Wednesday, January 21, 2009

I just called to rant

Forgive me, folks, it's been a while but I only call in here to rant these days. this time it's an eye doctor rant. Well, really it's a general health service rant with larger implications for the productivity of the American worker and the health and emotional well-being of patients, providers and the billing departments of medical facilities in general.

In November I went for my annual ophthalmologic check-up. (It was actually more like eighteen months because my ophthalmologist quit the practice and I had to wait months for an appointment with the remaining doctor who was over-booked and kept re-scheduling but that's not germane to this story.) I knew I'd need a new prescription so I offered to pay for the refraction but the administrator said they'd check with my Insurance and bill me if they didn't cover it. I paid my co-pay and sailed off to go through the tests. I passed all with flying colors except the eye chart when the doctor determined I'd need either contacts with progressive lenses in both eyes or two different prescriptions for the left and right eye. The only way to decide what was best for me was for them to order a bunch and try them out and for this I would need to pay upfront a non-refundable fitting fee of $200.
$200 seemed pretty steep to me, especially as that's what I paid at my last visit to go through the same thing. But heck I need to be able to see so I paid and set up an appointment and four weeks later (contact lens technician very busy) and three different types of contacts later we had a winner. The left eye prescription stayed the same and the right went up a point. For this I paid $200? Unbelievably, yes. I thought everything was good for another year. Ha! That's when the billing ordeal began.
On December 19 I got a bill for $45 for the refraction and $135 for the contact lens fitting. I called the billing department at 3:45 pm: Our office is open work days between the hours of 9 am and 4 pm. Please call back.
I called back at 9:10 am:Our office is open work days between the hours of 9 am and 4 pm. Please call back.
I called back at 9:30 and spoke to X who explained that I had to pay "$45 for the refraction and $135 for the contact lens fitting". Yep, I know, that's why I was calling. I explained I'd already laid out $200 for the item on the bill. I had the receipt in front of me and I knew I had to pay for the refraction but why was I being billed $135 for something I'd already paid for? X told me I'd have to ring the doctor. Despite sharing a party wall and a central dialing number she couldn't transfer me, so I would have to hang up and redial and listen to the options again: Press 1 for billing, 2 if you are a medical professional........
I duly spoke to Y in my doctors' office who a) didn't know why X couldn't transfer a call and b) why I was being billed. Y promised to fax through I copy of my proof of payment.
I thought the whole episode was a time waster but ultimately I wasn't concerned because I'd sorted it, right? Wrong.
Thursday last week I got a second bill. Identical to the first except it was marked Past Due.
I picked up the phone and took off my mild-mannered English accent, replacing it with "snotty Brit". This time I spoke to Z in the billing department who explained that I had to pay "$45 for the refraction and $135 for the contact lens fitting". Yep. I got that EXCEPT I HAD ALREADY PAID IN ADVANCE and THE DOCTOR"S OFFICE FAXED YOU CONFIRMATION. Z said she go check and put me on hold. Next thing I know I'm speaking to the administrator in the doctor's office. What do you know? It seems they can transfer calls. Amazing. I explain AGAIN why I'm calling and I'm told I will have to speak to the Office Manager. The Office Manager is busy she will call me right back. She calls me right back 5 hours later. She explains that I had to pay "$45 for the refraction and $135 for the contact lens fitting". AAAGH. I take a deep breath and tell her I have already paid $200. that's more than the $135 and the $45 together. She says I must speak to the contact lens technician who unfortunately has left for the day.
Friday I speak to the contact lens technician who professes not to understand why I'm being billed for her part but tells me I have to pay $45 for the refraction. I explain again, patiently, that I will do that but they need to explain to me why I paid $200 for a $135 coded item. She doesn't understand. She will speak to the Office Manager again and call me back. I explain I want this sorted today, before the weekend so it is not dragging into another week. She promises.
Monday and Tuesday I am too busy coughing to ring and check.
Today, Wednesday, I get a call from the administrator in the doctor's office: "Wow, you sound sick. I had that last week. Anyway. You were right about the $135, we've told billing, but you still have to pay $45 for the refraction"....
But I already paid $200. Why did I pay $200 if the amount you're charging is only $135?
..... "I don't know, I'll have to check with the office Manager and call you back".....

All this time, all this energy, all the paperwork and this isn't even an isolated incident. I went through the same thing over a co-pay I'd paid in cash (luckily I held onto my receipt) last year. To prove I'd paid I left phone messages with the receipt number, emailed, faxed and registered-delivery copies of the receipt and the drama only ended when I sent an email to the billing department expressing my fury at being harassed and hounded for a $15 co-pay I'd paid in advance and cc'd it to the President and press office of the hospital concerned. I got an apology.
My point is that if you work 9-5 there is no way you can sort out this sort of healthcare administrative problem without taking time away from that job. And that's just inefficient.

Thursday, May 22, 2008

More Healthcare Rants

I'm in the process of changing my Family Doctor (PCP, GP) and endocrinologist to the same practice as my opthamologist so they can easily share notes. I'm frankly totally fed-up that when I request each of the present ones to do that I am told they will and yet THEY HAVEN"T, NOT ONCE, IN THREE YEARS. I suppose it's a "we'll take in under advisement" thing, which really means "Go away and stop bugging us".
Anyway, each time I've tried I'm told it will take three months before I can get an appointment. This wouldn't happen in either of the two olde European lands where I have previously resided, but I sucked it up as the price of doing business in the US. A price, by the way, that costs me a huge amount of salary and the employers an increasingly prohibitive amount, too. But my experience thus far has been with changing practices. Imagine how mad I would be if I just wanted to see a different doctor in the same office.
The Guy and I received a letter from our ophthalmologist to say he was leaving the practice. As we were both due check ups in June I phoned immediately to get switched to the other eye doctor there. No problem I was told, except they were booking three months in advance. I got the first available appointments. For September 23. Almost 18 weeks away. That's more than 4 months. As long, if not longer, than you'd have to wait for an appointment under the free "socialised" medicine system in Europe.
Remind me again, why is the American health system described as "best in the world"?

via modernemama

Wednesday, February 27, 2008

Bless the mice

They're at it again, sacrificing themselves to find us a cure for diabetes. And this one sounds less invasive than the last research they had to undergo. These lucky (and possibly very brainy) mice were working at Harvard University where scientists found that adding a fourth drug, an enzyme called alpha 1 anti-trypsin, to a previously used cocktail it stopped the immune system from attacking the beta cells. It's a basic repair the pancreas job. Doesn't that sound exciting? We'd still have to take a bunch of drugs, but at least we wouldn't have to inject them.
Scientists are hoping to start testing it on human guinea pigs soon, so, thanks mice for all your hard work on this job.

Wednesday, February 20, 2008

Rodent Research

Let's give another big hand to the mice over at Novocell Research facility. The wee beasties were implanted with embryonic stem cells which then produced insulin. The cells kept the mice's blood sugar in check even after their insulin-producing cells were destroyed. And just to make sure that wasn't a fluke the scientists then removed the implanted cells and what do you know? Their blood glucose levels went up.
Unfortunately some of the mice developed tumors and died so there's a long way to go before we can throw away the insulin and the pumps. After all we don't want the cure to be worse than the disease, do we? But over the past few years we seem to be getting closer with each new piece of research.
Now if we can only hurry up and improve robot technology, no mice will need to be harmed in our quest to live diabetes-free.

Monday, February 11, 2008

Artificial Sweeteners Trick The Brain

Artificial sweeteners can cause weight gain. A study by Purdue University researchers found rats fed saccharin in yoghurt gained more weight than those fed glucose in yoghurt.
I have only three things to say: Told you so, told you so, told you so.
I'm so glad to get that out of my system.

Thursday, February 07, 2008

Recent studies and my 2c worth

There's been a bunch of diabetes-related reports hitting the press recently, so many that it provoked my blogging nerve, so here's my take. There will be opportunities for me to say "I told you so". A more charitable person might not do it. Believe me, I will. You can comment, or not, as you see fit.
Firstly, the study from the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases on the effects of low blood sugar on the heart health of Type II diabetics. The study, as you probably know by now, didn't show that lowering BG lowered the risk of heart attacks, it actually increased them. This seems to be a big surprise to everyone. They halted the study and from what I've read in the press are standing around scratching their heads and looking perplexed. Well am I the only person around here who knows that large amounts of insulin will stop your heart? Like any other medicine there's a fine line between something doing you good and something killing you. And if your beta cells are still functioning, no matter how poorly, all that extra synthetic insulin can be a problem.
Secondly, when I was diagnosed Type I (a million twenty+ years ago), the Head of Diabetic Medicine said to me: We're striving for tight control. BUT REMEMBER, don't strive so hard that you go too low because you'll bounce back up. That's what we want to avoid. That's what causes complications. No one ever mentioned it to me again but I never forgot it because it made sense. All those cells and blood vessels fighting to regulate themselves can't be good for the arteries or the nerves. Once again, if you give Type II diabetics too much insulin guess what'll happen.
Thirdly, there's the drug interaction to look at as well. The people in the study were taking many drugs. I don't think the body is designed to take many drugs. I take many drugs and I know this to be true, to lower my blood pressure I now take three drugs, yet my blood pressure is the same as it's always been. Too high. The drugs made zero difference. But here's the kicker. I can't stop taking any of them or even lower the dosage because my blood pressure skyrockets. They do no good, but I'm dependent on them. The therapy made things worse. I'd maintain here that it would have been better to say my blood pressure is higher than normal, it's always been so and we should leave it as such. But I drank the Kool-Aid. I don't think I'm the only one that this holds true for and I think there's too much aggressive therapy going on when we really don't know the long term effects.
I laughed when I read the final line from the interview with Dr Dove of The American College of Cardiology “It is a great study and very well run,” Dr. Dove said. “And it certainly had the right principles behind it.”
But maybe, he said, “there may be some scientific principles that don’t hold water in a diabetic population.”
Or maybe you need to reassess your scientific principles, Dr? Maybe it's not us, maybe it's you?
Another study on metabolic syndrome seems to show that Diet Soda plays a big role in the disease. Well, yeah. I told you that stuff is poison, right? And I was roundly mocked. I think I mentioned that it was a friend who was allergic to wheat who first told me I could cure the reoccurring bouts of thrush I got after a course of antibiotics by giving up Diet Coke. I did it, the thrush disappeared and it never came back. I also told you that your body thinks that stuff is sugar. And it does. Only it's worse, it's chemical sugar. That's bad for your body. Very, very bad. Bad enough to cause metabolic syndrome.
Finally, from the DUH department of medical research, it seems that obesity may be largely genetic! Well, DUH, DUH, DUH. I am now officially speechless.

Monday, November 05, 2007

A little tip(ple)

Here's a word of advice, freely given: never open a bottle of wine directly after taken a blood sugar reading. Not unless you want the tiny pinprick on your finger to become a gushing torrent of sticky red liquid.
Or, if you are going to be as dumb as I was, make it a bottle of white wine. Because when that geyser starts going just as you uncork the wine, you want to make sure that there isn't any blood mixed in with it and that's difficult to do with a glass of Cabernet. I learnt that the hard way. Eeuk.