Guaranteed Healthcare

There was this commercial that ran on the TV networks for a while. Basically, it was (or seemed to be) a PSA encouraging the public to be up front with your doctor about your health condition. If your doctor asks you where it hurts, don't lie, don't cover it up; tell your doctor the truth. Well, I think that PSA was probably funded by health insurance companies wanting to out their sickest patients.

My story seems to follow that pattern: tell the truth about your condition and the insurance companies pull out the big guns. (God forbid you might really be sick and want to avail yourself of the services you paid for. Oh, but wait, it's THEIR money; they make all the rules; I forgot.) I went to my in-network physician shortly after I turned forty-nine, time for the major mid-life work-ups. So I steeled myself.

The doctor and I went through the usual rigmarole. Then he asked me, "Got any shortness of breath? Chest pain?" "Yes," I answered. "When I mow the lawn, I get out of breath sometimes, and if I don't stop my exertion, my chest does hurt." "Are you sure?" he asked me. "Yeah, I think I'd know." "Well, you realize, you've told me you have chest pains. I don't think you want to go through that." I don't WANT to go "through that"? Like I opted in for it or something?

"Tell you what," he said. "Do you have a stationary bike?" "Yes." "Well, I'd like to get you to do a light work-out on the bike--I'm not asking you to self-test--but just see if you can duplicate the pain." "Yeah, sure, whatever." I was ready to change doctors right then. What I wanted was a referral for a colonoscopy and a heart stress test, as a routine matter for someone my age. But I left without either, with some vague physician instruction to try to stress test myself on a stationary bike. (And doctor's wonder why they have to worry about lawsuits? Would abject stupidity have anything to do with that?)

Two days later, while at work, I got a phone call from a heart physician's office saying they were ready to make my appointment. What appointment? I knew immediately that my doctor had gone into cover-his-ass mode. So I called his office to confirm what he had put in motion without informing me; the doctor wouldn't even come to the phone to talk to me. So I made the appointment with the heart doctor. He said a stress test was called for and he made the arrangements for the test.

A few days later, I received a phone call from the heart doctor's office. The insurance company was refusing to pay for the high-end test ($3,000.00); we'd have to go low end ($300.00). Rescheduled for two weeks later.

In the meantime, I get a SIXTEEN PAGE letter from my health not-provider, quoting me all manner of statute, in legalese, basically saying they ain't gotta pay nothin until I prove that I didn't walk into the doctor's office with the condition already present. If I couldn't give them documentation from all my previous health providers, going back to jobs held years before, they wouldn't cover me; and if I'd had any lapse in coverage in between jobs, they wouldn't cover me; and if it turned out I had a pre-existing condition, they wouldn't cover me. NO ONE HAD EVEN DETERMINED YET THAT I DID HAVE A PROBLEM.

This was supposed to be routine. (Is there any such thing anymore?) I stuck it out, though, gave the insurance company every thing they asked for, went to the stress test appointment, and told every doctor I talked to there what I thought. What kind of system is this? I asked. Well, every body's afraid of being sued. Well, if that's the case, the way the doctors acted in this case was CERTAIN to draw my ire and displeasure.

In his diagnosis, the heart doctor equivocated, said "You're not a heart patient. You're OK. But not all heart problems manifest with the low-end test. So you might not be OK." And I still don't know what might be wrong with me. I continue to have problems, but now I'm afraid to go back to the doctor (any doctor) and have Bureaucratic Insurance Hell unleashed on me again.

What I want to know is: how do people deal with this bull when they're really down and sick? Our "system" doesn't even come close to a "care" approach; this is health don't-care. We could fix this, though, I know we could, if the powerful would get out of the way. Get out of the way.