Healthcare Hullabaloo: Combat

Watching the news these days, it’s almost impossible not to hear something about war. We have the war in Afghanistan and the war in Iraq. Now, for a change in pace, the two Koreas are lobbing stones at one another. And let’s not forget about the war on terror.

The same thing happens when you load your home page, turn on the radio, or pick up a newspaper (Remember newspapers?)

War permeates even my non-news television watching. The Discovery Channel, the History Channel, and, of course, The Military Channel all are heavy on programming about war or it’s machinery.

Hey, when you think about it, even good old All-American Football is just a thinly-disguised war game. (Need proof? My poodle becomes very aggressive whenever he sees Michael Vick on TV).

Yes, like Elvis, war is everywhere.

Last week, I had my own little war with my insurance carrier as well as my eye surgeon’s office. Not a little border skirmish, mind you. While the opposition may not have realized it, I was preparing for M.A.D., and I’m not talking about the magazine. The blast doors were off the silos, launch keys were inserted, the ‘football’ was powered up, SAC was in the air over the North Pole, and an ELF signal was sent out to the Boomers.

I’m talking Defcon 1 here.

Regular readers of my blog may recall my past conflicts with these two warring parties. It all started last summer, when my insurance carrier and my eye surgeon failed to reach an agreement on contracted fees. The end result was that the eye surgeon ceased being an in-network participating provider for my health plan, and things got really nasty between them and my carrier. The situation soon turned into the out take reel from the classic movie ‘The War of the Roses’. I played the role of the Morgan Roadster. (Never saw the movie or need to refresh your memory? Check it out here:

http://www.youtube.com/watch?v=dXskW2VvfC0

Unfortunately for me, I was in the middle of a staged (2 part) surgery at the time. I was left blind in one eye with no one willing to fix it (while there were other, in network doctors who could finish the operation, no one wanted the responsibility of finishing another surgeon’s work, at least while that surgeon was still alive).

So, last month, I spent a great deal of time working with both my surgeon as well as my insurance carrier in order to get these two warring factions to agree to work together, at least until my surgery was completed. Against the odds, I managed to broker a deal between these two pissy children, and everything was set for my surgery, which was then scheduled in a about one month's time. I forwarded the carrier’s authorization number to the eye surgeon, and I was good to go – or so I thought. Then, 3 days before my date with the knife, I got a call from the surgeon’s business office

It seems that my Camp David accord of the previous month had fallen apart, and they now wanted me to pay for the entire surgery up front or else they were going to cancel it.

My first thought, as they say in Old Paree, was “Merde”.

Not willing to pay up front (I have very expensive insurance – why should I?) or wait any longer, I launched a vicious counter attack. I’m talking ‘Shock and Awe’ here. I made ‘Operation Desert Storm’ look like a backyard fireworks display.

I spent the next 72 hours attacking both sides, pleading, screaming, threatening, manipulating and cajoling both parties until, at exactly 4:58 PM Thursday evening, I got another tenuous agreement cobbled together between the 2 parties.

Henry Kissinger has got nothing on me.

People who don’t know me very well might think me a bit of a pussycat - I’m generally a pretty easy-going guy. However, underneath my calm surface lies a pit bull with ‘roid rage. I’m not a physical person - I don’t ever get violent - but I cannot stand dealing with mindless bureaucracy - especially when a bureaucrat tries to tell me I have to remain blind in one eye because these two brats can’t play nice with each other. Yeah, I reverted back into total North-Jersey guido mode.

“Oh yeah, tough guy? Where you from?”

You also should understand that this was not my first rodeo - when it comes to dealing with physicians and insurance carriers, I’m what you would call a professional. I am intimately familiar with medical ethics, malpractice, and insurance law. I know where every loophole is, as well as how to close it. As a consultant, I have used my knowledge and skills to personally collect millions of dollars from uncooperative insurance companies. I have over 25 years of medical practice management experience.

It would be safe to say that, unlike John Q. Public, I know my merde.

The amazing thing is, in spite of my knowledge and experience, it still took me 3 solid days to get this mess straightened out, and then only in the 11th hour.

Which makes me wonder - How would the average person, without my experience, fare if they were put into the same situation? How many people have to do without the healthcare that they need and are entitled to because they were unable to bully their way through the system?

I'm not trying to toot my own horn here -I'm just trying to illustrate just how limiting and frustrating our current health care system is today. People opposed to any form of National Health care like to say that they don’t want a government bureaucrat making decisions regarding their health.

For my money, I would have an American Bureaucrat, with a command of the English language, make those decisions, instead of some fumble-mouthed lacky working for $1.40 an hour in an off-shore call center. At least we would be able to reason with each other in something that resembled the Queen’s language.

What did you say? – you never had a problem dealing with your health insurance carrier? Don’t worry – you will – mark my words. All you need to do is require an expensive procedure, or a medication that isn’t on your carriers ‘approved’ list. As Hemmingway said, ‘Ask not for whom the bell tolls….”

Fortunately for the insurance carriers, only a small percentage of their subscribers will be in a similar situation to mine at any given time. The number of frustrated health care consumers never seems to get large enough to cause a united front to rise up against this type of mistreatment.

On the bright side, I made it through the mine field. I kind of feel like Andy Dupree emerging from that sewer pipe – covered in feces, but glad to be out of there relatively unscathed.

So far, the only ill effects I am suffering from this ordeal is a slightly elevated blood pressure, a lingering aroma of cordite in my nostrils, and an occasional urge to get up in a bell tower with a rifle. (Just kidding about the rifle folks- chill).

Here’s hoping that you fare as well as I did when it’s your turn over the barrel. Just promise me that, when your day comes, you'll drop me a line before you pick up that Mannlicher-Carcano.

I just may be able to give you some pointers.

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Who are you? Do you agree with me, disagree with me, or have another perspective to share?

PLEASE put your 2 cents in by leaving a comment or email me at HealthcareBlog@SystematixOnline.com