Archive for October, 2015

This is fucked up.

23 October 2015 at 9:56 pm
by Berck

I went to Mexico. It was awesome. I came back with dysentery.

Not really dysentery. But by the time I got back from Mexico, I was avoiding food and taking a daily dose Imodium to avoid shitting myself. And it had been a couple of weeks.

As a doctor’s son, I know that most things will get better if you ignore them. Two weeks is too long to have dysentery. Still, I was willing to ignore until I got to work one day it would not ignore me. I needed some 1970’s antibiotics to teach this thing a lesson. I know that, the internet knows that, everyone knows that, but people are stupid and I need a doctor to tell the pharmacist that.

As a doctor’s son, I don’t have a doctor. I do know that it’s hard to get a doctor. No problem, we have this awesome thing in America called urgent care. Urgent care is marketed as, “Need a doctor now, but don’t need an emergency room? Urgent care is for you!”

Because I’m a working American, I clicked on the, “I forgot my password” links to my insurance company and eventually logged in to figure out which urgent care I should go to. It matters, not because my insurance will pay anything, but because if it’s in-network, there’s a limit to what they can charge me. Doctors charge more than insurance companies will pay. They do this for lots of complicated reasons, but the end result is that you want to see a doctor that can’t charge you more than your insurance company will pay. Don’t have insurance? It doesn’t matter who you see, you’re fucked, and there is no free market.

I was really, really, surprised by the results provided by my insurance company. My insurance is Blue Cross Blue Shield Anthem. Or maybe it’s Anthem Blue Cross Blue Shield. In any case, it’s a lot of names that shield me from… who, exactly? Doctors that want to make a living?

Whatever. They returned exactly 1 urgent care center within 20 miles of my office. One. This is not right. I redid the search a dozen different ways and still only got one.

Which one? “Colorado Urgent Care Associates”, with an address on north Academy. That was 15 minutes away. Fine.

I drove for 15 minutes past dozens of urgent care centers.

I got to the address indicated and there were two options: Penrose St. Francis Urgent Care and Colorado Healthcare Associates. Hmm. Only one of them says urgent care. Both have the same address.

I walked into Penrose St. Francis and showed them the Anthem Blue Cross Blue Shield (seriously? They’re going with that as a business name?) search results for Colorado Urgent Care Associates. I asked if that was them. “No, that must be the people next door,” says the young guy at the front desk. I walk next door. They insist it’s not them, and suggest that since it’s an urgent care it must be the Penrose folks next door. I return to the original guy and tell him the neighbors deny all knowledge. He also denies all knowledge. I would have gone anywhere else at this point, but Anthem has assured me that THIS IS MY ONLY OPTION IN A 20 MILE RADIUS.

I ask him if his phone number is the one that Anthem has listed. He admits that it is. I decide that means he’ll accept my insurance and tell him that I have the dysentery. He gives me forms to fill out.

I fill out so many forms. I disclose the same basic information a dozen times. I promise that I will pay them for services rendered. Magically, after signing this form and returning it, they’re ready to see me.

A nurse types my information into a computer, prints out a hospital band and puts it on my wrist. This seems genuinely fucked yup, but I blame the lawyers and ignore it. She asks me a few questions, tells me that I’ve been shitting too freely for too long and that it’s about time I see a doctor. I glare.

Eventually I see a doctor. He tells me that antibiotics can cure me of this unpleasantness. This is not a surprise to me, because I have Wikipedia. I am surprised that when someone brings in the prescription 30 minutes later that it is precisely what Wikipedia prescribed. Usually, these days, doctors are way behind Wikipedia.

In the meantime, between the 5 minutes a well-qualified doctor spends with me and gives me all the information I had already acquired from Wikipedia, another girl walks in and asks me questions. Like, “Do I have insurance?”

You bet I do! I proudly produce my Western Digital Anthem Blue Cross Blue Shield Bullshit Signifier, and she disappears to memorialize it with a photocopy. She assures me that some company I’ve never heard of (that is neither Penrose nor Colorado Ugent Care Associates) will bill me for my visit. I tell her that I wan’t wait for them to do that.

Eventually, I leave the office with my prescription for 3 days of Cipro that Wikipedia told me was the preferred treatment. I stop at the first pharmacy I encounter. I stand in line for 5 minutes and they tell me it will be 4 hours for them to take the pills from the big bottle, put them in the little bottle and put a label on it. I tell them that I’ll pay someone else and drive to the next Walgreens that tells me the same thing. Eventually, I give my well-worn script to a very nice lesbian at King Soopers who tells me it will be half an hour, and that they’ll send me a text message when it’s ready.

I’ve lost all will to live, so I drive across the street to Home Depot to buy some phosphoric acid for my motorcycle tank. Because this is a terrible endeavor in and of itself, when I return to the King Soopers phramacy, it’s been 45 minutes. My phone has not peeped.

The lesbian expresses outrage at computers, but assures me my script is ready. I pay $4 for it, and leave.

I take the drugs, and within a few hours, all is good until I get the bills.

The first seems totally normal and I have no qualms with it. $220.00 billed for a 99203, new patient office visit level 3. I could reasonably argue that the standard of care to which I’d been subjected was far lower than that expected of a new patent level 3 office visit, but how could I prove it? I’d like to say that you should at least have to weigh someone to provide the minimum level of services required for a 99203, but who am I? Now, no insurance company would pay $220.00 for a 99203, so only poor schmucks who don’t have a job or insurance have to actually pay that much. I have insurance, and an insurance is only going to pay $126.36 for a 99203, whether or not they weigh me or take an actual medical history. This is what my insurance company approves, and because I have a million dollar deductible, this is what I will pay.

This sounds exactly what I would expect. And, you know, I worked in billing at a doctor’s office for a good many years, and while this is way more than we would have charged for a 99203, and while this is way less medicine than we would have provided for a 99203… times have changed and who am I? Sure, fine, new patient office visit level 3 by the rule of law.

All is fine until I receive a bill from Penrose St. Francis. This St. Francis guy must have been a real schmuck. They wanted an additional $252.15 for G0381 (Level 2 hospital emergency department visit). My insurance company was happy to approve $184.00 of that as my responsibility.

What? $120 for a 99203? Sure. What the hell is a G0381?

Apparently, because this urgent care is operated by Penrose St. Francis (a hospital company, founded by St. Francis, because he loved fucking innocent people in the ass), they are allowed to pretend it’s an Emergency Room. With a capital E. They have to meet some sort of minimum standard for Emergency Room, and now they are an Emergency Room. Nevermind that this particular facility is not a hospital, it is an Emergency Room.

Wait, what? It says that it’s an urgent care. But, according to their insurance billing, they are an emergency room. Oh, and they’re only open from 8am to 8pm. Emergencies never happen after 8pm.

I contacted Anthem. They assure me the billing is correct. The $184 is for the use of the facility, and the $120 is to pay the physician. They admit that there are nearly 100 urgent care centers in the city of Colorado Springs that would not be able to charge the extra $184, but that I went to the single one that could. Because it’s owned by a hospital, and because it’s an emergency room.

Because it’s an emergency room, had I gone to an actual emergency room I would have been charged EXACTLY THE SAME THING. Think about this a second. This is brilliance for Penrose St. Francis. They buy a strip-mall doctor’s office, call it an urgent care, and are able to bill for EMERGENCY ROOM VISITS. For the money they receive for those visits, all they have to do is keep a strip mall office location open for 12 hours a day. But, you know, Doctors are expensive. Oh, wait, THEY AREN’T PAYING THE DOCTORS. The doctors bill for their services totally separately. $120. $120 is fair, it’s after hours, they have a whole office to maintain… Wait a minute. Penrose is paying for the building, the staff, everything but the doctors and are still collecting $184 for a visit. The doctors are ALSO collecting $120 per visit, which is exactly the same as a doctor with his own office would be able to charge.

This is fucked up.