you know that ABC had to save Dr. Z up?" Alison asked.
"Actually, I didn't", said Bob. "I just thought I could get in to see the one doctor in the world who knew how to treat my condition so that this terrible itching would quit."
"I guess there's just nothing you can do", said Alison. "It's miserable. I know. You should have seen my aunt. Day and night."
The End.
C.2009 by NoHarmFarm