Saturday, March 06, 2004

Good News

My husband is out of the hospital and on the way to recovery. He had a vascular bypass in his left leg and seems to be doing nicely. The surgeon can't (and rightly so) tell us how long it will last. He said a month to ten years is the best he can predict.

I'm still having some problems with the surgeons (see previous post) as well as some new developments. I'm still working on the problem with the hospital switch. turns out SMH is out of our insurance plan, so we're gonna be stuck with 40% of the bill. Surrrreee we are. We might pay a portion, but since no one from either the doctor or the hospital bothered to ask if 40% was acceptable to us, I'm not about to foot 40%. I'm waiting to see how many digits are on the bill sent by the hospital. I realize I could have avoided his entire mess by calling the insurance office, but I "assumed" the doctor's office would have the sense God gave a duck. So I bear some responsibility, but there is more than enough to go around.

DH had his surgery on Wednesday. I called the insurance office on Friday to bring them up to date on what was happening. That's when I found out what was going on. They just found out that morning that the surgery was at SMH; all their authorization had been done for Doctor's. SMH is out of network, so we would be paying 40% of the bill! After I recovered from my heart attack, I asked what happens now. The insurance office told me that there was no notation in their files that either SMH or the doctor's office had called to get authorization for SMH - they, too, were assuming Doctor's. If they didn't get proper authorization, it was gonna be a royal mess, but I'd have a leg to stand on.

So, I called SMH's billing office and they gave me a name at the insurance office who apparently gave then information that SMH is out of network and what the payment schedule was. Okay, so here is someone else to blame. Then I called the doctor's office and spoke to the scheduling secretary. She didn't have in her notes who she talked to. my office, if it's not documented, it didn't happen. So you know what my thoughts were. But since I wanted information, I gave her a couple of names and the name she recognized wasn't the same name as the one the woman in SMH's billing office gave me. This one was the office manager. Now, I know something was afoot. The lady is sharp. There is no way she would have authorized this surgery without calling me and asking if we were aware of and willing to pay the 40%. I also knew that she had called the doctor's office that morning to raise cain about this problem. I think that's where she got the name; she was rattled and that was the only name she could come up with.

I told the girl that there is no way I would have allowed the surgery to be done at SMH since it was out of network. I asked why no one bothered to call and ask if this was acceptable to us. I also told her I didn't know where we were going to get the money to pay the bill. All the while she was agreeing with me and making sympathic noises. I also told her I wanted it entered into his chart that any and all future procedures would be at Doctor's. She told me she was doing it now. I'll be she did - and also entered a lot of other notes about calling and getting authorization and who she talked to and so on.

When I visited my husband that evening, he was being discharged. Hmmmm...48 hours plus after major surgery and he's being released. I wonder why? Could it be that the hospital realized that someone screwed up royally? I know the doctor is involved somewhere because he couldn't be released without the doctor's authorization. I don't know what the bill from SMH will be. Honestly, it should be zero. The doctor and hospital screwed up by not getting authorization from us for an out-of-network surgery. That's how it is in my world. What it will be like in the real world, we will see.

Talking to other people in the medical field I've found that "things" can be done to eliminate or at least reduce our cost. I hope so. I'm just waiting to see what happens. After I receive a bill, I will begin writing letters. I was smart enough to document everything that was told to me by both hospital and doctor's office. I got names and dates and nearly verbatim quotes. If I have to, I will file complaints with the local and state medical boards. I'm not afraid to open my mouth and tell everyone I know just what happened. I'll tell everyone I don't know what happened too- having a blog is a good thing. And, I'm good at writing letters. I've been told that I've made grown men cry.

Doctors and their opinions of themselves

DH's surgeon is one of the best. I'd recommend him to anyone. The problem is that he also knows just how good he is. And his partner has the same opinion of himself. I have reason to know that. My current opinion of doctors in general is that because they have training that I don't have, they must be gods and I must bow down to their superior knowledge. Well, I don't bow to anyone except my own God. I'll give respect to anyone until they prove to me they no longer deserve it. And that's where the partner comes in.

I called the service and he answered the page. Apparently I didn't show the right reverence to him. I asked a question several times and when he didn't come close to answering it, I thanked him (somewhat sarcastically, I admit) and hung up. He called back, and asked why I hung up. I explained he wasn't answering my question, so I thought the conversation was over. After a few minutes, I hung up again. This was after I realized he wasn't listening to what I was saying. When he called back ("why do you keep hanging up on me?", I explained that to him. Then, he decided to interrupt me. When he interrupted me the last time and said he told me he couldn't do that, I flat out told him that if he had allowed me to say more than two words ("could you" was all I got out), he would have know I was going to say something else.

He says I hung up 5 times, I say three, but I'll split the difference at four. Personally, I think was good for him to find out someone wasn't going to fall down at his feet and take the garbage he was trying to give me. Sure, I could have handled it differently, but I was at the end of my rope and had already tied all the knots I could tie and I was about to lose my grip. I've been living with this situation 24 hours a day seven days a week for six years unable to do anything except stand by and watch what was happening. I was ready for a meltdown and he was on the receiving end.

He wanted me to bring my husband into the office on Monday (this was Saturday). I advised that I work for a living and can't walk into my office and ask for time off unless it was an emergency. Then, he said they're open until 5 and I could bring him in then. I again explained that I work for a living and don't get off until 5; it's a 30 minute drive home and then another 45 minutes to his office. And that's if the traffic didn't hold us up. He didn't have an answer for that. And he actually said that I wasn't taking the situation seriously enough. He did (finally) offer some options. At this point, I didn't care what he thought. Anyway, I said I would talk to DH and give him the options and let him decide what he wanted to do.

I didn't write about everything that was said, or discussed (like the reason for the call in the first place), because this rant was mostly about the call itself. The doctor did give several options after I convinced him I didn't want to hear what he couldn't do. The call ended fairly amicably - I hung up but the conversation was really over with at that point.

DH had an appointment with the surgeon on Thursday to have the remainder of his staples out. I went to another office in the building so I didn't see the surgeon, but it probably was a good thing I didn't. He made a particular point of commenting about my hanging up on his partner. Could the partner have had his feelings hurt? Oh wah! This was after the surgeon kept him waiting for over 30 minutes in the exam room. And was seen only when he was because DH yelled out through the closed door asking when the doctor was going to see him. The nurse came in and said "he hasn't been in yet?" That tells me that the doctor was there and making DH cool his heels. We had the first appointment of the day (945a), the surgeon wasn't in the office when I left at 955a (he had just walked through the office I went to), and his nurse being told that DH had another appointment at 1000a. Retaliation? You bet it was. I'm sure DH was kept waiting to get back at me. They never thought that they were keeping a fellow doctor from getting to a surgery he had scheduled for 1100a on time. Didn't hurt me at all. Too bad they don't know that. I had been feeling a little bad about the conversation with the partner on Saturday. Suddenly, I didn't feel so bad. If the surgeon could act this childishly, then my actions weren't so bad after all.

To any doctors reading this: You might have education and training I don't have, but I have education and training you don't have. I can't do your job and you couldn't begin to do mine. You are not gods, and not one bit better than I am. I am not about to worship at your feet. A final word....get over yourselves.

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