Wednesday, August 24, 2011

American patients - A Day in the Life

I'm constantly amazed that so many Americans are vehemently opposed to any changes in their healthcare system, when the one in place is often completely rubbish.

I won't even go into the bigger social aspect of about 47 million Americans not even having health insurance. My beef is with the minutiae you have to deal with if you're lucky enough to have coverage and can get to a doctor.

First, you have to make sure that your health insurance actually allows you to see a specific doctor. While Americans aren't required to go to the nearest doctor or hospital, their health policy often has a "network" outside of which you cannot go without having to pay most of the costs yourself. (And let me tell you, those costs are astronomical.) The problem is often that the literature and lists of "in network" physicians, are out of date. Doctors drop health plans all the time, and coverage changes with surprising speed. Best thing to do is check with your insurance company AND call the doctors office to make sure they still take the plan.

If you're on more than one medication, say from two different doctors, there's no one to say "Hey - that combination of drugs is potentially lethal." Walgreens, a large chain in the US, has just started offering this service (as long as you get all your prescriptions filled with them) which will alert them to any potential problems.

Prescription labels often have a refill number on them, allowing you to re-order the medication. However, just because there's a refill order on the label, doesn't mean you can get it. My teens both use skin creams, prescribed by their dermatologist. Before we went to England in the summer they both told me they were out of certain creams, so I phoned my lovely pharmacist, and he duly phoned the dermatologist to authorize the refill. No go. Apparently it was just over a year since my kids had been seen by the doctor, so the receptionist couldn't authorize the refill. I explained that we were about to leave for a month, but she was unimpressed. (Jobs worth anyone?) I gritted my teeth, made the appointment, paid through the nose for a nurse (not even the doctor) to say everything was still the same and we could have the creams.

Last week I needed to fill another cream prescription for the Queenager. The pharmacist duly faxed the request to the dermatologist, and we waited. Two days later (the day before she left for college) still no cream. I called the pharmacist who said they'd faxed and heard nothing. I phoned the dermatology office where I was told flatly, that no fax had been received. "But we have a fax acknowledgment from you". Still flatly denied. Grr, and grr again. (This is where you learn not to argue but to just put the request in again.)

Hopefully we'll get the cream before she leaves.


  1. This is the patience clause of policies. Not quiet patience; dogged, determined, perservering, follow up minutely, don't use ajectives patience. You can only politely hound them, holding all remarks on intelligence or competence until the receiver is on the hook.

  2. Absolutely Joanne. One thing I've learned is not to say anything sarcastic or offensive, no matter how incompetent they are. They have what you need and they can make it even more difficult if they want to.

    One thing i relish however, is putting everything down on paper and then sending it to the doctor him or herself. Half the time they have no idea how rude or useless their admin staff are, and when tell them that they have just lost a patient (ie. dollars) because of that, they usually sit up and take notice.
    And of course, there are quite a few review sites like Yelp, where I have no problem giving my opinions.

  3. I am in no way defending the deeply flawed health system in the US but the gripes you have about not getting your prescriptions filled seem to be your own fault. I have never seen a prescription label that doesn’t clearly say something to the effect of “4 refills remaining”, then after that one “3 refills remaining”, etc., typically ending with “contact your physician for refill” after the last course is filled (assuming the prescription doesn’t completely expire with the last one). I don’t think it’s asking too much to take the responsibility of keeping track of medication expiration dates or noticing that you’re running low on something before going on a trip. It also makes perfect sense that a physician would want to see a patient when an entire year has passed since a medication was prescribed before authorizing a new round of cream or whatever.

  4. So understand your frustration. If you have a family with health issues and are lucky enough to have insurance, it is still a full-time job keeping track of everything and then dealing with the bureaucracy that surrounds each prescription/visit. I have had 6 different insurance plans in 6 years and 4 in our family of 5 need regular medication. One child requires special meds that have to be ordered every month, 2 weeks before I collect them from the pharmacy. Let's just say that my wall calendar includes schedules for calling in and collecting medication as well as soccer practices and dental appointments!

  5. Arrgghhhhh! I find it difficult enough with keepig up with my Boys meds. Problem is it is in liquid form and makes it difficult to know when it is running out can you beleiove it the bottle is opaque ????. Creams must ba a nightmare esp with teenagers who "forget" to tell you when they are low. It's not like they are pills or anything which are easily measured and doled out.
    In the Uk it is simple enough to just ring up the pharmacy they have all teh info and as lonmg as you have your medical number they can access your infomration anywher in teh country. It was a godsend when my Mum spilled the boys medicine by mistake while he was in Yorkshire!

  6. Eliza - if it were a one-off, I probably wouldn't complain, but the fact that you can bet money on the gaps in the system annoys me. The fact that you can obtain a degree here in health care administration (and that includes filing claims on behalf of patients) pretty much says it all.
    I think I said in my post that I had refills remaining with no expiration date stated. In the past they had had no problem with refilling prescriptions, as long as I told them over the phone that the kids' conditions hadn't changed. It's all a matter of litigation prevention on their part (which is the scourge of US healthcare costs) and a need to have us in there and charge me over $150 for a half visit.

    As a writer of US/UK issues, I take it upon myself to warn newcomers of the need for vigilance, and if that comes out as a gripe, then so be it on my blog. It is an appalling system, which I'm glad you didn't try to defend, and immigrants such as me, need all the help they can get.

  7. And yes Tattie - with teens you're right. I had asked them for 5 days straight to tell me which creams they needed. I was well ahead of the game, but well, one of them is playing on the school golf team every day and the other one is packing up to go to college, which is proving quite the drama.
    What can you do when you're only human?
    Jane - I cannot imagine how you do it with that many prescriptions to keep track of. I have to have almost a separate fling system for my medical claims. Every time something comes in from a doctor (and it's usually three different bills) I have to then line it up with what my insurance company says I owe. With more than a few kids, it's a job and a half, and there's always a query.

  8. I think it is a big flaw in the system that networks and coverages change, without notice. I would hate to phone my doctor to make an appointment, to be told my insurance didn't cover him any more, but I know it happens. It really undermines relationships.

  9. The US health system is so expensive, and once you are receiving treatment via insurance, they seem to try to bleed you dry from looking at my parent's and the "specialists" they have been sent to in recent years, even both are generally in good health. I have lived my whole adult life under the NHS and if I do live in the States at some point this will be a headache of a learning curve!

  10. Well, I hate to say it but I'm glad I'm in England. We might have to queue up for an hour or two in a busy hospital but we do get whatever we need and for cancer patients, children and older folk it is all completely free.
    All our pharmacists (chemists) give advice on drug combinations completely free.
    One of my blessings..... I must remind myself of that when I start to moan.
    Maggie X

    Nuts in May

  11. Cor, and I thought our system was annoying!

  12. Im with you all the way.Here is our recent saga: took Geekyboy to the ER at our nearest hospital to get a hole in his head glued. When they admitted us they sent us up to the childrens dept to be seen since the ER was busy.

    When I got the bill, insurance had paid only $30 of the $600 cost. Turns out that though all emergency care is covered as 'in network' the hospital was out of network, and since we were billed through the childrens dept not the ER it was barely covered. Argh!

  13. OMG - I've heard of that. A friend took her child to the ER last year and although it was covered, half the staff who saw the child (and there were many) were out of network and no one bothered to tell her. I can't understand how an in-network hospital can use non-network staff.

  14. I have to say here in US the expectations are unbelievable high (if you have insurance). I had my fourth baby in Alta Bates, Berkeley which (next to St Mary's in London) was a four star hotel. They also let me stay three nights at no charge. St Marys in London was shower curtains separation, no diapers, no help with diapers even for first time mothers, out the next hour if they could get you out and thousands of relatives all over the show, all day, all night. Yet the other mothers who had their babies here at Alta Bates, Berkeley had nothing but complaints.
    BTW, shout out for you today on my blog from Susanna of Modern Mother

  15. The year I started high school, I was in and out of the ER for about a month. The last visit resulted in a 3 day stay in the children's ward. Let me just say that my parents DID have insurance, but it was horrible, and hardly paid for anything. Anyway, when my parents finally got the hospital bills--months later--the charges for the ambulance ride for the last visit alone were about $300. Apparently, because the illness was the result of a pre-existing condition that no one knew I had (and that obviously wasn't mentioned when my parents first signed up for that insurance), the insurance company only agreed to pay for about 10% of those hospital visits.

  16. Before I left the US, I had insurance through my work. My only health problem was migraine headaches, for which I take a prescription medicine.

    At the time, I got very frequent migraines that would keep me from work - often 3-4 days a week - but insurance would only cover 9 pills a month.

    My choice was miss work or spend over $20 per pill once I went beyond the permitted amount. And if I got a headache on the weekend, I'd just suffer through it.

    Migraine is a MINOR health issue, imo - it's not life threatening, and the medicine for it is non-narcotic, non-addictive (Imitrex). In fact, here in Peru, I can buy it over the counter (for less than half the cost).

    But it is a horribly painful way to spend nearly half the month, just because the insurance company feels you shouldn't have to take a medicine that often.

    (Good news is that I've grown out of them as I've gotten older - hormones and what have you)


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