Op-Eds Speaking Truth to the Powers-That-Be
National health is the bogeyman of insurance companies, who have in turn fanned the flames with physicians and the general public to keep their fat businesses open and churning out the same inconsistent, poorly run mess that we’ve had since guys with big white smiles started knocking on doors and selling “health insurance” in the last century. Each company, even ones with the same name, do business differently in different states. For Obama, the challenge will not only be bringing people into the healthcare system, but ending dozens of fiefdoms and bringing more uniform quality care to Americans along with simple access.
If you want the point driven home to you, travel with your healthcare.
I am a citizen of the Sunshine State of Florida, and a holder of a private Paid Provider Option (PPO) health care plan administered by Blue Cross & Blue Shield of Florida. I recently took a trip with my family that landed me in the Realm of Blue Shield of California.
In Florida, our company of the same name has high deductibles for personal insurance, pays out very poorly on pharmacy benefits, and is very big for its PPO customers on the use of Urgent Care rather than the old Emergency Room when you have a problem that is short of immediate death.
In California, their personal plans, which, after years of consumer advocates fighting Big Blue, are part of a very big pool of insured that even dwarfs the pools of many private employers. They have exceptionally good pharmacy benefits, much less draconian deductibles, and generally better benefits for its subscribers at a lower cost than we do in Florida.
My wife had a bad head cold. She was worried that she might be getting an infection. When you’re going to fly across country in a couple of days, that is not something that you want to leave until you get home, as the airplane and the pressure alone can make you a whole lot sicker. She wanted to get checked out before she flew, and our physician was, of course, several thousand miles away.
We learned, from our one experience last year with an “out of network” outpatient center that you can pay thousands of dollars that would have been covered on the in-network plan, and, in spite of those clever charts that Blue Cross showed us, out of their network you are pretty much at the mercy of the providers in a very costly system. Thus burned, we wanted to find an in-network Urgent Care that was under our health care plan.
I went to the Blue Cross of Florida website. They only list companies inside the state. They do not have a suggestion as to what to do when you are on the road. So I called.
While I was not shipped off to some call center in India, after spending about four minutes navigating through all of the questions about my call that had nothing to do with seeking health coverage in faraway California, I waited about four more minutes and was connected to a woman we’ll call “Tonya.”
I’m not sure if Blue Cross gives their customer service employees special training to achieve that put-out monotone, or if they put them in a dungeon, or a dank basement to get them to sound like they hate their jobs that much, but Tonya was about typical of my phone calls to the insurance company.
She ran down the checklist of things that she is supposed to ask at the entry of the call. When I told her that I was needing to know what to do about finding an urgent care facility out of state that was covered under my plan, she put me on hold, then she came back and told me to contact the local Blue Cross and Blue Shield provider in California to get their list.
I went to their website, figuring that I could get a list of providers. No such luck, unless you were a subscriber. It required a password and account.
So I called their 800 customer service number. All of the options were for California subscribers with an account as well. Nothing for out of state Blue Shield members.
I hung up, thought for a moment, then called back, and tried pressing “O” to see if I could get someone. Even though it wasn’t a choice, it worked.
Speaking to another “Tonya” I was put through my paces of my member number, which I didn’t have, and all of the potential issues that weren’t mine until I politely told her that I was from another Blue Cross/Blue Shield and needed a list of Urgent Care centers that were approved.
“I don’t see why our list would matter to your Blue Cross. They’re not their centers,” she said.
I had to explain to her that this was the instruction of my insurance provider. She put me on hold for three minutes, then came back.
“They’re on line,” she shot back rather curtly. When I explained that it had a security account/password feature, she told me that there was a link at the bottom. I went back to the page. Sure enough, in the tiny print there was a note that you could click there if you didn’t want to sign in to get this list. I asked her why bother, then, having someone sign in if you can bypass this screen in the first place.
“I don’t make the website,” she said. “They want you to log in if you have a subscriber number.”
Never ask a common sense question to a bureaucrat. It isn’t their system. They just work there.
I downloaded the list, after nearly 35 minutes of trying to get the information. There were three urgent care facilities listed in the area. The ones closest to me had both closed. There was one in downtown San Diego, 15 miles from my hotel. Just then, my sister-in-law, who lives in the area, called. I asked her about the place in downtown San Diego.
She told me to call Scripps, one of the finest medical facilities in the world, which was two blocks down the street. She said that they take my plan.
I called. They did.
Yet they were not on the “official” list. My wife would have had to travel miles to a facility when one that was able to help me was literally less than a quarter-mile from my hotel because the bureaucracy at Blue Cross doesn’t keep information up-to-date.
I tell this tale of daily life that most, if not all, of you experience because this health care hassle is emblematic of how broken our medical system has become.
Dozens of sloppy bureaucracies make it difficult enough to get what you pay for in your home state. Traveling out of state with your health plan can be like going to a foreign country, even when you are with one of the biggest insurance networks in the country.
This was an easy and non-life threatening situation. Imagine you or your loved ones having to wade through this mess if you get hit by a car out of state, or someone mugs you in a shopping mall.
I can only imagine what happens when you have a regional provider who covers the East or West, or a handful of states, and you travel out of their coverage zone. How many doctors in California will even know what to do with the Iowa Mutual Health card, or the Lovelace of New Mexico card that you carry?
When physician acquaintances of mine give me their sermon on the Mount about the evils of National Health and its bureaucratic nature, I have to laugh. Their offices struggle with five, ten or twenty of these fiefdoms and their myriad rules and payment regulations daily. Many caregivers in our state won’t even deal with Blue Cross/Blue Shield of Florida because of the immense hassle.
When Mr. Obama gets to the subject of national healthcare, getting the same insurance as the congressmen and senators in Washington D.C. is not going to be enough. His health insurance team is going to have to tackle the mess that this quagmire of insurance companies has made of the healthcare system, and streamline it.
The 50 year old man in San Diego should be getting his medications for the same price as the 50 year old man in Vero Beach, Florida. If the guy from Vero travels to see his friend in San Diego, he should have the same rules, and same access, and same benefits wherever he goes from East to West, whether he is with Blue Cross, Blue Shield, or Spanky’s Super Duper Health.
In the current system, it is possible, even likely, that our President-Elect, even with his spiffy senate plan, might find himself faced with:
“I’m sorry, Mr. Obama but we don’t take your insurance. You might wait until the 19th when you become President. Then we cover you.”