Adventures in Healthcare

I pulled into the Publix parking lot Monday morning three weeks ago and I was in a fowl mood.

On Saturday I’d gotten a notice from my health insurance company that there were more i’s to be dotted and t’s to be crossed before I went for surgery on my knee the next week.

Why they have to always time these notices to arrive on Saturday I don’t know. But on Saturday and Sunday I can’t contact the Athens Orthopedic Clinic or my doctor (Dr. Chesser) and do anything about the insurer’s latest demands. It does fall in line with my latest theory concerning the insurer and that is that they are just trying to get me so frustrated that I cancel the surgery that they are supposed to pay for and then cancel my insurance.

I’m not paranoid. This theory was born from two months of fake and false bills from the company – when I would call to question the bills I would have to answer questions that have nothing to do with anything from a robot for five minutes, then hold on for another five to ten minutes before the most polite young man or woman (talking from somewhere in Colorado) would assure me that there had been a computer mistake and that it would never happen again. This has happened four times, starting shortly after my first claim.

Speaking of my first claim, I’d gone to the “Urgent Care Clinic” which is part of the Athens Orthopedic Clinic (AOC) located across from Athens Regional.

The book that came with my health care states specifically that emergency room or urgent care clinic visits do not require a referral from my doctor.

So I went to AOC’s Urgent Care Clinic and was x rayed and told that I would probably need surgery, but I could take a conservative approach and try to exercise my way out of it (with lots of ice and elevation).

I chose conservative and it’s a good thing (even though exercise, ice, and elevation didn’t work) I was notified by the insurer that the AOC Urgent Care Clinic didn’t fit the insurer’s definition of an urgent care clinic so they wouldn’t pay the bill.

I called and after my usual time with the robot and on hold I was told by the most polite young woman in Denver, Colorado that I should have known that the AOC Urgent Care Clinic was not really an Urgent Care Clinic so this was all my fault.

So I went to AOC and a very polite lady there told me that they do their billing of the insurance company through the doctor’s office and that even though I didn’t see the doctor (whose office was not even in the same building) for another month my visit to the Urgent Care Clinic was billed through the doctor’s office. So the insurance company treated it like I’d seen the doctor (even though I hadn’t) and it was billed to them under some number that she rattled off and for that I needed a referral. My brain was about to explode. I asked the AOC lady if maybe the lady who checked me into the Urgent Care Clinic should have told me of this when she took my insurance card and personal information before I was examined by the Physician’s Assistant. After all, she had two hours to look it over while I waited. The AOC lady assured me that this was all my fault. It was my responsibility to understand how my insurance worked. The insurer wasn’t to blame. AOC wasn’t to blame. It was all my fault.

Secure in the knowledge of my own ignorance, I went to Dr. Chesser’s office and had them send referrals for my future dealings with AOC. While there I received the news that after years of struggling to stay independent Dr. Chesser was giving up the fight and going to work  for the UGA Health Services.

I love Dr. Chesser, his wonderful nurse Nichole, Melissa and everybody in his office, but I can’t complain. They helped me through the toughest period of my life caring for Mama and Phil. They all went above and beyond the call of duty (such as the morning Dr. Chesser came out to the parking lot and gave Phil a shot as he sat in the car and refused to go into the office).

I’ll always be grateful to Dr. Chesser and I can find another primary care physician for myself but I was uncomfortable changing doctors in the middle of my knee treatments. I was afraid that the insurer might somehow use changing doctors as an excuse not to pay the bills.

Now I had spent most of a Monday morning talking to a new nice lady (Angie) at AOC about what was needed, then I had tracked down Dr. Chesser’s new office at UGA and he attempted to give me what I needed.

But I knew that the “referral” that Dr. Chesser gave me wasn’t going to be what Angie said the insurer required. As I pulled out of the Health Services parking lot I turned toward Publix. I needed a couple of things and I thought that it would be easier to get them before I went back to AOC.

As I entered Publix my eyes fell upon the lottery machine. $114 million payoff. I pick up lottery tickets maybe four times a year. Usually when I’m very depressed and have bills that I don’t know how to pay. This day qualified on both counts.

I veered over to the counter and handed the guy a five dollar bill. “I want five quick picks on the Big Game or whatever it’s called now. Cash payoff.”

I looked at the ticket. $114 million. I folded it and put it in my wallet. I immediately felt better. As I cruised toward the produce section I started daydreaming. The red convertible sports cars under the Christmas tree for everybody. I would be able to tell the insurance company to go to hell. I could pay cash for my medical care from now on.

A smile returned to my face. I always have been lucky. Maybe not a billion to one or whatever lottery odds are, but I always have been lucky. After all, someone has to win.

I left Publix and went to the AOC and still smiling, I found Angie.  I produced the document that Dr. Chesser had given me and she was skeptical.

She went to her computer and a few minutes later returned and said that the insurer said that this was unacceptable. “You have to get Dr. Chesser to go on line and fill out this.” She showed me a rather complicated form that called for several codes and things that I figured Dr. Chesser would be as clueless about as I was. But I kept smiling.

“I guess I’ll have to postpone the surgery until I can see a new primary care doctor” I said. Angie looked at me and answered “have a seat in the waiting room and let me see what I can do.”

After only about five minutes she entered the waiting room and handed me a piece of paper with a number on it. “I explained the situation and we have approval for the surgery and your next two visits , but they said to get a new PCP as soon as you can.”

I didn’t want to frighten Angie so I resisted the urge to hug her and instead started singing the Rolling Stones song “Angie” after I thanked her and turned to leave. Needless to say my singing made everybody smile.

That Friday, I was back in Publix checking out. As the young lady separated my cold objects for separate bagging, I reached into my wallet for a $20 bill. I spotted my lottery ticket and before I left I went back to the customer service counter and handed it to the young man standing there.

“Can  you please check this for me and see how many millions I’ve won” I said with a confident smile. He fed the slip into the machine and to my surprise opened the cash drawer, reached down and handed me a one dollar bill.

I always have been lucky.

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