I got a call the other morning as I was racing to work from a woman who claimed to work for the “third-party administrator” of one of my health insurers. Yes, I’m one of the incredibly lucky people who actually have two health insurance plans, one for each of my full-time jobs. The woman wanted to know whether I would like the assistance of an RN on their staff in managing my health care. I knew what she really meant. I said no.
What she really meant, and what certainly triggered this call, was the two MRIs I have had in the past few weeks, the first of which was denied (and then reversed on appeal) and the second of which was pending (and did get approved). All of a sudden, I was costing a lot. Did she really think I would say, “Who needs the doctors and specialists who have been taking care of me for years and dealing with my family’s history of heart issues when I can get advice from an RN who works for the insurance company?” But I was pleasant and just said no.
No, apparently, was not an acceptable answer. A few days later, I got an unctuous letter from the same woman. I’d say it was a form letter, but form letters generally have proper punctuation and sentences that include both nouns and verbs. This one had neither.
“I hope this letter finds your health improving,” this person wrote to me. It gave me the creeps. Privacy, anyone? Who was she to be reviewing my records and telling me I was sick? She isn’t a doctor or a nurse; she’s a pennypincher. “You have been identified as someone who may benefit from Case Management due to your complex health needs.”
BS. You have been identified as someone who has good and dedicated doctors who are making decisions in your best interests, and not the insurers’. You have been identified as someone who is costing us money.
“Case Management is a personalized service that provides you with a Patient Advocate (Registered Nurse) to ensure that your care is being provided timely, appropriately, safely…” Do you see what I mean about the grammar? In fact, the only thing that has of late stood in the way of “timely, appropriately, safely” provided care is fighting with the insurance company to get medically necessary tests performed.
How dumb do they think I am? Do they think I would trust a nurse (I have great respect for registered nurses, except when they are being asked to trim health care costs.) on the payroll of an insurance company rather than the doctors who have taken care of me for decades?
“Please contact me at your earliest convenience,” wrote the woman I never intend to speak to again. “I look forward to hearing from you and learning more about how … our Nurses can help you.” Grammar again. She looks forward to learning more about how her Nurses can help me? Maybe she’s being honest and doesn’t have a clue because there is no clue. Or maybe they’re saving money by hiring people who can’t write letters rather than just paying for the MRI in the first place.
This is not, I should add, Obamacare that I’m talking about. I have old-fashioned, pre-Obama, employer-provided insurance. This is the ugly underbelly of managed care, which was destroying the health care system long before Obama got his hands on it.
I discussed it with my doctor of 25 years. He just shook his head. I remember when it first became clear to me, and everyone else, that members of Congress were spending more time raising money than doing the people’s business. Now, as every doctor I know who is still in private practice tells me, they work for the insurance companies and some days spend more time fighting with them than taking care of their patients.
I am truly lucky. Blessed. I have insurance. I have wonderful doctors. I know how to stand up for myself. I have problems that can be fixed by the best of modern medicine, and I am in a position to get the best. But I keep thinking of a time, many years ago, when my cousin Irwin was a big-shot doctor at Harvard. When I saw him, it usually was on “private patient” days, with well-to-do patients, no wait, etc. But one time, I had some rash, and my mother was nervous, and so I went in on clinic day. The place was packed. The wait was long. But we clinic patients, all of the poor people and me, got exactly the same care that the private patients did.