Saturday, August 10, 2019

There Is A Code For That... Or Is There?

A week ago Ross experienced  an unusual medical episode.  It happened mid afternoon on a Friday.
We weren't sure if was an anomaly or something that may reoccur.  I suggested we call Ross' primary care physician.

The call was picked up by the answering machine with the following information and instructions:
      "The Doctor's office is closed right now.  If this is an emergency please call 911."

I suggested Ross call one of the specialists he sees.   That office did pick up the phone.  We explained what Ross had experienced.   The receptionist determined that since Ross wasn't having difficulty with that doctor's particular proficiency, we should call his primary care physician.
We told the receptionist that the primary care physician was not in the office.  She suggested that if we felt we couldn't wait until Monday, we should go to the hospital emergency room.

We tried another one of  Ross' speciality doctors and we were told the same thing.

Our health insurance has a service called "Nurseline".   The nurse would be able to give advice about who you should call if you are unsure about which type of physician you should contact based on the symptoms you are having.
We told our "story" to the first "nurse".  She listened to the whole thing and then explained that she wasn't a nurse.  "I only handle insurance claims," she said.   I can transfer you to the Nurseline.
A pleasant woman answered the phone.  I asked if she was a nurse.  She said yes.
I told our "story".  She said, "Would you like me to set up in-home nurse care?"
I was confused because what we were describing would not have required in-home nursing care.   I told her that we thought we were talking to someone who could direct us to the type of physician we should be contacting.   She said, "Oh you want the Nurseline."  I'll transfer you.

We finally did speak to the nurse from the "Nurseline".  She told us to contact our primary care physician.

And around and around we go.

I called our Primary Care doctor first thing on Monday morning.   I asked if Ross could come in that day to see the doctor.  The receptionist asked why he wanted to be seen.   I admit I was being a little vague, on purpose.  I thought Ross would feel more comfortable speaking confidentially with the doctor.
"He's just not feeling right," I said.   She pressed for more details.  I finally told her that it was a follow up visit to a recent emergency room visit.  Which it kind of was.
She told us that the earliest Ross could be seen was Friday.
"If you feel he needs to be seen before then, I suggest you go to the emergency room."

I suspect the receptionist was pressing for us to state a more specific reason that Ross wanted to be seen was so that she could find the proper code to check off on the insurance forms.

Of course if we thought what Ross experienced was an emergency, we would have sought immediate care.

I remember, not that long ago, if the doctor was not available in the office, the patient would be able to leave their phone number and the doctor would return the call.

I also remember, maybe a little longer ago, when the doctor would agree to meet you in the office, during off hours.

I understand and appreciate the fact that there have been incredible advances in the science of medicine.

What I don't understand and do not appreciate is the fact health care seems to be driven by whether or not you are in or out of "network", whether or not your insurance is accepted and whether or not "there is a code for that".

By the way we did see the doctor on Friday.  He is a good doctor.  We like him.  He was reassuring and we felt much better after he spent time with us.

8 comments:

  1. Hari OM
    Ugh... in Australia, I could just pop along to the local medical rooms and wait to see 'next available'. It might mean a three hour wait, but it was in that day of need. Here in the UK, one has to register with a GP (primary physician). I have not done this. I so rarely require any medical help (Maybe once in five years on average throughout my life.) I know that now i my 60s this may not continue... but... I just don't like the systems! Glad you were finally able to put minds at rest. YAM xx

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    1. First of all, I wish you continued good health! And yes we are glad it worked out too.
      Here in the US most doctors offices don't have hours in the evenings or weekends. So, people have to rely on hospital emergency rooms for care during off hours. And then it is usually a six plus hour ordeal.

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  2. Medicine has changed so much over the recent years. Doctors used to be available now not so much so. Push seems to be going to ER. Maybe more billable things there it's weird in that I have typed consultations where doctors did them online not even in same room as patient!

    Betty

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    1. I bet, over the years, you have seen many unusual occurrences. As I said I am appreciative of the advances in medicine, but there are some parts of our health care system which make me yearn for the good old days.

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  3. Ugh - I feel your pain. There are no easy answers, and that is sad. Our health is so important. Hugs!!

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  4. The medical care system is so broken... Glad Ross is okay.

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