Medical decisions in America

One Sunday in early December I felt a bit off. A pain with a trail of alarm, a visitor bringing awareness to the brilliant functioning of every other day. On Tuesday I was truly ill. I called the doctor’s office, the physician I had chosen from my insurer’s website. They were between my office and my house and I needed them urgently.

The receptionist asked me whether I was a new patient, and which insurance I had. Ah, she said, we don’t accept that company. I found you listed on their website, I responded. We’re a provider, she said. A participating provider, but not a preferred provider. You need to select a preferred provider, she explained. But you are on their database, I repeated, more slowly this time. I never had an option to choose, preferred or participating. We get this all the time, she said. Their list is wrong. I don’t understand, I said. I broke down. You need to call your insurance, she said. I’ll book you for an appointment today at 5, and you check with them. But make sure, because sometimes people come in your situation and end up with bills. The receptionist was calmer and more sympathetic as my voice cracked and silences sprouted between my words. Bills! I thought. Half of American bankruptcies are due to medical bills! What’s happening? You have our address, she said. Yeah, you’re at 1700 17th St. Oh! No, you want the DC location. You called Virginia. But…this is your address in the website, I replied. Well, she said kindly, you need to call your insurance company.

I hung up the phone and broke down some more. I was desperate, and the person who I was told could take care of me was turning me away. I called the insurance company, and a very understanding young woman offered a name in the District. The office picked up the phone. Yes, we accept that insurance company, they said. But no appointments are available until mid-February. They hung up.

The fever inched up, as judged by a medical student friend, an unlicensed foreign doctor, a RiteAid thermometer. On Friday I woke up with a pain in my left lower back. It hurt to move and I was nauseous. I stood and stared at my bureau, poking under my ribs. What are you deciding? I reminded myself. $25 copay and a trip out to Virgina, or stay at home? Another poke, another pain. $25 copay and train and train and bus or stay at home. Another poke. It took a long time to decide. I packed my bag and collected my papers.

The clinic was clean and kind and right where it was supposed to be. The doctor thumped my back where I said it hurt. Her eyes widened and she started writing. Take two of these a day for ten days, she said. Lots of fluids.

Waiting for the bus back I felt a vague euphoria. I’m going to get better, I’m better already. I rushed the prescription to a pharmacy, and went to get my first food of the day. Ah, the pharmacist said when I returned, you have prescription for 20 pills. Your insurance company says you can have 6 pills every 30 days.

On Friday afternoon the insurance company computers decided that I wasn’t as sick as the doctor said. Or, the company doesn’t care. With the clear medical danger of cutting off antibiotics mid-course, and a written request from a doctor, they refused. We could expect a response in three to five business days, they said. The cost to them of the additional pills? $34.

When I’m ill, I’m not good at making decisions. I bought two boxes of dry cereal and tried to put them in the fridge. If a friend asked me, can you pick up my kid from school, I would say, I probably shouldn’t be driving right now.

Choice about health decisions is an impossible expectation. First my employer picks the insurance company. I try to pick a doctor from a list full of errors. When I am sick, the company decides how much medicine I can take. The same corporation that can’t keep track of the location of its doctors tells me I get three days of pills instead of 10. If a car company sold brakes that stopped 30% of the speed, and told us to wait three to five days, maybe, for the remainder, it would be hauled over the coals when the first person plowed into a tree. And yet the health insurance companies hide behind layers of disclaimers and lobbyists and tell us we chose it. Well, I have sat in fear and confusion, and I want something better. Where is it? Who do I talk to?