I've adhered to every policy and procedure required of me by an industry that is intentionally designed to obfuscate, obscure, and generally cloud any patient's ability to monitor claims and payments:
First, the nurse practitioner is four-deep in my explanation of benefits. You have the owner of the whole Group; the local MD's name on the building; the MD who oversees the nurse practitioner; and then the nurse practitioner. I can imagine how much is left over for the practitioner who actually sees the patient. Very little, which is why they panic if they spend more than 15 minutes with a patient; followed by their discouraging office visits.
The same thing happens regardless of what area of medical care: primary, specialty, imaging, pathology. They all have multiple names for the facility where the procedure/visit was conducted; the name(s) of the company that conducts the procedure; and finally, multiple names for the interpretor of the procedure/visit. It is not only difficult to keep track of all bills and claims, but no one tells you in advance what name will be on a claim OR a bill. You're just supposed to trust everything processed through the system. I recently found where a provider owed me $14. I asked for it and got it. But would they have sent it to me otherwise? If I owed the $14, you better believe they'd spend a lot more than $14 to get everyone's $14. Job security for claims processors in medical facilities.
Second, I was recently penalized for bringing images with me (that I'd already run around and collected/paid for) to see an orthopedic surgeon. The medical assistant who took me to the exam room, after asking me all of the questions she had, told me, "Since you brought your images on CD, I won't be bringing them up on this screen." After I hesitated, she added, "The doctor is looking at them in his office."
Doctor comes in and tells me I need a hip replacement, that X-rays are not the end-all but it's the only choice left if I want to be rid of the constant pain. No images, no posters, no helping me to understand what is inside of me. Just, "It's only one night in the hospital followed by in-home PT until outpatient PT. Let me know. Goodbye." No genuine checking for understanding in any way. Oh, and we won't talk about the broken coccyx. Go talk to somebody else about that. So now to a urogynecologist I go - in TWO MONTHS.
Finally, no, I do not think we need a single-payer system. Neither do I think we need a national speed limit. Medical care, for those with chronic conditions and/or co-morbidities, handicaps patients at the most basic levels by applying generalized practices to everyone. Everyone doesn't FIT ALL MODELS! You have to have personalized care that's not penalized.
When the nurse practitioner won't allow the patient to visit to discuss the difference between a calcium supplement and a bisphosphonate when bone loss is found, the patient is denied care. Fortunately, this patient knows how to look it up to find the answer. Now I think my PCP owes me the $25 copay.
