community health

For the Ragtag Daily Prompt #69: community.

The photograph is from 2010, when the mad as hell doctors toured California to talk about single payer health care, medicare for all.

Small communities rolled out the welcome:

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In this community, every table was sponsored by local health groups: clinic, the health department, mental health, addiction treatment. In small communities everyone knows someone who has lost their health, their health insurance and/or their job and home.

Here we are setting up for another program:

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People asked questions:

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And they listened and responded:

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The health care industry has money. The insurance companies are for profit and make enormous profits. But in the end you and I have VOTES. When we stand up as a nation and say that we want medicare for all, Congress will listen. Stand up.

The mandate for health care already is a law: no one can be turned away from an emergency room. But as things stand, we do not take care that the person in the emergency room has care after the emergency room. The hospital may take the person’s house. We already have the government doing no profit care for over 50% of the care in the US: Medicare, Medicaid, active duty military and the Veterans Association. It is time to shut down the for profit insurance companies that refuse medicines, refuse care, refuse to answer their phones, tell me on the phone “we don’t have a fax”, the parent company tells me a medicine is covered and then the part D drug coverage still refuses: it is BEYOND TIME TO SHUT THEM DOWN.

Is the goal of health care profit? Or is it care for our citizens, support for families, works like the police and the fire station: we all support each other. Stand up, shout and VOTE.

 

 

Cloudy with a chance of hope

This is for the Daily Prompts: hopeful and year.

I took this from the beach with my zoom lens: fog, clouds, lowering, indistinct. My daughter left for college in September and is home now…. well, sort of, except she is off with friends all over the place, including right now.

It’s been a cloudy and hopeful period, since September. It is the first time in 24 years that I have not had children or teens at home, and the first time in 28 years that I have lived nearly alone…just the cat. The cat is not happy with then young adults leaving. She blames me.

I am worried about the US Medical system, the corporate takeover where more and more physicians are employed and then have no connection to how their patients are billed. They also take no responsibility for people going bankrupt over medical bills. We physicians are as responsible for the mess of US Health Care as the patients are, as Congress is, for letting 1300 insurance companies use 500 billion dollars on administrative costs….And people say I don’t trust government healthcare….but don’t take away my mother’s medicare, the VA benefits, medicaid for the disabled and very poor or the healthcare for our active duty. And yet I see for profit companies like triwest: the government contracts my local VA care to them and I fought Triwest for a year to get them to pay me for my Veterans Choice patients. And they won’t pay me for the time we spent fighting to get paid, nor the interest for waiting on a payment for an entire year. Guess who got that money? The For Profit Contractor Corporation: Triwest. And Noridian, the local medicare contractor, held my payments for 6 months. They said my paperwork was wrong….turned out it had been wrong for six years but they frankly didn’t care until they were getting audited. So who paid the price? I did and you did. In rising costs and confusion and physicians quitting. Again, I did not see a penny for the time on the phone, for the time spent trying to ask Noridian why, after 6 years of payments, they were refusing my renewal…..and meanwhile I saw my patients and went further into debt. And do you think the bank corporation wrote off their profits? No, you laugh at that…..

But, you say, where is the hope? The hope is that I think we are at the point where enough physicians are quitting outright, enough Veterans Choice patients are calling their Congress People, the patients refuse to be patient any longer….and I am seeing more people fight for a single payer system, for a system where the money does not go to profit and administration while people die waiting for prior authorization and insurance corporations change the rules every week and refuse and refuse and refuse care…..I think people: patients and physicians: will wake up and change the system.

And that, Mr. Trump, is what I would do to make the US great again….

 

 

 

 

 

Far from the maddening crowd

For the Daily Prompt: maddening.

The early morning is my time to write and think and be quiet. And the other time is outside walking with my camera.

The medical money machine in the US grinds people up, grinds doctors up, doesn’t care, and makes money. Sometimes it is so maddening….

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.