5/11/2008

Why Health Insurance Matters


(No...not a new injury, a pic of my sis in law's left arm fracture)


I have always understood that health insurance matters for a myriad of reasons. It is your barrier against financial devastation - your ability to pay less than "retail" to make sure you stay healthy, right? What I guess I never did know was that it put you in a class of citizens that matters at the point of service.

I know that my regular readers are not physicians (although many of us play good ones in our families lives!). Yet anyone can take a look at the above X-ray and say "hey...that's not right", "that's pretty ugly", or at a minimum "yikes!". Inherent to each of us (well, those of us with brains), is the ability to understand when an xray, like the above, is "serious".

So help me understand something. When my sister in law appeared in the ER of her local hospital, and they pushed the most serious drugs they could find based on her pain meter, and the above xray - was the seriousness of this injury truly recognized? I would like to think so - especially given the fact that, since her husband recently lost his employment with benefits, she has entered the land of the uninsured. More so, because each ER is required, under law, to ensure that they provide care to a critical injury - without regard to ability to pay. It seems they followed, for the most part, Standards of Care - they x-rayed, they attempted to control pain, and about the only thing they didn't do was bring in an orthopedic doctor for a consult, but did contact one who said "Have her call in the morning to make an appointment." After five hours in the ER, they sent her on her way with that doctor's name, as well as a group of doctors (whom they circled) at an Ortho Clinic tied to the Hospital who "accepts patients without insurance", and a splint cast.

My sis in law assumed that she needed to see the Ortho Clinic the next day, since that is what the ER circled, called them the next morning, and went in a day later. The doctor removed the splint cast, re-x-rayed the arm, looked at it, said "this will be fine and heal fine", wrapped her up in an ace bandage (like you would do if you thought you sprained your wrist), gave her a prescription for 60 Percosets, and said "good luck with that".

I was floored when she relayed this an hour later to me. Seriously floored. She indicated to me that she was in a bunch of pain, and that she could actually feel the bone move around in her arm. Nice.

Luckily, my SIL is a smart woman. She asked her baby sister H (who is an ER nurse), to take a look at the X-ray. (It was online at the hospital group). My baby SIL (H) asked one of her ER docs to take a look. He asked her "When is surgery?". H indicated that the clinic removed the splint cast, wrapped it in an ace and said it would heal on its own. The Doc was floored. He immediately told H to get my SIL in there as she needed a splint cast on it at a minimum to protect from immediate and imminent damage. There was little else he could say about the standard of care that my SIL received at the Clinic as the clinic is tied to the hospital group - aka His Employer. In unspoken terms, the standard of care was non-existant.

To confirm that this was more serious than the Clinic Orthopedic Physician indicated, my SIL asked my MIL (also a nurse) what she should do. My MIL asked her to bring a copy of the Xray to the hospital where Mom works. Mom had a highly respected doc look at it and he immediately said "She needs surgery, and she needs it fast. If she doesn't get surgery within the next week, she will become permanently disabled, as she will lose the ability to use her left hand". Okay, I could look at the Xray and surmise that one - but it is nice to have it confirmed huh!

Mom indicated that my SIL was uninsured, and passed along information about the care that she had received at the clinic. This doc (who is in another state, and is not employed by the same group of hospitals) was livid. He even offered up his services free of charge for this patient - but indicated "that the hospital would demand payment before hand since she was uninsured - unless she could get emergency Medicaid". When informed that she lives in another State, he offered to consult one of his colleagues, indicating that he could probably convince that doctor to perform the surgery pro-bono, but again, that the hospital would demand payment - so she should start the process ASAP with the State to get Medicaid.

The very next morning (now Friday!), she contacted the original hospital (to keep you connected, the ER Hospital, H's Hospital and the Clinic are all tied together as one entity) and asked to get the process started as she was going to need surgery ASAP. She got the runaround. "Lots of people have lost their job and are trying to get on Medicaid - it might take weeks or months". She doesn't have weeks or months, she is down to days, hours and minutes.

She completed the paperwork anyway - but was very clear with the person on the other end of the phone that the standard of care offered up was lacking and that the information and care given to her under their corporate veil would cause her to become permanently disabled. As the hospital employee hemmed and hawed, L surmised to her that if she had insurance, this whole situation would be completely different - she would have already had the surgery, and she would already be on the mend - but because of the economic circumstances today (her hubby was a homebuilder), she finds herself in an unenviable position - and being treated sub-humanely. She was also clear that perhaps she should contact an attorney - because although she believes that folks are too sue happy - if she is going to be permanently disabled and unable to work, she would need assistance with living expenses. (Although she has no ability to pay an attorney to push on her behalf right now - and most in the area she is in would only be interested in the case after she is permanently disabled as it would be far more of a payout for them)

Wow...mention calling an attorney and watch what happens. Well, sort of. Within fifteen minutes, a patient rep contacted her - received "her side of the story" and said that she would call back after she received the clinic doctor's "side of the story". (Irrespective of what he says - or even "in his opinion" - no physician worth his salt would remove a splint from the above injury, slap a non-protective ace on it - issue enough narcotics to knock out a horse or keep a drug seeker happy - and said "good luck with that". Well, unless he was concerned that he wasn't going to get paid.)

So here she sits - waiting to see "what the clinic doctor's side of the story is", waiting to see if somehow - with a wing and a prayer - emergency Medicaid will come through, waiting to see if a kindly doctor from another state can convince one of his colleagues to do a pro-bono surgery, and waiting to see if the medical community thinks so little of a critical injury in a patient that they will allow a healthy woman to lose use of her hand permanently.

One little card and she would have had the surgery the next day. One little card and she would have been treated with care and concern. One little card, and she would already be on the mend.

And that is why insurance matters.




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