Dealing with doctors and @#%^&@@@@@ insurance

Is there a bigger topic of conversation in America right now, other than the price of gasoline, than the topic of medical care? Is anyone exempt from the rising cost of medical insurance and healthcare? Or is it just me?

Last night, I drove Cindy and our friend Cissie up to a medical building attached to St. Joseph Hospital on Peachtree-Dunwoody Road. When we got to the office, Cindy had to lay her veins bare and bleed a little bit on the counter, with copies of insurance cards, payment of deductibles, preliminary information about her condition, preliminary patient information spilling all over the floor and the counters. By the time we finished, we had already been there for a little over a quarter of an hour.

Then we sat down among the washed and the unwashed. Waiting. Wondering. Talking. Providing support. Trading magazines. Waiting. Wondering.

Finally, they called Cindy's name and she hobbled up to the front of the reception. They led her to an examination room, where the doctor examined her and the nurses/assistants took more information. A never ending process of information-gathering.

Meanwhile, Cissie and I are sitting in the waiting room, waiting and wondering, trading magazines, waiting and wondering. Again, finally, Cindy came in and called me back to the examination room. A nurse started talking to us about healthcare and the cost in time and money and effort to keep it moving and working for you. The nurse opines that it would be better to get the insurance paid immediately and then make the patient pay immediately so they can get paid. She is really concerned with the doctors being paid. That effects her paycheck. I am thinking the longer the process the better for me. Put it off. Put it off.

Meanwhile, no doctor to be heard or seen or found. The nurse is talking and kibitzing and giving us her opinion. Cindy is giving her opinions. I am quietly reading the diplomas on the wall and the other certificates doctors have on their walls. This guy graduated from medical school at Emory the same year I graduated from law school. Interesting.

Why is there something comforting about having a doctor who is close to my age? That is odd. At one time, not so long ago (to me, anyway) all the doctors were older than me. Some of them were really old. Then, I moved to Griffin and my doctor became the guy who used to live across the street from me when we first moved to our present house and may have played Pop Warner football against me in the late 60's and early 70's. That was fun to have a doctor with whom you had so much in common. Now we are both old together. There is a comfort there, I think.

But going into a strange environment like the medical complex between Northside and St. Joseph's, with all of the doctors and medical practitioners jammed together like a pack of hungry wolves. Not really knowing anyone. There was some comfort to find that he was about our age, I guess. That we had something in common.

But, anyway, we are still sitting and the nurse has put a Winter coat on and has bid everyone adieu. She is nowhere to be seen. Everyone seems to be leaving. It is only around 4:30 in the afternoon. Is their day through early?

The door is cracked, half open and half closed. We can hear a male voice. Is this the doctor? Is he coming in? There is a shuffling of paper on the outside of the door, and suddenly a guy around our age enters the small office. We shake hands.

He is pleasant. Not overly handsome, but personable. As soon as he enters, Cindy is telling him she wants the surgery now. He tells her she will have to meet with the surgeon. He asks if we have anybody in mind to perform the surgery. He has a list of surgeons. Do we want to have the surgery in Griffin?

Cindy is adamant. Absolutely not. A short tirade about the problems with Tenent hospitals. He gets the message. Tirade extends. He says that is fine. He knew a doctor in Griffin who we know. We could use him. Cindy is further adamant. Absolutely not. Would rather have a surgeon in the Dunwoody area. Likes the doctor in Griffin, but not the hospital.

The doctor finds a plastic throat to show us the thyroid and what needs to be done. He suggest the surgery is probably necessary. Cindy is adamant. She wants it gone now. The doctor listens without raising his head from his papers.

They couldn't do a biopsy because of the size of the goiter. Such a lovely word. Goiter. A quite goofy word, I think. We find out that goiters are common for people in the midwest, away from the ocean and seafood. We find out that goiters are common for people from Germany and France. That's Cindy, all over. At least since she left New Orleans and California. She apparently doesn't eat enough seafood for someone of German/French heritage.

Cindy emphasizes that she needs this goiter (she doesn't use that term. I don't think she likes having a goiter. Sounds kind of rednecky to me. Something you might get from not eating enough kaolin in your diet. I see Cindy out in the road, eating kaolin to get rid of the goiter. No, on second thought, I can't see that at all.) removed. It is causing her to be dizzy. The doctor says probably not. That it must be something else.

So finally, we have the name and telephone number of a doctor nearby. We leave and go to my parents' house. We discuss treatment. Cindy is adamant about having it removed. She is tired of having this growth on her neck. She is tired of feeling like it is causing all sorts of problems with her condition. She doesn't want to be dizzy anymore.

We go eat at a Thai restaurant and Cindy eats shrimp. Good Cindy. We travel home. We go to bed.

This morning Cindy calls the doctor, or actually leaves a message on his voicemail. A nurse calls. Cindy tells her about her goiter (I love that word. Sorry, Cindy.). Cindy makes an appointment for the following morning. She calls my mom and dad and asks if we can stay with them tonight. Grudgingly, my dad says yes. Mom has bridge club tomorrow. Cindy promises no trouble, no mess.

Then the doctor's nurse calls. Our insurance won't cover the expense. The doctor is "out of network". Our insurance may not even cover the surgery. The deductible is so high.

"I thought we agreed to have a low deductible so it would cover the problem?"

"No, we had to have a high deductible so I could afford to pay the damn premium."

"Yeah, but..."

"Look, we have other expenses we have to deal with."

"Ok, ok."

Cindy keeps the appointment with this doctor and looks at me. "Call the insurance company."

So, I call the insurance company. I am working my way through the computerized prompts. Cindy is telling me something. Cindy's mom calls and tells her something. I hang up in frustration. I call again. Cindy's mother calls again. Cindy is telling me more things. I hang up again. I redial. Her mother calls again. I leave the room.

Upstairs, I try again. After several computer prompts, I finally get a human being, somewhere in Georgia. She is talking to me. Very polite and gentle. Very nice to talk to someone of whom I can actually ask a question. I bounce down the stairs. I ask her some questions about coverage. Cindy is looking at me expectantly. The customer service person is going to give me some names and telephone numbers. Cindy is pushing an envelope with a set of questions and information to share with the person. I hand her the phone. She is talking to the person.

Cindy's phone goes off. It is her mother. "Cindy? Cindy? Cindy?"

"No, its Tom."

"Tom, where is Cindy?"

"She is talking to Blue Cross/Blue Shield."

"Good, then I will talk to her later."

"Alright." Click.

Finally, after listening to Cindy fill in the customer service person with every possible, minute detail of her condition, they end the conversation. The customer service person is sending me a list of doctors. I now have to drive to the office to await the list.

I hop in the car and head out. My phone rings. It is Cindy.

"Did you take the dog out?"

"Uhhh....no."

"I thought so. You need to come home. He can't wait any longer."

"Aww, Cindy."

"Its' got to be done."

"Alright. I'm coming."

So, I drive home, get the dog on the leash, take him outside, watch him do his business. Return inside. "I'm leaving."

"Ok, call me with the list."

"Ok."

I drive back to the office. No list. I check my emails. No list. No email. Cindy calls.

"Do you have the list."

"No."

"Aughhh... She said she was going to email it to you in five or ten minutes."

"Well, its not here."

"Ok, call me when you get it. Maybe I'll call the doctor."

"Ok."

So, I decide to go on line and try to get a list off of the Blue Cross/Blue Sheild website. I get on line. I maneuver through the list. There is no list of ENT surgeons. Cindy calls.

"Have you got the list?"

"No, I'm on the website now trying to find it. They don't have any lists of ENT surgeons."

"What do they have?"

"Do you want to hear all of the types of doctors on the list?"

"Go ahead."

So I read all of the doctors on the list.

Cindy says, "Find the ENTs."

"Ok."

Suddenly the ENT doctors springs before my eyes.

"I've got it. Hold on a second."

"Ok."

Forever, forever. Finally, I find a list of ent's in Dunwoody.

"Ok, I've got it."

"Read them to me."

I read the list.

"Most of these guys are on Peachtree Dunwoody and seem to practice together. Do you want the numbers?"

"Yes, give them to me."

So I read the numbers. Slowly. What she cannot hear, I read again. Slowly. Even slower. Finally, we are at an end. I can go on to other things. Things which might benefit my bottomline rather than take away. Cindy calls later and says she has an appointment with a doctor on Thursday afternoon. All is right with the world. For now.

The shadow of non-coverage still looms above us like a raincloud. Like the rainclouds which are perched over Griffin as we speak. Unlike those physical rainclouds, the rainclouds of the insurance turning down the claim hang over all of us, every day, no matter what the claim. Agggh!