Friday, May 11, 2012

Health Insurance Ridiculousness

I might have mentioned a while ago that, for some strange reason, perhaps related to my Crohn's Disease but perhaps not, my blood iron levels have dropped from a near-normal 18% to an all-time low of 4% in a matter of about six months.  There was nothing in a recent colonoscopy or endoscopy to indicate blood loss as a possible explanation.  The explanation is probably something else, something more serious, and I need to be examined by a hematologist/oncologist as soon as possible.

But not according to my health insurance, Pinnacle Capital Blue Cross of Pennsylvania.

Before referring me to the specialist, they want me to have a "pill cam" exam.  Fine.  Annoying, and inconvenient, but fine.  It might actually be fun to swallow the camera and download the images of my insides, even though I have to wear the receiver and hang around the medical office for six hours or so.  But that's why iPhone games were invented.  And if it spots a leak, great.


I received a phone call yesterday letting me know that before I can take the pill camera, I have to have a barium upper GI X-ray exam with small bowel follow-through.  This is a high-contrast radiologic study where you swallow a dense liquid and pictures are taken showing in silhouette your GI tract.  IT IS ABSOLUTELY USELESS FOR DETERMINING WHAT IS CAUSING MY IRON ANEMIA.

I told them so, and THEY FREAKING AGREED WITH ME!!!  But after two hours and four layers of supervisors, I still have to have this stupid, unnecessary test on Monday because it's on Their Checklist.  I will waste several hours of my life, waste the time of a radiologist and at least one radiology technician, and be exposed to a series of bursts of radiation which I do not need and which are absolutely, completely, and totally well as being useless in determining if I am bleeding internally somewhere.  The test is on their checklist because they, like so many health insurers in the United States of America, operate in Cover Their Asses mode one hundred percent of the time.  It keeps medical costs high but lawsuits low, I guess.

To add insult to injury, the pill camera then has to be delayed for a couple of weeks because I will need to make sure the barium is all out of my system.  They can't take decent pictures until the barium is all gone.  So now there's that much more additional time added to my wait to see a hematologist.

And finally, as I mentioned above, I live in Pennsylvania, one of the worst states in which to practice medicine.  Specialists not only left here in droves, but no new ones are coming in to the state.  Even primary care is starting to be in crisis in Pennsylvania, largely because of archaic and punishing malpractice and torts laws.  I am friends with a neurologic surgeon -- a "brain surgeon" if you will -- who retired early a couple of years ago because his malpractice insurance rates reached 50 percent of his gross income.  FIFTY PERCENT.

I'd have quit, too.

If it wasn't for our teaching hospitals, we'd be hard-pressed to have state of the art medicine here at all.  Doctors simply do not come to Pennsylvania unless they have no choice.

As for the few brave souls who do stay here in practice, they are swamped with patients and it takes months to get an appointment.  Now, I'm married to a doctor.  You would think I would have an "in" when it comes to getting an appointment.  No such luck.  Last year I needed a dermatologist after my family doctor was unable to clear up a skin condition that persisted all summer.  I called in September to set up an appointment with a doctor to whom my wife refers regularly and often, so you could say that she is in part responsible for a nice chunk of his income.  In September they were able to squeeze me in for the FOLLOWING JANUARY.  And they were doing me a favor.

Harrisburg still has three or four dermatologists.  I can only imagine how long it's going to take to get an appointment with the one hematologist/oncologist here.

A more cynical guy might think that the insurance company is hoping that my lousy blood just kills me first and saves everybody the trouble.  Either that, or that I collapse in crisis somewhere so it becomes some hospital's problem.

I can't say I'm going to be happy with either of those outcomes, though.

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