In a Healthcare Crisis, the Insurance Company - Yes, the Insurance Company! - Came Out as the Savior

I'm guessing that nearly every American has his or her own healthcare story to relate. This is not surprising, given the state of healthcare as it exists in the United States today. Politicians and taxpayers alike clamor for more options and more choices regarding the state of an individual's health. As one cynical friend recently noted, members of Congress are so far removed from the actual sad state of healthcare today, not only the shape that it's in, but also its very existence and affordability. After all, he noted, Congressmen and their immediate families have their own healthcare coverage - and very good coverage it is - for life. If you can't experience the pain of not being able to afford dental or medical insurance, if you haven't had your provider limit you to a very select few number of physicians, if you have to wait for a medical condition to turn into a full-blown crisis that requires a trip to the emergency room - where no one will be turned away - maybe you just 'don't get' what the rest of the country is going through. Privilege does indeed have its perks.

A few weeks ago, I had written about a close friend who had been diagnosed with an antibiotic-resistant staph infection. What she thought was a very sore back rapidly turned into kidney failure and dangerously low blood pressure by the time that she finally, grudgingly agreed to go to the county hospital's emergency room. Yes, she had a personal physician. She had pretty good insurance coverage as well. How she got this particular type of staph infection remains a mystery; she doesn't work in a hospital, nor had she been in one recently. As her condition worsened over a matter of months, she chose not to go to her family physician because she frankly had little faith in his competence based upon a prior experience.

At the emergency room, she was seen by a doctor immediately. (By that time, she literally could not walk from the car to the emergency room entrance.) Physicians hooked her up to intravenous fluids and a variety of monitors; her kidneys were literally on the brink of shutting down, and she suffered what now appears to have been a heart attack as well. Thank goodness that she was where she was when this happened: doctors and nurses were able to 'shock' her heart back to a rhythm. Although she was admitted, the physicians treating her at this particular hospital were mystified as to how to treat her condition. It was then that she was transferred by ambulance to New Jersey's Cooper Hospital, in Camden, where she stayed for three weeks while antibiotics were pumped into her system round the clock. At the point when it was determined that she was 'well enough' to be transferred to another facility for the balance of her care and treatment, she went to a nursing home/rehabilitation center in southern New Jersey, where she stayed for nearly four weeks.

There were problems at the rehab center. When she ran a high fever there for no particular reason, the doctor on call insisted that she be taken back to Cooper. At this point, she was feeling well enough to be her usual feisty self, and refused to go back. Subsequently, she switched her personal physician to the doctor who was the medical director of the rehab center. He allowed her to remain, upping the dosage on her medications.

This entire incident dragged out for weeks, weeks turning into months. She wanted to go home, she felt well enough to go home, and her doctor allowed her to make that call based on the evidence in hand. Unfortunately, he was leaving for a European vacation four days before she was scheduled to leave the rehab center. On the Friday that she checked out, no doctor gave her a last medical check; no nurse took her vital signs. She knew that she would continue her regime of antibiotics at home; arrangements had been made with a medical supplier and visiting nurses association to help continue that care.

Once she was 'out of the system', she was, amazingly enough, on her own. The doctor who was the medical director at the rehab center has not contacted her to this day, three weeks after she was discharged. She has left him numerous messages on his cell phone and at his office, all to no avail. She contacted the Cooper Hospital director of infectious diseases, wanting a follow up visit with the physician who was in charge of her case there. She did get an appointment with the infectious disease center, but not with the doctor who had handled her case. She waited 45 minutes to see another physician who was part of the department, who had not previously treated her, and who could not find her chart. Eventually, her chart did show up during the course of the exam, but little could be determined as to where she stood medically at this point in time as to how she was treated at Cooper. Despite calls to the doctor originally part of Cooper's infectious disease center who had originally treated her, she has yet to speak with her. She has never spoken again with the physician who had treated her at the rehab center, either.

Since when has the 'dumping' of a patient still being treated for an infectious disease back into her own home, with no medical discharge work done, become common practice in America?

Thank God, and I mean this sincerely, that the insurance company (whose name rhymes with "Gretna") stepped up to the plate. Perhaps theirs was not an entirely altruistic mission; they were, after all, footing the bills for her treatment.

Representatives of the insurance company called her at home the day she was discharged. They asked about her medical supplies, about the visiting nurses' appointments, about the possibility of undergoing physical therapy. They were the only ones who called on a regular basis. When she had questions about her medication, they were the ones who were able to contact her infectious disease physician and arrange for a series of tests and an MRI to be done. They called at least twice a week, sometimes more often. They wanted to know if the nurses were showing up. They wanted to know if the syringes and medical equipment were being delivered on time. They actually inquired about her health. Last week, she mentioned to them that they really shouldn't be paying for all of the syringes and extra tubing that they were sending every week. The woman on the other end of the line at the insurance company was taken by suprise. She explained WHY the syringes were being sent, and how they were to be used: instead of using one new syringe for her pump every day, she was to use a new syringe each and every time she administered the medicine (which is once every four hours). Two days later, a representative of the medical supply company came calling at her house to make sure that she was administering her treatments herself in the proper way; they had been contacted by the insurance company to check on her.

Throughout this entire ordeal - and being diagnosed with a MRS staph infection is not something I would wish on anyone - her insurance company has been the one and only constant.

Her treatment continues, as it will probably for the next three months, at least. In the meantime, she has made plans to see a new family practitioner and has a late August office visit set. She wonders how she will be able to get all of her medical information together in time for that visit. I have a feeling that if she will request a copy of her files from her insurance company, at least they will forward them out to the new doctor.

I wish this article could have a 'happy ending', but like many things in life, it doesn't. While her insurance company has picked up a massive amount of charges, out of pocket bills from various doctors, imaging centers, and labs continue to trickle in every day. (The stack is literally 2 1/2" high so far.) The tab runs into the thousands of dollars, and there is, frankly, no way that she can afford to pay them. The last I had heard, she had been told that after three months of contact from the time that collection agencies get involved with these bills, they will be dropped. She won't be hassled because these groups apparently anticipate that most patients will not or cannot pay their out of pocket charges. I've never heard that before, and I guess only time will tell if this is really true.

In the meantime, my friend's illness continues; she changes and administers her own medication a couple of times a day, and is hoping to be allowed to discontinue it - if she can ever get medical approval from somebody, anybody. It's too bad that her insurance carrier can't make that decision as well.