By Tom Dodge, KERA 90.1 commentator
Dallas, TX – I know of someone in Arizona who needed hernia surgery, went to a doctor and bargained a reasonable fee, then paid for the surgery out of his own pocket.
I was thinking about going to Arizona as I struggled to beat my way through the virtually impenetrable bureaucratic jungle of health care in order to get an emergency appointment with a retina specialist. If I had given up after my first try I would have been justified in calling it Health Uncare.
But because the light in my right eye suddenly went dim, I couldn't give up.
Granted, this morass developed because of unusual circumstances. But I was angry nevertheless because unusual circumstances occur daily to somebody and when they do the system is unbelievably cruel. My special circumstances began when my doctor of 30 years retired. Then the doctor replacing him suddenly went defunct last April first, April Fool's Day, and disappeared. My insurance company assigned me a replacement who retired before I ever met him. So, I was assigned a third one, but before I had my "establishment visit," as it is called, I had the medical emergency.
I called the retina specialist, Dr. Rajiv Anand, who told me to come in "ASAP." When I tried to do this, I learned that my referral (from the defunct doctor) had elapsed. Even in chronic cases such as mine, referrals are good for only three months. I don't understand this. Why do patients with a chronic condition need referral renewals? Why do I need a middleman doctor to tell me I am blind in my right eye?
Actually, why does anybody need them? Is it because we would needlessly make appointments with specialists because we know the insurance company will pay? If this is the rationale, then why not stipulate that the patient pay for the initial visit out of pocket and be reimbursed only if the visit was warranted?
So, I called my middleman doctor. Of course I got the dread rotary. Eventually, I got through to a real person. But before I got off the line with her I was thinking that the rotary was more personable. "Dr. Middleman doesn't give referrals without seeing the patient," she said. Her voice was as cold as one of those slush drinks that make your head hurt when you drink them too fast. "Okay, I said, can you set me up for an appointment? I have a medical emergency." "Dr. Middleman isn't seeing any new patients," said this slush machine. "I'm in a world of Catch-22," I said.
She said, "I can schedule you for an appointment with one of Dr. Middleman's colleagues." "Okay, fine. When?" "In two weeks." "That won't work. I'll be totally blind by then. I could have Anand call Dr. Middleman." "It wouldn't do any good," she said. My head was splitting.
I called the insurance company in desperation and a Good Samaritan there named Bonnie called the slush machine in my behalf. In a few minutes Bonnie called me back. "Call her back, she said, "and make the appointment. Then call Dr. Anand and tell him we have authorized the referral and will backdate it so that you can see him ASAP."
This time Mrs. Slush Machine had miraculously metamorphosed into my best friend. I have my referral though I don't understand any of it. There's a great song by Ronnie Dawson called "Whatever Happened to the Old Sawbones?"
I think there's only one left. And he lives in Arizona.
Tom Dodge is a writer living in Midlothian.