I sure hope not.
But lets test out the theory and find out how the local HMO operates shall we?
I'll be having heart surgery soon... at least... that's is what my cardiologist and cardiothoracic surgeon say. But after a long and very informative meeting with the surgeon I met with his scheduler. She and I matched calendars and then she called the anesthesiologist to make sure he was available. All good so far... then she said "I'll call the insurance company for authorization."
I'm a computer software techie. Highly trained, high skilled, very experienced. I enjoy my work, get excited by intricate problems, new technology, and new possibilities. I had just had a meeting with a highly trained, highly skilled, very experienced surgeon who got excited talking with me about my problem and the options he could provide me for fixing it.
He said to me "You are going to be a good day."
"For you maybe," I said.
He smiled and continued, "Some days are general contracting work and some days are artistic days. You are going to be an artistic day."
I liked hearing that because I know the feeling. I know it means he'll be at his best, using skills and knowledge only he and a few others have and turning out his best work. He'll be bringing his "A game."
Earlier he had talked with me about some of the technology being developed today that is still in testing phase or just starting to be used. But he said they were rare because the hospital would kill him and his partners if they used the new technology all the time. He rattled off some prices to make his point.
I want this guy making my medical decisions with me.
I do not want some low-level analyst sitting at a computer looking at a spreadsheet deciding what medical care I receive based on what is most cost-effective and profitable.
Now... I fully expect that my care will be covered and that in fact I won't have problems getting ok'd. What I need is fairly routine these days.
But I've done some reading and in everything I've read they've talked about a cardio-rehabilitation program (exercise, treadmills, etc) afterwards. So I asked about that. The answer I got was... if the insurance company ok's it. If the Doctor says it is required and the insurance company ok's it then a program will be set up if you want it. We don't set it up right away because sometimes they won't pay for it and then you are responsible for the full cost. We then shared a few comments with each other about the problems of our health care system today. She was right there with us.
So... we'll have to see what the spreadsheet says now won't we?
For most if not all of my life I have had something called mitral valve prolapse. In 1990 and 1991 (or was it 1991 and 1992?) I experienced something called atrial fibrillation. Atrial Fibrillation is where the heart loses all rythmn and goes from 90 beats to 240 to 40 to 180 to 75 to 320 to 220 to... whatever... in the span of a handful of heartbeats. Very disconcerting. They use meds to get it back in control usually. In extreme cases they use the paddles and shock it back into rythmn. You can also do it yourself most times by pushing as if moving your bowels. I've learned to do it myself and have not had a problem since.
I sit here writing this with my heart rate elevated a bit. Pounding hard. I've felt worse... but there it is.
I get palpitations and occassionally the elevated heart rate fairly often. But I get things back in shape in a matter of moments. The last few years I've also gone for a yearly check-up with a cardiologist. This year he sent me for some additional tests.
A couple weeks after the first couple tests were done I get a call from his nurse to schedule another test he hadn't mentioned. Alarm bells went off "Uh-oh. He saw something he didn't like." But it's a test I've done before so maybe it's just an add-on.
A week or so later I get another call from his nurse wanting to know if I have a couple minutes to talk with the Dr. At this point I know it is bad news. My mitral valve has gotten worse.
The mitral valve is where the blood enters the heart after getting mixed with oxygen from the lungs. Blood comes in through the valve into the left ventricle. The valve closes and the left ventricle pumps it into the right ventricle which subsequently pumps it out to the rest of the body.
In my case the mitral valves proplapses which means it sort of collapses in on itself and doesn’t seal when it closes. This results in blood leaking backwards. It also means the left ventricle has to work harder to pump a sufficient quantity of blood to the right.
In the past the amount of leakage was small enough not to be a big deal but now it is enough they want to repair or replace the valve before any more damage occurs to my heart. They won’t know until they go in whether they can repair it or not. They’ll try to repair if they can. If not they’ll replace it with a valve made from cow tissue.
If I moo or start chewing my cud later you’ll know why.
Hopefully they screen them for mad cow disease beforehand. Otherwise I might become a froth at the mouth right wing Republican.
Up until a few days ago I hadn't been feeling any noticeable symptoms. I guess I was aware I'd been having palpitations more often in past months but it wasn't really a problem and I've gotten used to them being a part of my life. But now I am feeling a heaviness in my chest. Not breathless but I can easily see that as the next stage.
So next week a heart catheterization to see if there is anything else that needs fixin' while they're in there. A final appointment with the surgeon, a prep day (blood tests, x-ray, that sort of thing) and on Monday, Aug. 27 I'll have heart surgery.
If... the insurance company authorizes it.
I haven't seen Sicko yet. I've been urged to by a few folks and I've told them that I've been living it.
My main experience with murder by spreadsheet is in the mental health area. I have a couple family members with mental health issues. Here in New York we don't have parity legislation. Limited days of coverage inpatient and outpatient. If you need more...
... tough shit.
What that has meant to me is destruction of my credit rating and elimination of any and all savings. I am a gainfully employed, insured, well compensated professional making more then I ever expected to make... and I live paycheck to paycheck. Luckily I've had the resources to withstand having to pay full freight to take care of my family members needs but I don't have those resources anymore and those needs still exist.
And that is just the money angle. We haven't even talked about hospital discharges mandated by the insurance company when all the health professionals involved know the patient isn't ready.
The result? A return trip and higher risk for the patient. A seemingly never ending cycle because "care" doesn't last long enough to ever really do the trick.
It's criminal... and it has almost cost them their lives on multiple occassions.
Murder by spreadsheet?