August 27, 2009

Today I had an appointment with the surgeon who I expected to do the surgery on my ankle. I presented him with the second opinion from one of his colleagues, and he agreed with it.

"Yes, you really do need this surgery," he said. "But you need someone who can do an arthroscopic exam for bone fragments and a ligament reconstruction at the same time, and I can't do that. There's only a handful of people

who do."


Is there any reason why I couldn’t have those surgeries separately? I asked.

Well, no, he said. But it really didn’t make sense to separate them and the insurance company would probably dispute it. The thing is, he knows the other orthopedic group with whom I have the appointment - one of the best in the city, he hastened to add - and he knows they have a lot of restrictions about what insurance they’ll take. He said they probably wouldn’t accept the open car insurance claim in payment.

At this point, I was almost in tears. “What are my options?” I said.

There’s this one guy over at Jefferson who does both, and he might take the insurance, he said. “And there’s another guy up in Princeton, but that’s it as far as I know.” (And by way of passing, told me he had a patient that week from 100 miles away who drove to his office with a badly broken arm because he couldn't get anyone closer to accept his Medicaid.)

So I came home and called the doctor at Jefferson. The office assistant informed me they’re no longing accepting New Jersey car insurance cases. “No, no, my health insurance is Jersey. My car insurance is Pennsylvania,” I said, desperate to get a break.

Finally, I got one. The office assistant took all my information and said she had to verify my coverage and the open claim. I told her I was on COBRA, running out of money and really needed to get this surgery done ASAP.

She said she would try to help me. She called back in five minutes and now I have an actual appointment - in three weeks. (I still have another appointment I made two months ago for the week after this new one, but that's with the guy who won't take my car insurance.)

Let's recap, boys and girls. Keeping in mind the slogans of health care reform opponents (waiting lists, not getting to choose your doctor, not getting the tests you need, etc.), of course:

1) The original injury? Almost two years ago.

2) Because the original claim went through my car insurance as required by law, my health insurance company had no record of the three months of physical therapy. Because they had no record, they would not authorize the MRI until I went through physical therapy. It took me months to straighten that out.

3) Finally get an MRI authorized a year later. Former employer changes his health insurance plan (because the premiums are too high), which affects my COBRA. MRI authorization is no longer valid. Return to "Go," start over.

4) By this time, developing painful cysts in the back of my knee from hobbling everywhere. Doctor advises me to ignore it "because it wasn't in your original accident report and the insurance companies might get confused and deny payment."

5) The Penn Health System (University of Penn) gets into a fight with my insurer over reimbursement and the insurance company kicks them out of their plan coverage. Start over AGAIN.

6) Pick new doctor who turns out to be a little crazy and who's running various money-making scams. Change primary doctor AGAIN.

7) Make first visit to foot and ankle specialist, who tells me it's just a sprain. Gives me shot of cortisone, which makes the swelling go down but causes excruciating spasm in ankle.

8) Go back to specialist twice. The office is run like a high-speed assembly line and he spends barely five minutes with me. I insist he look at the MRI - he says, oh, you do have a small fracture and a ruptured ligament. Tells me to wear a brace and go to physical therapy AGAIN.

9) I make appointment at Penn (which is now back in my insurance plan, six months later) for a second opinion. The doctor confirms the diagnosis, points out it was actually on the original ER x-ray report (which no one bothered to read until then) and says physical therapy won't do a thing at this point, I need surgery.

10) She refers me to one of her partners.

11) When I call to make an appointment, his assistant tells me he "absolutely" won't see any car insurance patients if he has to split the billing. Back to square one.

12) I keep the appointment I made with the first specialist, which is where today's story begins.

There are five medical schools in Philadelphia and at least two of the teaching hospitals are in the nation's Top 10. I can't even count how many hospitals we have - 20 or more. Out of all those experts, four doctors perform this reasonably common procedure - and it sounds like it's for insurance reasons.

Now, picture this whole thing with single payer. You get hurt, you go get treated. They send you where you need to go - and there are no worries about whether or not they take your insurance. They order the MRI when you need it, and they locate the right specialist to do the surgery. They send someone to check you at home after the surgery, and they cover the physical therapy - without a copay.

Oh no, Democratic Congress! No, President Obama! Please don't throw me in that briar patch of evil socialized medicine!

I might die of happiness.

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