Do No Harm…or Just Do Nothing?
A response to an issue that is both personal and (indirectly) professional.
In seven years of providing health care as a registered nurse, I’ve seen a lot of insurance snafus. In most instances, the type of coverage (or complete lack of) never even factored in to the care, most often with trauma cases witnessed in my level-1 trauma center, not-for-profit, teaching hospital. I am now layering in an additional perspective through my graduate education while working on my MSN degree to become a family nurse practitioner and primary care provider. And my views on health insurance aren’t softening.
From the start, I’ve noticed that the good people of America who pay their premiums and “do the right thing” by maintaining coverage for all the what-if’s and unfortunate accidents of life are the ones who get jerked around an inpatient setting, while those patients we call “self-pay” are somewhat able to set their own terms for hospitalization. If your insurance carrier says you only get to stay in the hospital for 48 hours post total hip replacement surgery, then you better be ready to ship out with your walker, bedside commode, and pain pills ready or not, unless something convinces the insurance company otherwise, which is not simply done via a valid MD opinion. In this country we like to make big medical decisions from a business standpoint, duh. However, if you were a little tipsy downtown and became the victim of a hit and run resulting in a similar hip injury with surgical intervention? Well, we’ll do our best to get you all fixed up and back out on your feet as soon as possible, but without insurance dictating the length of your stay, something as simple as saying “my ride can’t get here” will likely buy you another day to recover, maintain access to physical therapy, nursing care, MD rounds, regulated administration of medications, and three hot meals delivered to your door.
Now really, the health care system is too big of a concept for me to take on fully, to dictate just where we went wrong and/or how to fix it, and certainly not in just one post. I’m not even trying that, as it’s confusing, daunting, and also politically/racially/culturally charged thus easy for the general public to get distracted. My inpatient experience is simply a background example, as this is a snippet of a larger issue — one very much worth addressing, and one that was brought to mind this week through a personal experience. My husband is a healthy 40-something, and a few years ago we both decided to go ahead and begin seeing primary care MDs in order to set a baseline of our health and have someone who was already familiar with us prior to any major illness or injury. It’s smart to practice preventative health care, so we participated.
This week he was scheduled for his annual checkup, yet through an insurance spat with his MD’s practice, BCBS is no longer accepted and he fell in to the out of pocket payment category, which equals a ridiculous sum of money. Luckily, he has no major health concerns/comorbidities, no lengthy past medical history, and no long list of prescribed medications. Other patients may not be so lucky — they may need medication refills, adjustments, or initiations, or blood lab assessments and corrections, or diagnostic tests, or monitoring of heart conditions, or a million other things. Unless we were simply left off a mailing list, my husband was never notified of the network changes. BCBS is a major carrier in this region, and this group of MDs is a well-regarded one, with 8 physicians that cover a large amount of patients. I hope these other patients are able to find new providers to take them on and continue care, but that is easier said than done.
