One of the big claims in the current health care debate is being framed around government interference between you and your doctor.
So let's talk about how your insurance providers use networks against you. It's another form of getting between you and decent health care.
Until you get really sick, you may not even realize how egregious this is.
Anyone who has a PPO, or most other forms of health insurance, has already discovered that when you change plans you often change providers. And anyone with insurance has long since realized that there are "in network" providers and "out of network" providers. And that if you go out-of-network, you will pay considerably more.
So yes, your choices are already being interfered with. But consider what happens in an emergency, and in the aftermath, despite what your insurance policy may say.
I have told my story before, with regard to an emergency I had and how it helped me decide to drop my health insurance. But I haven't told you how it unfolded, and understanding how emergencies unfold is essential for understanding the situation, and understanding the full load of bull the insurance companies are slinging.
At 7 p.m. one Sunday evening, I started to feel nauseated. When I looked at my supper, I realized I couldn't eat. I announced to family (some of whom were visiting) that I felt queasy and tired and was going to bed early.
A little after midnight, I awoke and rolled over, intending to answer a call of nature. As soon as I rolled over, I felt something tear and I screamed.
At once I had my daughter and partner at my side demanding to know what was wrong. I managed to roll the rest of the way out of bed, saying, "It felt like something just tore. I'll be fine."
No I would not. I did not know that I had around eleven hours left. And that's statistical fact: With the illness I had, from the moment I felt my intestine tear, I had eleven hours before I reached the "less than 20% chance of survival" point.
Keep that in mind: Eleven hours.
I made my trip to the bathroom, but by the time I had returned and covered the ten feet from the bathroom door to the seat in our bedroom, my partner was saying, "You're going to the hospital."
Me: "I'll be fine, give me a minute." I was sure I had a typical GI bug, and that I must have pulled a muscle.
Daughter: "Mom, you're all gray!"
Partner: "I'm taking you to the hospital now."
So off we went to the nearest in-network hospital.
Time elapsed: about 30 minutes.
Triage sent me to the admissions clerk where, now sweating with pain, I provided insurance info and filled out a living will.
Nearly two more hours passed while I sat in a waiting room. Just as I was about to say, "I can't take anymore, get me help now," I was called into the ER. The nurse took one look at me as I staggered along the hallway and said, "You're going straight to the top of the list."
Time elapsed: about 3.5 hours.
And this is where things get fuzzy and where that in-network/out-of-network thing gets so important.
I was by this time weaving in and out of consciousness. I was screaming in the pain, despite morphine, though I don't remember it. Periodically my partner had to yank me upright by the front of my hospital gown so I wouldn't drown in my own vomit.
I vaguely remember being wheeled around for tests.
Let me tell you about the necessity of those tests. Pain is often referred. You might feel a heart attack between your shoulder blades, or even in your abdomen. A heart attack might simply make your pinkie finger hurt, or think you strained your right shoulder. You might feel a gallstone miles away from your gall bladder. Appendicitis usually hurts around your belly button, but not always.
Doctors know that the simple fact I felt pain in my lower right abdomen was virtually useless for accurate diagnosis, so they had to test everything that might be related. I had an EKG. I had chest x-rays, I had a CT scan.... And I was barely aware of it.
Time elapsed: almost 9 hours.
I do remember returning from x-ray to receive Last Rights around 9 a.m. I do remember my priest standing over me and thundering the prayers so I would hear him. My daughter tells me that during those minutes the entire ER fell silent, including the patient screaming in the bed next to mine.
After the priest, I saw my own blood pressure monitor: 40/20. I knew I was going into shock. I knew it. Damned if I cared.
The next thing I remember was a nurse in my face shouting, "Stay with us. Hang on. I'm talking to the surgeon. Just hang on it won't be long now."
Now that they had diagnosed me, my life was hanging on another time thread: the surgeons were all in the middle of their operating day. All had patients open on their tables, in procedures they could not hurry. Some even had other equally critical cases in queue. So they had found the surgeon who estimated he would finish his current procedure soonest, and whose next patient could be safely bumped an hour or so. The was the only choice. Precious minutes ticked away.
And finally, "You're next for surgery. Hang on. Stay with us!" Apparently I followed orders.
It was now fast approaching noon.
Time elapsed: Over 11 hours.
Everybody was shouting because I was that far out of it. My family panicked until my partner just told them to go home, they couldn't do anything, and the nurse apparently had to snap at my son when he got upset about my falling blood pressure: "She can hear you!"
Yes, I heard. But I also saw. I was dying.
Now comes the fun part. Who, I ask you, in those hours, me included, was in any position to ask: "Is the EKG team on my plan?" "Is the surgeon on my plan?" "What about the CT providers?" "The radiologist?" "Anesthesiologist?" "Pathologist?"
Theoretically my policy had me covered. It was an emergency. I was literally dying in the ER. I had a rider that said all of those people would be taken care of as if they were in-network because I was in an medical emergency.
Actually, no. None of them were. And no amount of arguing and appealing changed the outcome.
But in the crisis, as your life hangs in the balance, you are certainly in no position to demand in-network providers. In fact, I can guarantee you won't even think about it.
Until you've been through it. And then you'll realize just how many ways insurance companies are interfering with your care. Oh, you'll get your care if you have an insurance card. But then you'll have to pay for it a second time.
And the next time you need an ER you're going to think twice about it and put it off. Maybe until it's too late.
Eleven hours. And I had no way at the time to know how close I was.
The news of Ted Kennedy's passing deserves more than a nod from me. The Kennedy brothers were a huge part of my political life, from the time I was ten, in fact, and Ted's battle for health care reform was a true devotion to country. We shall miss you, Teddy. May you now enjoy your rest. You have certainly earned it.