Saturday, June 17, 2017

Consumer vs. Patient

I love our doctor. She's everything a medical professional should be: smart, knowledgeable, caring, respectful of me, my time and my life. Not that I like visiting her in her professional capacity, but every time I must it just reinforces how wonderful she is. But whenever I venture beyond her stethoscope, I am reminded that nothing in medicine is simple these days. As we all try and negotiate the new landscape, some things work well, others not so much. And I got to see shining examples of both thanks to my nose.

Without getting too detailed I was having some sinus issues, and was referred to a specialist. He examined me, did some tests, but wanted more to be sure. And so he suggested that the right thing to do was to have a CT scan of my head. He was part of a large practice, and they have a radiology department on site with all of the toys. I called in to make an appointment. They were most helpful, found a time that worked and slotted me in. Done and done.

The paperwork was submitted to the insurance company, and kicked to a benefits manager. These companies exist as middle men, with the goal of keeping costs down. That led to a call from one such company telling me that my test was approved. All well and good. "But," said the rep on the phone, "you may be able to get it done cheaper nearby." I've had these conversations before; usually their version of "nearby" is in a different time zone. Plus the hassle of scheduling and getting authorized by a new place eats up so much of your clock and your sanity that it's not worth it.

Still, I bit. "Where is this place?" I asked. She did a search, and indeed, in this case, a reputable scanner was 5 minutes further down the road. But then the rep did something extraordinary (or at least by the standards I was used to): she offered to help. "Can I call them while I have you on the line and get you an appointment?" Sure, I replied. I heard a new dial tone, and a call being placed. She got right to the scheduler at the other end, explained who she was and why she was calling, and asked me to chime in: "When works best for you?" The scheduler and I worked through some dates, but said she needed the right paperwork to make the appointment. The benefits rep jumped right in: "Sending that to you now, along with the authorization numbers." A few seconds later, the scheduler came back: "Yes, it just came through. You're all set. See you next week."

And the rep wasn't finished. Once the scheduler hung up she asked, "Would you like me to call and cancel your original appointment?" By all means, I replied. She gave me her number in case there were any issues or questions and rang off. For perhaps the only time I can remember, I was treated by Big Medicine not as a patient, but as a consumer.

But there's a yin to the yang. While these benefits managers do get lower prices from suppliers, they also review a doctor's recommendations. And that means that an outsider is looking at paper and not patient, and making decisions. The specialist had recommended some procedures to fix my issues, and we set it up. Then 2 days before the appointed date, a letter showed up disallowing parts of the plan. That resulted in a panicked call to our own doctor, and she reached out to the specialist. Turns out he had spent the better part of an hour explaining what he wanted to do and why to the insurance company. But upon reflection, they felt they knew better, and said no to part of his approach. Not to worry, he told me. He was going to do what he thought he should do, and would work out the magical codes later. And so we proceeded without the overreach of a far away reviewer who was diagnosing me from a chart.

I'm happy to report that all is good, and I can now see why this breathing thing is all the rage. As to the system, there are definite growing pains, some more painful than others. You just have to hope that you get the favorable bounces. And you have to hope you have our doctor: she's the best.


Marc Wollin of Bedford tries to be a good patient. His column appears regularly in The Record-Review, The Scarsdale Inquirer and online at, as well as via Facebook, LinkedIn and Twitter.

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