Category Archives: anger

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On death and feelings

When my mother was dying of cancer, she did not want us to cry.

So we didn’t. We had her at home in hospice for nearly six weeks and we did not cry. Almost.

My sister called me. “I started crying today, at the kitchen table.” My mother was in another room in the hospital bed. “Everyone left. No one stayed with me. Everyone left.”

I didn’t cry but when people called to say how were things, I couldn’t speak. I sat there with the phone, silent. Because what I wanted to say was my truth and I knew very well that that was not what they were calling to hear. So I did not speak.

After my mother died, time passed. I felt…. many things, but the strongest one was “I wish my mother had let me cry.” We did what she wanted. But I wanted to cry.

My sister got cancer and fought it ferociously. She refused hospice until the last week. I flew down three times in the last two months.

Six days before she died, her friend and I were helping her. “I’m sad!” said my sister.

“Don’t be sad.” said the friend.

“It’s ok to be sad.” I said. “What are you sad about?”

My sister started crying: “I won’t be at my daughter’s high school graduation! I won’t see her get ready for prom! I don’t want to leave her!”

“You won’t leave her.” I said. “You will be there. Not in this form.” I meant it absolutely.

“I want to stay!” she said.

“I know.” I said. “I am so sorry.”

With my sister, I did not do what she wanted. I thought of my mother and that I wished she had let me cry. With my sister, I tried to listen to what she wanted and listen to what I wanted. I tried to be honest with her. She even got mad!

But… I watched her go in the cancer bubble. Where fewer and fewer people were being honest. They were afraid. They did what she wanted. They wanted her to be happy. And she tried so hard….

When I had arrived for the last visit with my sister, she was sitting with my cousin. I hugged her. She was not speaking much. I asked if she would like me to sing something and she nodded. I started singing “I gave my love a cherry”, a sweet lullaby. My sister shook her head, angry and fierce. I studied her. “How about Samuel Hall?” I said. My sister smiled and nodded. I started singing “My name is Samuel Hall.” It is about a man who is going to the gallows for killing someone and he is entirely unrepentant and angry. My cousin looked at me, startled. “I haven’t thought of that song in years,” he said. We both sang it to my sister. “To the gallows I must go, with my friends all down below, damn your eyes, damn your eyes.” That was the right song, angry, resisting, raging. “Hope to see you all in hell, hope to hell you sizzle well, damn your eyes, damn your eyes.”

I flew back to work three days before my sister died. I am told that she was scared when she died. “I said, don’t be scared.” said a friend.

Why not? I thought. Why can’t the dying be scared, be anxious, be angry? Why are we afraid to let them? I would have said, Why are you scared? And I would have said, I am scared too. And sad. And angry.

I told my counselor once that my husband was on the couch, angry, and I had to leave the room.

“Why?” she said.

“I am afraid.” I said.

“Why?” she said.

“I am afraid he’s angry at me.” I said.

“So what?” she said.

I thought, so what? “I want to fix him. I want him to not be angry.” Even if it isn’t at me.

“Why can’t you stay in the room?” she said.

I practiced. I stayed in the room. He was angry, grumpy, acting out. It’s not my anger. I don’t have to fix it. It may be just or unjust. Does it really matter? It is his anger not mine. I can stay present.

A friend said that his friend was dying leaving small children. “He was so angry that almost all his friends stopped visiting.”

A man and his sister are not speaking four years after their father died because they disagreed so strongly about how his lung cancer should be treated.

An elderly woman in the hospital agrees to go home for care with her son when he is present and with her daughter when she is present. When neither is present she will not make a decision.

A woman says to me that she is angry that hospice didn’t tell her which drug to give at the end to keep her friend from being anxious.

I hope that we learn to stay present for the dying and for the living. For all of the “negative” emotions. I see most of my hospice patients want LESS medicine rather than more. As their kidneys fail, the medicines last longer. They do not want to be asleep. They may cry. They may be angry. They may be unreasonable. Why should they be reasonable or nice or peaceful?

We want most to be loved entirely. Even when we are sad or whiney or angry or anxious. Who wants to be left alone when they are afraid? I hope we all learn to stay present.

And when we were alone, in that last three days, my sister said “I’m bad!” I said, “You are not bad. You’ve done some really bad things.” She said, “I’m sorry.” I said, “I love you anyway.” And she lit up like a buddhist monk, like an angel. And we both cried and I am so glad I was there.

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All of my patients are smart

I am a rural family practice doctor for over twenty five years and all of my patients are smart.

All of my patients are complicated.

I don’t mean that they all have degrees or PhDs or are intellectuals. I mean that they are smart in all sorts of ways.

I was talking to the UW Pain and Addiction Telemedicine Team four years ago. I said that when I had a new chronic pain patient who is angry about the law in Washington, I would give them the link to the law: http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PainManagement.

“You give them the link?” said one of the faculty. “But they can’t understand that.”

“Why not?” I replied. “I did.”

This was met with silence. My attitude is, well, I am a physician. I am not a lawyer. Yet I have to follow the pain law. Actually we all have to follow all the laws in our country. We say ignorance of the law is no excuse. Yet then the attitude of the pain specialists at UW was that the law is too confusing for my rural patients.

I think UW is wrong and I think that it is disrespectful to patients. Treat them as adults. Treat them as smart. Treat them as if they can understand and you will get respect back. And if they trust you they will then tell you when they do not understand or need something translated from medicalese to english.

I worked with a patient who works every day. She is in a wheelchair, a motorized one. She has cerebral palsy and can’t talk much. And she is smart too.

This election is about the United States population being smart. They know something is very wrong and they want it fixed. I think that Citizens United needs to be taken down. Corporations are not people, unless the CEO can be the physical representation of the corporation and go to jail when the corporation lies and steals. Wells Fargo, I am talking to you. I am taking my money to another bank. Pay reparations. The United States population is sick and tired of the rich getting richer and corporations stealing from people for profit. Democrats and republicans are sick and tired of it. We are not going to take it any more. If you have gotten rich from corporate underhand theft, lies and confusing regular people, give the money back. Because you can buy an island, but if the United States population rises up to hunt for you, there is no where in the world you can hide.

It is time for corporations to give the United States population the government back. Or we will take it. Because every patient I have ever taken care of in over twenty five years is smart. That is not to say we don’t all do stupid things. And some people won’t change. But in the end, everyone can learn and everyone can change.

I took the photograph in Larrabee State Park in September. This tree is down: but it is not a nurse log yet. It is not dead. The roots are still providing nourishment and it is sprouting branches all along the downed trunk.

 

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Playing Poker with Putin

People keep saying, “I don’t TRUST Hilary Clinton.”

And they say, “Her smile is not sincere.”

I am confused and dumbfounded. Uh, I thought that is the POINT of politics. NAME A POLITICIAN YOU TRUST.

I DON’T TRUST ANY POLITICIAN.

So here is a game: Playing Poker with Putin.

This requires three people, of any sex.

Player 1 is Hilary Clinton.
Player 2 is Donald Trump.
Player 3 is the moderator who in this case happens to be Mr. Putin.

NOW. The moderator begins to ask questions. Every time the moderator asks Hilary a question, Donald interrupts. Donald, you can be as foul and rude as you want, though you should not swear, because you are on national television. You can talk about “lady parts” and the size of your hands. And all the rest of it.

Putin: go for the jugular on everyone.

Hilary: you have to smile. The entire time. You cannot object to being interrupted, because that is bitchy if you are a girl and manly if you are a man. You cannot show anger. You cannot show any emotion at all except a totally sincere smile no matter what the two men say and no matter how many times you are interrupted.

If the person playing Hilary loses her temper she (or he if a guy is playing the part) loses. Then Donald and Putin have to stage a mock battle throwing pillows at each other and insulting each other’s wives. At the top of their lungs. Be as mean as possible. Then Donald will turn the country into a dictatorship because “I have to be equal to Putin.”

So….my definition of politician is someone who can keep their head no matter how nasty the conversation gets. No matter how many lies are told. No matter how many insults are given. And you do the best you can in office to represent the entire country and for the good of the world.

Play on, Hilary. You win Best Politician Ever in my book.

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Fraud in medicine: why “help” won’t help

This article:Β  Doctors wasting over two thirds of their time doing paperwork showed up on Facebook yesterday.

The problem is that “hiring people to help with paperwork” will not help.

Why? We’ve already done that and it’s a huge mess.

For example: I was referred to an Ear Nose and Throat Specialist at one of the Seattle Mecca hospitals. I had to travel two hours and then in the waiting room I was given a four page patient history to fill out. I filled it out. I had been referred by a Neurologist, who sent a letter and note. After I filled out the forms, HIPAA and “you will pay if your stupid insurance won’t” and address and consent to be treated and yada yada…. I waited.

At last I was shown to a very luxurious room. There a medical assistant asked me many of the same questions that I’d filled out on the form and which were already in the letter and note from the neurologist. She typed these into the EMR- electronic medical record. Then she left. And I waited.

At last the distinguished otolaryngologist entered the room. He said, “I see that you are here for chronic sinus infections.”

“No.” I said. “I am not.”

Silence.

“I see that you did not read anything I filled out and I am a physician and I drove two hours to see you.”

Silence. “Um.” he said. “Uh, why are you here?”

“Strep A sepsis twice and we want to know if my tonsils should be removed.”

Right. So… all that paper you fill out before the physician saw you? Yeah, like, my impression is that physicians don’t read it until after you leave. And maybe mostly don’t EVER read it.

I plan to find out the next time I have to see a specialist. I will write “you don’t read this anyhow, so I am not filling this shit out” on page 2 and see if the specialist notices. Bet you money they don’t. Though when they yell at their staff for not entering my medication allergies or the review of systems, they might notice.

So… I am a primary care physician. What do I do?

A new patient has one form: name, address, insurance information, hipaa and “you pay if your insurance doesn’t”.

I do the health history myself in the room entering it in the first visit, which takes 45 minutes to an hour. WHOA! INEFFICIENT! Nope. Actually it is brutally efficient. For four reasons:

One — I enter it myself and ask the questions myself and I am really fast at it.

Two — now I know the person, because I went over all of it: complaint, history of present illness, past medical history, social history, allergies, review of systems, and I ask people to bring all their pills including supplements to the first visit and I enter them too. And I look at the bottles. I don’t like vitamins with 6667% of the Recommended Dietary Allowance of any vitamin, lots of vitamins now have herbs in them too and I would not recommend taking cow thymus, labeled as bovine thymus.

Three — Now I don’t have to spend time reading forms filled out in the waiting room or a history entered by someone else, because I don’t have time to do that anyhow. I did it all in the visit. I will still have to read old records and any labs or xray results or consult notes or pathology reports and hey, where do you think the waiting room paperwork falls in that priority list? Yeah, like never.

Four — I hand people a copy of the note as they leave and ask them to read it and to bring corrections if I got it wrong. They go from thinking that I am a drone staring at the laptop to saying, “Hey, she typed nearly everything I said (and she has three spelling errors).”

Because the truth is that medicine is really complicated now and it just doesn’t help to have more people “do the paperwork”. I have to read the notes and labs and reports myself, because I am the physician.

There are three things that WOULD help:

1. One set of rules. Hello, the insurance companies, all 500ish of them send us postcards and emails every week saying “Hey, we’ve changed what we cover, meaning we cover less and we have new improved and more complicated prior authorization rules! Go to our website to read all about it.” Guess how often I have time to do that. NEVER NEVER NEVER. I read medicare’s rules. So medicare for all, single payer is partly to have ONE SET OF RULES. I can memorize miles of rules, but not if they are changing in 500 companies every week. Shell game. Also, prior authorization means “your insurance company is making your doctor fill out paperwork in hopes that they can delay or refuse the care your doctor thinks is best for you.”

2. One electronic medical record. Right now there are about 500 of them too and none of them talk to each other so we are all “paperless”. Ha. It’s worse than ever, because we get 100 pages or 200 or 300 of printed out electronic medical record for every single new patient. I need two more big file cabinets for my “paperless” office. Hong Kong did it in 9 months. What, are we wimps? Make a decision.

3. Standardization of lab and xray and home health and physical therapy and nursing home and rehab and hospital order forms. Because every stupid lab form is different: not only arranged differently but also the lab panels are different, the requirements for what that lab wants to fill the order is different and the results are arranged differently on the page. Hello. Stupid, right? Any efficiency expert would laugh.

And that’s how we could really help doctors help patients.

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Emergency preparedness

In Venezuela now
some people get water once a week
and sicken from it

First, withdrawal
When we have our eathquake
Tsumani and roads and bridges are gone

If one in three adults in Utah
Got an opioid prescription in 2014
What are the numbers here?
Opioids
Alcohol
Benzos
Caffeine
After the first wave of death
and grief, withdrawal begins
Not just addictive drugs
from insulin
from blood pressure meds
anticoagulants
seizure medicine
chemo ground to a halt
I read that alcohol is best to trade in disaster
and chaos and loss
Guarded by guns in small gangs
We are told to store water
Where?
If the house falls down
and I can get out, where would I put water?
A bunker in the ground?
I stock straws for water
I wish I could buy 9000
for my town
I stock books for when the computers
go silent
I stock songs in my head
memorized all
I fight for all my patients
Who would I not fight for?
Maybe it would be better to die
or be captured early
I stock love not guns.

http://www.nytimes.com/slideshow/2016/05/26/world/americas/desperate-times-in-venezuela/s/27VENEZUELA-SS-slide-3ZIT.html?_r=0

http://www.theguardian.com/us-news/2016/may/26/utah-mormons-prescription-painkiller-addiction

http://www.newyorker.com/magazine/2015/07/20/the-really-big-one

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W is for wrath

W is for wrath, the seventh sin.

From Webster 1913:

Wrath

1. Violent anger; vehement exasperation; indignation; rage; fury; ire.
Wrath is a fire, and jealousy a weed. Spenser.
When the wrath of king Ahasuerus was appeased. Esther ii. 1.
Now smoking and frothing Its tumult and wrath in. Southey.

2. The effects of anger or indignation; the just punishment of an offense or a crime.
“A revenger to execute wrath upon him that doeth evil.” Rom. xiii. 4.
Syn. — Anger; fury; rage; ire; vengeance; indignation; resentment; passion. See Anger.

 

Wrath is a sin, yet is it ever justified?

I am wrathful about this: http://www.npr.org/sections/health-shots/2016/03/23/471595323/drug-company-jacks-up-cost-of-aid-in-dying-medication

In my state a terminally ill patient may choose Death with Dignity: http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct

The person must be terminally ill, must not be suicidal and must go through a process. But one of the tablets prescribed, which only the person may administer to themselves, has had a price increase from $200.00 to over $3000.00.

I heard this from another physician, who has a patient who is going through the process.

I feel wrath and anger and hurt and rage that a corporation is choosing to make an enormous profit from terminally ill patients.

And so wrath may be a sin, but it is also an appropriate feeling at times.

In a sermon about forgiveness, hate is also discussed:

“Let me also say a word here about hatred, since I am speaking of forgiveness as being the release of hatred. ManyΒ  of us,Β  I suppose, like myself, have been taught not to hate.Β  We have been taught that hatred is always a bad thing and there is no place for it.Β  Thus, we feel uncomfortable in the face of this intense emotion and attitude.Β  Many times I have stumbled on the line from the biblical book of Ecclesiastes which reads, β€œThere’s a time to love and a time to hate.”

Can there beΒ  a time to hate?Β  Ironically, whenΒ  reflecting on the subject of forgiveness, I see that there is a place for hatred.
Β 
First,Β  yourΒ  hatredΒ  letsΒ  youΒ  knowΒ  thatΒ  youΒ  areΒ  feelingΒ  diminishedΒ  andΒ  perhapsΒ  being stepped on and treated as no human being ought to be treated.

Secondly,Β  yourΒ  hatredΒ  letsΒ  youΒ  knowΒ  thatΒ  you’reΒ  fightingΒ  backΒ  andΒ  thatΒ  youΒ  have somethingΒ  toΒ  fightΒ  backΒ  with.Β Β Β  ItΒ  letsΒ  youΒ  knowΒ  thatΒ  theΒ  situationΒ  isΒ  intolerableΒ  andΒ  you will not put up with it.

AndΒ  soΒ  hatredΒ  canΒ  beΒ  aΒ  naturalΒ  andΒ  evenΒ  necessaryΒ  responseΒ  toΒ  situationsΒ  thatΒ  threaten human dignity.Β  Says one author, β€œNot to feel resentment when resentment is called for is a sign of servility,… a lack of self-respect.”  (Forgiveness, Haber)”

From: November 15, 2009, here: http://www.quuf.org/index.php?page=2009—2010-sermons

p7
http://www.quuf.org/uploads/Sermons/Is%20Forgiveness%20Always%20Called%20For%20Part%20II%20Nov%2015%2009%20print.pdf

I took the picture in 2007. No wrath here, but three different expressions, and all complex….

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Dear Mr. Donald Trump

Two weeks ago I sent this letter to Mr. Trump and all of the presidential candidates. To date I have gotten a form letter from Mrs. Hilary Clinton.

Dear Mr. Donald Trump and all Presidential candidates:

Mr. Trump, I am a rural family practice physician, a woman, who owns and runs my own medical clinic. I take care of patients from age zero to 104. Currently my oldest is 98. I take medicare and most insurances, but not medicaid.

I am running into legal immorality across the board from health insurance corporations that are maximizing profits at the expense of my health care dollar, our taxes and my patients. I would like your advice.

For example, the Veterans Hospital contacted me in May of 2015 and asked me to accept Veterans Choice patients, veterans who live more than 40 miles from the nearest VA Hospital. I accepted. I have 6 veteran patients, who are very complicated. To date I have not been paid for one visit. Now, before you say this is the fault of our government, it isn’t. It is the private for profit government contractor Triwest who is not paying me. They have my notes and we have followed their instructions on how to submit bills. Would you advise me to drop these patients?

For example, my father died in 2014. I called the oxygen company to pick up 6 tanks of oxygen. Then I found 8 more. I gently inquired why he had 14 tanks. The company said that his medical orders said that he should wear it continuously, so they delivered it. “Medicare paid for it.” they said. Ah. Well, I kept the other 8 tanks, because it is my and my father’s oxygen in those tanks: the company can have the tanks back when they are empty.

For example, the head of the sleep apnea supply company came to see me. He said, “You are getting in the way of your patients getting needed equipment.” I said, “Really? How?” “You only allowed a refill of one of the 8 necessary pieces of CPAP tubing instead of signing off on the whole group so we can fill as needed.” “Ah.” I said, “Actually my patients are tired of you mailing them 8 pieces of plastic that are filling up their closets and they don’t want extra plastic crap.” He mails it at the interval allowed by medicare, never mind whether the patient wants or needs it.

For example, I called a patient’s insurance to get a prior authorization last week for a limited sinus CT. They no longer do prior authorizations. They will decide whether to cover the CT scan once they read my notes. I asked if there was ANY way to see if it would be approved. They offered to let me send a letter to a PO Box in Wisconsin. My patient was sick, Mr. Trump. What do you suggest the patient and I do?

This is all legal. But it is not moral. So, Mr. Trump, where do you stand? Is our country’s highest value free enterprise and profit at any cost, no matter how many of our seniors are legally ripped off? Or do we have morals that health care and our elderly are important and need to be protected from legal but predatory businesses.

Please let me know, Mr. Trump. I would rather stick with my small clinic in the United States. At this point I would be financially and emotionally better off working as a temporary doctor internationally. I am sure that there is immorality internationally, but I will be less ashamed when it is not MY country.

Thank you.

 

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7 Sins and friends

My blogging from A to Z this year is titled 7 sins and friends….. sins? I am thinking about emotions and how many our culture says are bad or that we should not feel. Men are encouraged to be strong and silent and women are encouraged to be nice. “Feel good all the time!” says our culture. But we can’t, won’t, don’t.

People say, “Try not to feel that way.” Now when someone says that to me, I think, that is a feeling that they are not comfortable with, but I am comfortable with it, enough to express it. We label feelings with value judgements. Happy is a good feeling, anger is terrible, but really it is all neurological information. It is part of our system for exploring the world, just as touch and taste and sight and hearing help us explore the world. Imagine if we could not feel fear: a toddler walking off a cliff because they have no idea to be afraid. And without pain, we would not pull our finger back from being burned. If we can’t grieve, we can’t truly love.

I sat down yesterday and made a list of emotions and feelings, from A to Z, and I have more than one for each. I will only choose one for each letter, at least that is the current plan, but think of the richness and complexity of human feeling. Why don’t we celebrate it instead of excoriating it? And doesn’t every human have the full spectrum of feelings? We may not be comfortable with a feeling or have a name for it, but I think we all have all of them.

The photo is from Halloween, 2005, dressed up for church.

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Fraud in medicine: Veterans Choice

Yesterday I tried another tack to get paid for seeing Veterans Choice patients.

We are more than 40 miles from the nearest Veterans Hospital. Starting May of 2015, I was called by the Veterans administration to ask if I would accept a veteran as a patient. I said yes. I have seven by now, but we are currently refusing to take more.

That is, I can see them, but so far I have not been paid a penny.

The VA sends me an authorization from Triwest, the (for profit) contractor in the Northwest region, I see the patient, I fax my note and everything to Triwest, I fill out forms for referrals…. my biller follows Triwest’s instructions…. and they do not pay us. Over 25 visits now, over $5000.00

I have called Triwest, I have written to my senator and representative, I have called and called….

Yesterday I looked at this site: http://www.va.gov/

From there to the US map: http://www.va.gov/directory/guide/division.asp?dnum=1&isFlash=0.

We are district 20: http://www.va.gov/directory/guide/region.asp?map=1&ID=20

VA Puget Sound Seattle: http://www.pugetsound.va.gov/

Under “about us” a dropdown menu to the leadership team: http://www.pugetsound.va.gov/about/leadership.asp

And I called the office of William H. Campbell, MD, FACHE | 206-277-1330, chief of staff, third one down.

The administrative assistant who answered asked if he was expecting my call.

No, I said and explained. I said that I very much like my veterans and would like to continue to work with them but as the owner, CEO and sole physician in a small business, I do need to get paid. Please help.

She put me on hold. And then I spoke to Dr. Campbell and explained again. I said that I am not getting paid, we have contacted Triwest multiple times and followed their instructions, when I call Veterans Choice the response I get is “I don’t know.” and that my patients can’t get their mail order refills because even though the VA called me to see the patient, I am not “entered” in to their pharmacy system.

Later I got a call from a person who promised to speak to Triwest and expedite payment.

I got a call from the head of pharmacy at the Seattle VA.

Who knows? I might, someday, get a check from Triwest.

The issue is really that this is not an isolated problem. All of the insurances are getting worse. I get postcards from 50 different insurance programs a month telling me how they have changed their benefits for the different plans and inviting me to go on line and read their detailed instructions. Noridian, the northwest for profit contractor for medicare, held my payments for 5 months last year because they were getting audited and suddenly realized that my application and everyone else’s had been wrong for years. Doctors are quitting all over the Olympic Peninsula and I suspect all over the United States. At this point I do not think anyone could DESIGN a more unintelligent, arcane, frustrating system. And if you see a US doctor, half of their staff is there to go on line or on the phone to get prior authorization to get a CT scan, get an MRI, see a specialist. And the paperwork for every lab, every insurance company, every xray, every physical therapy office is DIFFERENT: tell me, is this efficient? No, but someone is making a huge amount of money and it is certainly not me. I want my health care dollar to go to health, not to stupidity and not to corporate profit.

And I am wondering if it is worth it……

I took the photo of the trees and bunkers at Fort Worden in 2005.

 

 

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Fraud in medicine: prior authorization III

I see a patient who has had prolonged sinus symptoms AND her right upper molar has been irritated for weeks, but then Saturday it started hurting. She saw her dentist. The dentist did x-rays and said it’s her sinus. “But my tooth hurts too.”

On exam, her gum is bright red above the tooth, but not swollen as it can be with an abscess. No fever. No bright red spot over the maxillary sinus.

I call our independent radiology service and ask for a limited sinus CAT scan. She is off on Mondays only, it is Monday, she is out of town next Monday. Can they do it today? Yes, but she needs a prior authorization.

I call her insurance, after looking up the CPT code for sinus CT on google. As usual I have to enter numbers before I talk to a human:
patient insurance id number
my tax id number
my national provider index number
and others until I get a human.
Then I have to give the numbers AGAIN because the insurance company deliberately makes it inefficient, even though I have entered them into the phone it doesn’t transfer to the representative and you know that it COULD.
I give my name
patient’s name
patient’s date of birth
clinic address
clinic phone
clinic fax number
tax id
national provider index number
and finally explain: we need a prior authorization for a limited sinus CT and she has five ICD 10 symptom codes.
“She doesn’t need a prior authorization.” says the rep.
“What?” I say, “So it’s covered.”
“We don’t guarantee coverage, but we don’t give prior authorization.”
“What do you mean, you don’t guarantee coverage. I am calling to check.”
“We review the chart afterwards and THEN decide if it’s covered.”
“No. That isn’t good enough. I want to speak to someone who will check the codes and tell us if it will be covered.”
“I will have to transfer you to the (patient something).”
“Fine. Transfer our information please too.”
We go on hold. Time passes.
We are back to a recording:

TALKING TO A REPRESENTATIVE DOES NOT GUARANTEE COVERAGE OF A TEST. PRESS ONE IF YOU ACCEPT THIS.

No two. No other options are offered. I press one.
I talk to the new representative. “I have five diagnosis codes and want to know if the sinus CT will be covered. She is off and they can do it today. She is only off on Mondays.”
“We don’t do prior authorizations.”
“Isn’t there ANY WAY we can find out?”
“You can mail a letter to a PO box and we will review it and let you know.”
I am ….. hard to describe…. my head hurts.
“Would you like the PO box address?”
“How long does that take? Yes we want it. Don’t they have a fax?”
We get the fax number too. I hang up and look helplessly at my patient. “I think it will be covered. I would recommend we do it.”
“Ok.” She says. Her face and tooth hurt.

I call the independent radiology center and set it up for 2 pm.

They call back in the afternoon. She has a sinus infection and the tooth is bad too, they don’t quite look connected. I call the Ear Nose and Throat specialist who wants her on three weeks of augmentin if she tolerates it and then to see her. I thank him and get it rolling.

But….. ok, so the insurance companies contract with me and the patient say that they can change the benefits any time they want. They “notify” me with postcards with online links. Like I have time to read and remember the changes for …. 50 different plans? There are over 500 in the US.

When are we going to stop letting insurance companies take our money and refuse care and refuse to pay the physician and the radiologist? Medicare for all, one set of rules, I COULD LEARN THEM. I can memorize huge amounts of data: I am already busily memorizing the ICD10 diagnosis codes. There are only 48,000.

And I don’t know yet if her insurance will pay for the sinus CT…..

The picture is from Lake Matinenda in Ontario: no computers at our cabin, no outlets, phones mostly don’t work…. heaven.