The letter was short, but not sweet. The endocrinology practice was not accepting me as a patient. If I had any “issues” with the denial, I should take it up with ”the referring or primary care provider and not our office.”
Yeah, well I did have issues. I stood with that sheet of paper in my hand and realized I was more disturbed about the blunt brush-off than the fact I that I was not going to receive treatment.
Why is dealing with the American medical system such a pain in the neck?
I am appreciative of the good care I receive overall. Even when I’m flung back in a dental chair, mouth wide open, being poked and prodded, I am able to feel grateful. I can hear my mother, in her 80s, telling me, “Be sure to take care of your teeth!” I am glad to be able to carry out Mom’s wishes. Orders.
But there are so many other times when I ask “What the heck?” This was one of them. Back story: My nurse practitioner was concerned about a nodule on my thyroid. As I detailed in a previous column, an ultrasound revealed some disturbing features. A biopsy was recommended.
More than a decade ago, I’d had a biopsy, conducted by an endocrinologist in his office. But times had changed. This time, it would be more expedient to have the procedure done by the hospital’s interventional radiology staff.
That was fine with me. The biopsy went smoothly and the nodule was determined to be benign. My NP wanted me to see an endocrinologist nonetheless. It would probably take a while, she warned me, and would likely be in Portland. I was good with all that as well.
Still, I had to admit this was not a, um, healthy trend. On my first go-round with the nodule, years ago, I’d easily and quickly gotten an appointment with a Harvard-trained endocrinologist in Lewiston. I was more than happy with the care I received from him over five or more years. This was not that long ago.
Yet while I was taken aback by the latest chapter in my health care story, I was not surprised. Getting appointments, dealing with medications, haggling over bills that have been coded wrong—at times it seems like dealing with medical needs is a part-time job.
Take my recent battle over prescription drops for my dry eyes. I’d been using Restasis for a number of years. In the last few years before I retired as a school librarian, I’d obtained them for free by downloading an offer from the manufacturer. When I went on Medicare, I still received the offer, but it wasn’t being applied. It took me at least three weeks to get the simple explanation for this. No free Restasis for Medicare recipients.
This was annoying, but the co-pay was not onerous. A person might think that free eye drops for people over 65, whose eyes might be drying out at a faster rate than those of younger people, and who are likely living on a fixed income, might appreciate free drops more than a 35-year-old, but there you have it.
Anyway, one day, when refill time arrived, the pharmacy gave me a generic. I checked with my eye doctor to make sure that was okay, which it was. Except—not with my Medicare Part C provider. We will pay for it this time, they said, but not the next time. In kind of a mean way.
Meanwhile, the pharmacy insisted on refilling the eye drops even when I didn’t need them. This forced me to call them to tell them I didn’t need the drops yet. Also, I had to talk to at least five people, and send a rather blunt email, to get the drops taken off “auto-fill” so this wouldn’t happen again.
For the next properly timed refill, I got Restasis. No generic. All was well for a couple of months. Then—the generics arrived again.
I took a deep breath and persisted, calling both the pharmacy and the insurance company, until I got the answer I needed. It turns out I had to make sure the eye doctor’s office stipulated Restasis, not the generic. Otherwise, the pharmacy was obligated to give me the generic.
It’s like we need a handbook to navigate this stuff.
I now have three boxes of Restasis stashed away, so I can turn my attention to other medical matters.
Like the “not a bill” I just received from the insurance company. They were denying payment for two shots I received in January during my physical. Denied? How I hate that word. The jabs were for tetanus and pneumonia prevention. Nothing exotic. I felt my blood pressure rise until I saw that the insurance company was going to ask my provider for “missing or correct information.” The statement concluded that there was “no action needed.” On my part, that is. Now, that’s what I like to hear.
Meanwhile, my NP told me she was going to try for another thyroid referral. Within a few days, I got a call and I now have an appointment with an endocrinologist. In Lewiston. It’s not until July, but I am not complaining. I need to save my energy for my next health care issue. It’s sure to pop up within the hour.
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