Situation Normal - All Fouled Up

I thought we had finally found a doctor, Dr. M., that would continue to see my son permanently. He was hospitalized twice during her three month vacation, and when she returned, she told him that he would have to find a new doctor*!

Our understanding of the reason he was told to find a new doctor was that Dr. M. would not have prescribed him the medication he was put on in the hospital while she was on vacation, and she would not prescribe it to him, as an outpatient, ever. This medication has brought him more sanity than he has had in four and a half years, so we were very alarmed. We talked to the secretary about transferring his care to the doctor in that practice who had seen him in the hospital and who was the one who put him on this medication, Dr. O.. The next week we were told that he had agreed to take my son as a patient. Well, things have been ducky for a few weeks, until this Thursday.

In the crowded waiting room, I was concentrating on my sudoku, trying to keep my focus off of the screaming torture taking place in a sadistic movie on the blaring television in the waiting room. My son was across the room with his head phones on. I was marveling that, though this was the movie channel the TV was always tuned to, the employees did not seem to be worried about it's effect on the mentally ill people in the waiting room; or me for that matter. I was debating about whether I was going to get up and change the channel, when noticed that my son was standing in front of me, holding out a fat envelope. I asked him what it was and he nodded toward the secretary, who was licking another envelope flap, and said, I think it's a bill. I took it and he went back to his seat.

A bill!!? A huge bill! He is on Medicare and has our state's insurance as his secondary coverage; his co-pay is zero and he is considered disabled by the government. Inside the envelope is a multi-page print-out of a predictably obtuse billing history for my son. He doesn't get billed, Medicare and the state insurance system do. I tell the secretary that they must have made a mistake and she tells me to talk to the billing person.

What ensued in his office was very disturbing to me. The man in billing, pulls out his stack of EOB's and points to each column; to the amount that was billed which was bigger than the amount allowed, which was bigger than the amount Medicare paid, which was bigger than the amount owed by the state insurance program..... and then that's when the shake-down started. He said that my son owed them that amount for every visit he had made to Dr. M. at their practice. I point out that is the column belonging to the state program. He said yes, but the state program had not paid them for ANY of their patients, so the patients must pay it!

I suddenly thought of all the schizophrenics trying to hold on to a shred of sanity, trying to survive in this world with severely faulty perceptions of reality, being handed a bill for something they would not know that they didn't owe. Most of these people don't have any money, or barely enough for subsistence living, and the clinic they are depending on, for their prescriptions, has the gall to trick them into thinking they must pay or lose their access to the clinic; or worse fear that they will be thrown into jail for not paying their bill.

I told the billing man that he had a problem with the state program that he needed to resolve, and that that he should not try to make the patients pay the state's portion. I told him that our son had full coverage, and that if he contacted the state program they would verify that. He then said, "Yes, they tell you that you are covered, but they haven't sent us any money." I pointed out, again, that it was a problem between him and the state, and that for them to expect the patients to pay that amount was wrong. Expecting their patients to be his liaison between their office and the state was absurd. Even if they had the clarity of mind to look into the problem, it was not their job! And, that some quantity of their patients would not know that the office had no right to make them pay it.

He then wanted to know if my son was the one who had to have the weekly blood tests. -Yes. (The blood tests are not done at their office, and we don't even know if they ever look at the results. The pharmacist where we get his medicine is the one who tells us the results.)

Were we happy with the doctor he was seeing? -Yes.

Was the medicine helping him? -Yes.

Do we want him to continue to see this doctor? -Yes.

Well then, why would we refuse to pay the bill? After all they filed the bills with the insurance company for us, as a favor. -Huh?!!

Once again, I say that my son's co-pay is zero, he does not owe them this money, the state does. And, was that a veiled threat about whether my son could continue to see his doctor? The billing guy's response is to show me a sentence on his print-out that says patients are responsible for the bill if their insurance does not pay it. I responded that the state has always paid in the past and that my son had been assigned to this practice based on the fact that they were one of the providers on the state's list. The doctors agree to accept the amount allowed for the service, as determined by medicare and the state's insurance program. And, again, it was not the responsibility of mentally ill patients to be his go-between with this problem he was having with the portion owed by the state insurance program.

This is not a verbatim transcript of what was said, but you probably get the idea. My son walked in after the billing guy and I had been arguing for quite a while, and he became upset that, by making the billing guy angry, I may have just gotten him kicked out of that psychiatrist's practice. I couldn't continue it any longer, and my son and I left the building. I collapsed into tears outside, thinking that by trying to stand up for not only my son's rights, but for the rights of all of their patients who could not stand up for themselves, that I may have just gotten my son booted out from the best psychiatrist we'd seen yet.

I don't know why they are having trouble getting their money from the state insurance program. The state should not be stiffing doctors when they submit bills to them. It will make the few doctors that participate in the program, want to leave it. We may have found the ONE good doctor that will participate. The state's negligence is hurting the people who need help the most.

I wonder if the non-payment by the state insurance was another reason the other doctor refused to see him any more. They might be trying to cull government insured patients from their patient list. They certainly wouldn't be the first ones to do it.

*[Here is where, if you are sick, you have no clue how to find a new doctor. This might be your seventeenth doctor in four years. Most of them were assigned to you when you were released from the hospital.

If you can remember that you might be able to get another doctor by calling the state insurance program's toll free number and call it, you will be confronted with an automated answering system that is confusing, convoluted, and even pressing zero won't get you a human. You might have a friend or relative call for you, but the answering system will be just as confusing and impenetrable for them. Some of their systems cut right to the part where, if you don't enter the extension for the person you wish to talk to, it ends the call automatically. How do you know whom you wish to talk to?

If you remembered to save your book that lists doctors who will accept your state medical insurance, medicaid or medicare, you will discover that many of them dropped out of the program after the directory was printed.

If you have access to a telephone during doctors' hours, you can leave messages on many answering machines. Odds are against any of them returning your call, but if one might, how do you get a returned call if you don't have a phone?

Let's say you are lucky enough to find a doctor who will see you, and their next available appointment is two months from now. How are you going to get your medication between now and then? What if the doctor will not see patients who take the medication you are on?

Next you'll realize that the doctor's office is so far away from where you live, that you have no way to get there. Never fear, they will tell you that there is a free service especially for taking people to their appointments. You are supposed to call the state insurance program's phone number (see above) a few days before your appointment so they will put you on their schedule. Just because you are on their schedule does not mean they drop you off just before your appointment and pick you up just after it. Partly because you can wait for hours beyond the time your appointment was for, to actually get in to see the doctor. Your time spent with the doctor will be about ten minutes.

We haven't used this service yet, partly because my son has frequently been terrified of strangers and would not have gone with them. But another big reason is that I talked to people and watched others, in doctor's waiting rooms, who depend on this service. I have seen people who wait in the waiting room all day. I have also seen some very rude drivers.]