Still an altruist in America...

Patients are crazy. Like, certifiably. I think (but can't back this up with other experience with different specialties) that pain practices experience this to a spectacular degree. This patient had called yesterday and spent 20 tearful minutes on the phone with one of my coworkers trying to tell her that her last appointment, she thought, was "on the house." She lost her insurance at the first of the year. The situation was explained to her that although we didn't collect our fee at her last appointment due to her finacial distress, she was still responsible for those charges. Seemingly, she understood. This morning, she called the office front desk threatening to withdraw from her pain medications (which could kill her were she on enough meds). After a discussion between the office receptionist and myself, she called the patient back who then wailed that she was going to have to resort to prostitution to pay her bill.

On one hand, I roll my eyes. This is the business I work in; emphasis on business. Right or wrong, health care in the US is a business. Doctors are caregivers, but they are too often businessmen and women first. The way things are set up, they kind of have to be. So, while I'm fairly disgusted at this reality, it's the one that pays my bills... indirectly, anyway. On that side of it, I am of the opinion that if you know you can't afford this particular doc because you no longer have insurance, you need to make other arrangements and not pull manipulative threatening behavior on innocent staff.

On the other hand is my utter disgust that this woman can't get the care she needs for her chronic pain. Sure, she could be a drug seeker; if she is, however, the focus of her treatment is to keep her from getting over on the pharmaceutical industry, rather than finding an appropriate treatment plan that will not only reduce the pain she lives in but keep her from becoming emotionally and physically dependent on narcotics. I heard, at some point, that this is one of the major causes of homelessness; someone has a condition or injury they can't afford to treat either because they are uninsured or under insured, which then affects their quality of life and ability to work and make a living, which leads to their losing assets, money, house, and sometimes loved ones. It just sucks. I feel for the woman at the same time that she's infuriating.

While my job goes mostly unrewarded, I had an amazing experience yesterday. I have been cleaning up some outstanding accounts that the last billing company never bothered to follow up on, and as a result, have managed to collect money from insurance for dates going back to January of 2009. Some of these doctor visits required copays, so when I sent out patient statements last week, out went these bills for super old dates.

I got a phone call yesterday from a woman who received one of these old bills; it was for her husband, who had since passed away. She sounded maybe middle-aged, exhausted as she explained that she was trying to get things in order and keep a house, and I could expect payment by the end of the next month. After I hung up, I was heartbroken for this woman. I spoke to my boss, who scrunched up her face and said "write it off."

I looked up the phone number, struggling to remember the wife's name as the phone rang. Ringback tone - Bach. I smiled. When she answered, I explained that since the office visit was over a year ago and we got payment from the insurance company, we were going to go ahead and write off the copay. One less thing for her to worry about during her time of having to worry about everything. It was uncomfortable as I heard her tear up, heard her thank me for helping him (him? he's not the one worried about medical bills anymore...), heard her God Bless me.

It kind of made my day that I could do one little thing to help this woman out. And that I have a boss whose first instinct is to try to make the crap she's going through a little easier. Turns out, some people in the health care industry actually give a shit about other people.

Another day in American Health Care Paradise...