Chronic Illness and Mast Cells, Injustices of the Healthcare System

A Word on the Bizarre: Health Insurance and Shoddy Corporate Policies Part One

I dislike large healthcare corporations and insurance companies. The freedom for physicians to make sound decisions regarding the care they provide and how they run their practice is quickly becoming extinct. As more physicians are pressured to join the perceived path of least resistance, control flies out the window. Here is an example of established patients being dropped due to the health insurance they hold without the option to pay out-of-pocket (so I’m told):

Back at the beginning of the year, I went to my PCP (primary care physician) for my usual monthly follow-up. When I arrived at my doctor’s office I signed in and took my usual seat in the hallway just outside the doctor’s office (to avoid air freshener and perfumes). Several minutes later I was called to the front desk to pay my copay, fill out new paper work for the year, and give a copy of my insurance card. Little did I know, I was about to be sucked into my doctor office’s version of the twilight zone.

About 30 seconds after handing over my insurance card, the front office lady says, “we don’t take that insurance any more”, then she promptly stared at me with a blank look on her face.

“O.k.”, I said. “When did that happen, because he is a preferred provider on my insurance?”, I asked. (Side-note: Every year as December ends and January begins I have anxiety about health insurance and whether my doctors will be covered. I am diligent with looking my physicians up to make sure they are in-network.)

“We can not see blank Insurance patients any more”, she says.

“But I know he’s on the preferred provider list”, I said.

“We sent out letters to all the patients with blank insurance and it stated we would not be taking blank insurance any more. You should have got one”, she says.

“I didn’t receive a letter. This is the first I heard of it. There must be some mistake. That can’t be right”, I said.

She looks at me like I’ve grown three heads.

“Well, whether he takes my insurance still or not, I have to see him today. I’ll just have to pay out-of-pocket”, I stated.

“I can’t even check you in”, she says.

“What do you mean you can’t check me in?”, I ask.

“We can no longer see blank insurance company patients”, she says.

“I understand that you are saying you don’t accept blank insurance company anymore, but I can pay out-of-pocket today.”

“Ma’am, you’re going to have to talk to so and so, because he is not allowed to see blank insurance patients any more”, she says.

“That doesn’t make any sense. I am completely willing to pay out-of-pocket up front to see him. I’ve been coming here for almost 20 years. I am an established patient”, I stated.

“Ma-am, let me check and see if so and so is here so she can talk to you. Like I said, I can’t even check you in. We’ve been told not to.”

Panic begins to set in as I stand there waiting to find out if I am now without a doctor due to some policy making prick sitting in an office at corporate thousands of miles away from the reality of their edicts.

“Ma’am, she’s here. Just go on back to her office. She’s straight across..,”

“I know. I’ve been coming here for years,” I interrupted.

With fear and frustration, I walked to so and so’s office, and told her what the problem was.

“Did you get your insurance through the health portal?”, she asked.

“No”, I stated.

“Is it through your employer?,” she asks.

“It’s through my husband’s employer.”

“I think they’ve got it mixed up, but let me look something up here”, she clicks away on the computer. Blank insurance company changed as of the first of the year, and we are no longer accepting blank insurance through the health portal. But we are accepting blank insurance still through your employer. It’s very confusing because most of our patients with blank insurance bought it through, you know, the web site. And we are having to turn those patients away. You are one of the few lucky ones that have blank insurance company through their employer. We cannot even let blank insurance patients pay out-of pocket,” she stated.

“Why?”, I ask.

“It’s the new policy now. If we know you have insurance and we don’t accept it, we cannot see you as a patient. Now, if you don’t have insurance at all and you pay up front we can still see you. But not if we know you have insurance”, she stated matter-of-factly.

“So you’re telling me that an established patient cannot pay in full up front and be seen here, just because you do not take their insurance any more?”, I asked.

“That is correct” she stated.

“That doesn’t make any sense”, I stated.

“That’s what they told us at of the beginning of the year”, she said.

“That is ludicrous”, I stated.

“Well, you don’t have to worry about it because we are still taking blank insurance through employers” she said.

“O.k., well thanks”, I stated.

Shaking my head, I walked out of her office and back to the front desk to pay my copay, now that I was being “allowed” to check-in.

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