Kafka's famous literary work, "The Trial," could have been written about our present U.S. healthcare system. I certainly felt I was caught in a Kafkaesque world today. The trouble is, the sequence of bureaucratic hires to whom I have expressed these sentiments didn't know what I was talking about. They have never read "The Trial," the story of a man who feels faceless, powerless in an impersonal, bureaucratic society. But then again, these employees didn't exhibit much knowledge of anything other than the script they had been taught to parrot either.
EXAMPLE (please imagine Elaine May's singsong impersonation of a telephone operator in the days before direct dial): "I will escalate this matter to our Advanced Resolutions Specialist who will call you between 7 AM and 7 PM within 24 to 48 hours."
What did I want? My diabetic test strips. As a 14-year Type 2 diabetic required by my doctor to test my blood sugar levels twice daily, I have had no test strips for my glucometer for over a month now. I have been calling repeatedly to find out why my supposedly superior healthcare insurance plan (PacifiCare Senior Supplement)to which I pay $499 monthly (in addition to the $539.40 monthly I pay for the privilege of having Medicare because U.S. citizens who paid into the Canadian healthcare system most of their lives are not entitled to U.S. Social Security benefits) has been withholding my test strips from me for the past month. I use their highly vaunted mail order service in order to save money on my prescription drugs and diabetic testing materials (two different departments to navigate).
SAMPLE CONVERSATION:
Healthcare Employee: "Your doctor has not sent in the correct prior authorization, so we cannot send the test strips."
Me: "My doctor, who is a highly reputable endocrinologist, has already faxed in THREE prior authorizations for my test strips, and I have also mailed you his prescription three times."
Healthcare Employee: "We cannot work from the prescriptions. We can only work from the authorizations."
Me: "Well, you already have the authorizations."
Healthcare Employee: "I do not see three prior authorizations in the system."
Me: "Do you see one authorization?"
Healthcare Employee: "Yes, but in box seven, your doctor put "Type 2" and "Diet" as the reasons you need the test strips. Medicare now authorizes payment for only one test strip per day for Type 2 diabetes. It's not us. It's Medicare. Medicare is declining the authorization. If you do not have Type I diabetes, Medicare requires "fluctuation sugar control" or "hypertension" as reasons for two test strips per day. Otherwise they will not pay."
Me: "My blood pressure is already rising through the roof. You can put down hypertension AND fluctuating sugar control as reasons for two test strips."
Healthcare Employee: "Your doctor will have to fax a new authorization."
Me: "I HAVE NO TEST STRIPS, AND I AM DIABETIC. (pleading) Can you send me enough test strips for once a day until my doctor fixes up box seven?"
Healthcare Employee: "No, I cannot do that."
Me: "Will it be cheaper for Medicare if I fall into a diabetic coma, and my heirs inherit one test strip per day?"
Healthcare Employee: "I will have to escalate this matter …
PREAMBLE TO THIS CONVERSATION:
My doctor gives me a new prescription for two test strips a day for three months. It is for One Touch test strips, which fit my One Touch glucometer. I changed to this glucometer a few years ago because my healthcare plan switched to it. Before that I used other glucometers
(Accuchex, Bayers, etc). So now when I call my healthcare provider to ask why my test strips had not been delivered, I am informed that they no longer use One Touch, and I will have to get a new prescription for Accuchex, Lifestyle, Ascencia, or Bayer test strips plus a new matching glucometer. Since I already have an old Accuchex glucometer, I ask my doctor's office for a new prescription for Accuchex test strips (there are also different models, but I won't further complicate this story), which they mail to me, and I then mail the prescription to Prescription Solutions (a division that handles the drug and supplies service for PacifiCare). Nothing happens. No test strips. When I call to find out why, I am told that they don't "work from prescriptions." I have to get a prior authorization. I do so, this time for Accuchek test strips. Then Prescriptions Solutions informs me that, no, I will have to get ANOTHER authorization for ANY kind of test strips. I do so, and my doctor's office faxes it through that very day. To make a long story short, despite two letters and a series of phone calls, including one with an Advanced Resolutions Specialist, I STILL DO NOT HAVE ANY TEST STRIPS. This is the first time in fourteen years that I do not have test strips. As I write this, the situation is not resolved.
President Obama wants to reform the healthcare system. Never mind the trillions of dollars budget cuts over ten years. The first thing he needs to do is get rid of the bureaucratic nonsense that is clogging the system. And send me my test strips.
May 12, 2009 at 8:59 pm
Um, OH MY GOSH. I just stumbled upon this blog and got sucked in by the Kafka reference, but now I want to get you test strips! This is unbelievably absurd, and you’re right – Obama’s first order of business should be to give Medicare a big whack on the head and say, “HEY! These people have actual HEALTH PROBLEMS and aren’t just trying to PULL THE WOOL OVER YOUR EYES. Please send them their FREAKING TEST STRIPS or else drag them into a ditch and blow them up like Josef K, because that’s just about what you’re doing with your ridiculous restrictions. Hmph. After you wait until you’re old, they’ll probably say, “These test strips were only meant for you. And now I’m going to close it–er, throw them away.”
May 12, 2009 at 9:14 pm
An excellent, excellent post and a compelling comment from Megan.It is beyond absurd. If you have been out of test strips for one month, that means you probably tried to get them about 6 weeks to 2 months ago. Wonder what they’ll say when your plan has to start shelling out $75/visit just so you can get your blood checked at your doctor’s office. Or when your blood sugar hits 300, your blood pressure blows out (from the aggravation), and you don’t know it, pass out in your car, which hits a restaurant window, shutting down that business for three weeks and you end up in the hospital and THEN your insurance plan will have to cover $150,000 for a hospital stay. Or deal with a nasty lawsuit from your children? What do you think test strips actually cost? $20/month? Even $60 or $100? Is anyone in government reading this??? To think that the insurance companies will figure out a way to cut costs is ludicrous when they couldn’t give a hoot about the patients who are paying them $6,000 – $12,000 a year just to be insured.