Sunday, April 27, 2014

The Patient Satisfaction Coordinator

Went to acupuncture 7x since the ER visits in order to fix my arrhythmia, which was in overdrive all week. Sheer terror: racing heart for up to 9 hours at a time, reduced oxygen due to heart dysfunction, feeling of suffocation, spastic limbs, kidneys unable to retain anything, unable to sleep. My ER discharge papers recommend acupuncture and massage as the best treatment for Long QT Syndrome after potassium, which I have been loading along with healthy food, after getting my nausea under control. The arrhythmia calmed down after several consecutive days of acupuncture treatment, but my brain is on fire and I am becoming suicidal again. Endlessly thankful for my acupuncturist, who has been working daily without pay to restore my heart function. I will pay her in May for the April treatments, then will be behind again for the Month of May. Even though the ACA is supposed to prevent discrimination against any licensed health care practitioners, I am pretty sure they will not reimburse me for these services, because they list acupuncture as uncovered.

I went to the clinic last Monday with the ER Physician's instructions re: follow-up visit post-ER. But the clinic would NOT take my Medi-CAL card and I had to leave without the ECG and thyroid test specified by the physician. I felt sad when I left the medical center without receiving services as specified. Worse than sad. The stress made my arrhythmia kick in, and I lost the progress i had made in managing my medical condition on my own. Big mistake.

Despite conversations in person and by phone with 12 different state employees, including at the Medi-CAL office, the Family Resource Center, and the SSI office, not a single employee was willing to help fix the problem with my insurance card. I submitted my application in November 2013, and I got verification that my application was complete in December 2013. In February I was told they needed additional documents, which I promptly submitted in person at the FRC. While there, I was informed that my insurance was now "authorized" based on the completion of all assessments/documents, and I was told my card would be switched on shortly. Two months later, it is still not working. Each person I spoke to refused to help me with my problem, and instead informed me: Not my department. We don't handle that. A total of 12 state employees passed me off, insisting they were not the one to help with my problem. Even my case worker, David Lang, insisted that my case was no longer his responsibility, because he had completed the only portion for which he was responsible. He also told me a lot of people at the Medi-CAL office were quitting due to being overwhelmed with work.

Last week the Patient Satisfaction administrator from the Hospital contacted me to ask if she could help me with a temporary 2 month Medi-CAL insurance policy. There were repeated conversations in the Hospital about why I was not able to visit my Cardiologist, Neurologist, or GP this year. So, next week, I have to take a cab back to the hospital to sign a piece of paper, authorizing Linda to submit an application for a Temporary Medi-CAL insurance policy for April/May, until I have a chance to "work out" my problem. Linda told me that the Supervisor at the FRC is the person who can "switch on" my policy. Strangely, while at the FRC they did not bother to tell me this, nor did they inform me I could apply for temporary coverage.

Does anyone else think it strange, that the administrator who offered to help me with my State insurance policy is actually a Hospital employee? How many administrators do we really need to administer a basic health insurance policy? Apparently: 13. Twelve stressed, untrained state employees who don't know how their system works. And one highly paid corporate administrator who does.

I suspect fully half of our health care costs go to these troupes of administrators, who serve no purpose other than to confuse a simple process. This confusion keeps HMO's, hospitals, and insurance companies in control of the process and the money that flows through it. Administrators and healthcare providers have no incentive to become efficient; it is inefficiency that allows them to control and bill for diagnostics and procedures. I suspect half our healthcare costs are eaten up by this racket. It is the patients and doctors who are suffering. Shame.

The health care industry in the U.S. is terrified of (the increasing accessibility of) genetic tests: they are afraid of losing control, and therefore will not authorize DNA tests. Patient ignorance works in the system's favor. The look in doctors eyes when you bring up the connection between familial genetics and a specific medical condition: sheer terror. Not just because of losing control, but because: genetics is complicated (though not nearly as complicated as our healthcare system).

The other problem with high medical costs in the U.S.: We are the only country with universal healthcare that does not attempt to control the costs, allowing pharmaceutical companies, HMO's, hospitals, insurance providers to charge as much as they please. This practice favors the wealthy – those able to pay for expensive policies and out of pocket uncovered expenses. Genetic tests, for example, are not covered by health insurance companies in the U.S. and they are very expensive.

The health care system in the U.S. is set up to benefit the wealthy, who are likely to receive unnecessary tests. Meanwhile this same system deprives the poor and sick, who regularly do without needed tests and services, ensuring that they remain dysfunctional and poor. Our economic system follows this same model. We are being split down the middle. But we have something in our favor: there are more of us. Many more. We may be sick, but we are not dumb. It is just a matter of organization. It may very well be that the information revolution and control of our own genetic data will allow us to turn this relationship on its head.

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