I AM PAYING THEM TO DRINK THEIR MILKSHAKE.

Once upon a time, as most of you know, SEK had cancer.  His cancer requires he take thyroid replacement hormones for the rest of his life, but this January his Primary Care Physician informed him that he could not, in good conscience, continue to prescribe said hormones unless SEK saw an endocrinologist at least once a year, so he referred SEK to one who works at the UCI Medical Center.  Because the United States has the best health care system in the world, three months later he arrives at the UCI Medical Center for his appointment.

SEK: I am here for the appointment I have been waiting three months to have the pleasure of attending.

NURSE: Do you have a referral?

SEK: My doctor referred me, otherwise I would not have the appointment which I waited three months to have the pleasure of attending.

NURSE: Let me call your Primary Care Physician.  (dials phone, provides my name and information, listens)  They have no record of a referral.

SEK: Then why am I here?

NURSE: (shrugs)

SEK: Why did I receive an email reminding me to be here today at this time?

NURSE: (shrugs)  We can always restart the process—

SEK: And I can wait another three months to be told there's no record of my referral?

NURSE: Or you can see the doctor (which was becoming a pressing necessity, as SEK was experiencing some of the same symptoms that led to the diagnosis of cancer in the first place—most notably, an uncontrollable urge to nap) and pay out of pocket, straighten things out with your insurance company and be reimbursed.  

SEK:  Fine, fine, this is why the Good Lord invented credit cards.

SEK sees the endocrinologist, who is really quite extraordinary, has a few tests runs and leaves the office to get three gallons of blood work drawn at the lab.

SEK: I have this long sheet of paper covered in X marks and this pad of stickers.  Please steal my blood.

LAB ATTENDANT: Gladly!

The LAB ATTENDANT rolls up SEK's sleeves and withdraws three gallons of blood from SEK's arms.  As the LAB ATTENDANT's affixing the stickers to all the tubes, he says

LAB ATTENDANT: Wait a minute—these stickers have your Primary Care Physician's name on them in addition to the endocrinologists'.  

SEK: And this is a problem?

LAB ATTENDANT: You needed to get this blood drawn at your Primary Care Physician's lab, otherwise you'll have to pay for these tests out-of-pocket.

SEK: (sighs) How much out of pocket?

LAB ATTENDANT: $1,800.

SEK: Fine.  I'll just take these tubes and stickers and drive them to the other lab.

LAB ATTENDANT: You can't do that.  You need a special license to transport blood.

SEK: My blood?  I believe it's called a "Driver's License," and I used it—

LAB ATTENDANT: It's the law.

SEK: (feeling the effects of losing all that blood) So what you're telling me is that I need a special license to transport my blood—

LAB ATTENDANT: As soon as it's outside of your bod—

SEK: THEN BY GOD MAN JUST PUT IT BACK IN.

LAB ATTENDANT: What?

SEK: PUT IT BACK IT IN.  Did I need a special license to drive it here?

LAB ATTENDANT: No.

SEK: But it'll cost me $1,800 to transport it to the other lab in those little tubes?

LAB ATTENDANT: Yes.

SEK: THEN PUT IT BACK IN ALREADY.

The LAB ATTENDANT is surprisingly unpersuaded by the logic behind SEK's argument.  SEK leaves the lab minus the $1,800 pound of flesh they stole from him and THE END FOR NOW.

Comments

[tomemos]

I sympathize. My insurance paid for my wife's (relatively minor) surgery last summer, and the amount of insurance equivocation and mistakes grew breathtaking. They had approved the surgery but had to be goaded into paying for each part of it. By the end my phone calls with them were like calling up someone who owes you money and hearing, "Huh? I'm getting bad reception on my phone! I'll have to call you back!"

[J.S. Nelson]

To quote myself several years ago: you're a vortex of misfortune, Scott.

[todd.]

Ruth gets a blood draw for the same purpose every couple of months, but ever at the PCP, AFAIK. Some place called Westcliff that just does blood tests.

[Ahistoricality]

I thought this was going to be about new gastrointestinal problems: that's when you have to to drink a milkshake.

(Actually, to be honest, I thought it was about bribing students to do things that that are actually immensely satisfying in themselves. Too close to home?)

[Tom Elrod]

This is all Obama's fault.

[NickS]

That's absurd.

How Can A Poor Man Stand Such Times And Live?

[Rich Puchalsky]

What? You paid $1,800 plus the cost for the appointment?

I would guess that you're going to get reimbursed approximately never. My advice: you've said before that you know a friendly lawyer. Get them on the case now. Have them write a friendly letter to the doctor's office starting the wheels turning and asking how they got a potentially mentally deficited patient to shell out $1,800+ for some blood tests.

What I do when this kind of thing happens -- when not mentally deficited, if that's a phrase -- is to go back and ask to talk to the office person who does the billing. There is always some alternate way they can fill out the forms in order to make it work with the insurance company. I have never, ever encountered a doctor's office without such a person, because if they don't have one, they don't survive.

[Doctor Memory]

But Scott -- remember! If we had single-payer health insurance, that would lead to long waits and bureaucracy! Only constant vigilance can save us from such a horrible fate. God bless America.

[Gas]

Wow.
We people from Eastern Europe often think that such darkly comical absurdities happen only in our countries.

[Patterico]

These bureaucratic snafus will disappear as soon as we can get government to fully take over health care.

Seriously, stories like this are why I come here. Well done as always.

[Rich Puchalsky]

I'm certainly willing to believe that your part of the government is shoddy and mismanaged, Patterico. I wonder how many people have been wrongly convicted due to some bureaucratic snafu in the prosecutor's office? But of course we don't hear about those because the poor and nonwhite people who get convicted must of course be all guilty.

[Nobody]

For a moment the fail boat uprighted itself in the grand coup of arrived-consciousness animated Gifs. People were leaping onboard. SEK, and you missed it, starboard short a whole footknot.. Come on now, JOIN the merry-go-express.

Truly Capotely yours,
Crazy Boy Maximus

[Knitting Clio]

Something nearly as absurd happened to my husband. He got a referral from him his PCP to a dermatologist so he could get a biopsy for a suspicious looking skin lesion. Since dermatologists these days are so busy doing botox injections and other cosmetic (i.e. highly profitable) procedures, he had to wait months for the appointment. Then, when he shows up for it, not only do they not have a record of the referral, they neglected to tell him that the physician had died weeks earlier. So, back to the PCP to get another referral, wait another several months, and then finally see a live dermatologist who confirms that it's (fortunately) only precancerous. Good thing it wasn't malignant.

[alkau]

Once again you have turned what should be simple to something that is beyond understanding. I know the feeling of having blood work done often and I make sure all tests are done that all my MDs will require in the next few weeks. It is very simple to do this because MDs work with each other here and also know there is a limited supply of blood to take.
The other issue that is addressing this issue - I told you to find the Office Manager because that is the person really running the office. What I suggest now is tell your credit card people to NOT pay these people unless they have corrected the mistakes they have made. That way you will not be out of money and the mistakes will be corrected quicker.
And now I will say they can't put the blood back because it is no longer "clean". They add stuff to the blood depending on what tests are run. If I could I would take back blood they don't use - my supply is limited and I have trouble making "new" cells.

[SEK]

Somehow these comments never made it to my inbox. Hm...anyhow:

You paid $1,800 plus the cost for the appointment?

It was $800 for the appointment would've been $1,000 for the tests, had I not slunk away.

What I do when this kind of thing happens -- when not mentally deficited, if that's a phrase -- is to go back and ask to talk to the office person who does the billing. There is always some alternate way they can fill out the forms in order to make it work with the insurance company.

I have now talked to everyone, on all ends, multiple times, and the end result is that they won't approve a retroactive referral, even though I shouldn't have even been to schedule the appointment in the first place without a referral. So the referral that doesn't now exist, but which did exist long enough for the original appointment to have been made, is still an issue, but not so much of one that they won't write me a referral to see an endocrinologist in Riverside, which would've been nice in the first place, what with it being much closer to home. So what's not an issue is whether I need to see an endocrinologist -- everyone agrees to that -- but whether my needing to see one last December was done through the channels in which I wading now which, I remind you, are the same ones I spent no small amount of time in last December.

On some planet, that makes perfect sense; on this one, it's bone- and soul-crushing tedium.

[JimB]

Sorry to read of your difficulty with doctors & referrals. I wanted to write for two reasons:
1) I too am a thyroid cancer survivor (since 1995) and am on thyroid hormone for life (total thyroidectomy);
2) This part jumped out at me"..but this January his Primary Care Physician informed him that he could not, in good conscience, continue to prescribe said hormones unless SEK saw an endocrinologist at least once a year" - my first reaction was "Get a different PCP".

I guess I'm lucky, although I've had 3 PCPs since the diagnosis, all of them have not had any problem monitoring my care, including yearly blood tests and continued prescription writing. I saw an endocrinologist at the 5- and 10-year "anniversaries", plus one additional time when the tests weren't making sense - turns out the lab was having difficulty with the tests.

So, while I certainly sympathize with the losing of the referral (I only recently got back on an HMO plan vs. a PPO, and dread dealing with referrals), I guess I'm questioning the "need" to see an endocrinologist. I obviously don't know the details of your situation, and am not a doctor, but I have been very much an active participant in my post-cancer care for 16 years.

Anyway, just wanted to provide my 2 cents. I hope you get it all sorted out, and good luck with the post-cancer care.

[BigHank53]

But we do have the best health care system in the world!

Whenever you hear that phrase, you'll notice that whoever is speaking doesn't specify who it's best for. Sure as shit isn't the patients.

[dsquared]

Scott, mate, that tiny voice which tells your doctor that you need an expensive appointment every year to get your regular script filled isn't "conscience", it's "greed". JimB is right here.

[SEK]

I guess I'm questioning the "need" to see an endocrinologist. I obviously don't know the details of your situation, and am not a doctor, but I have been very much an active participant in my post-cancer care for 16 years.

I'm on seven years remission, and last saw an endocrinologist five years ago, so I don't think my doctor was out of order. His staff, and the people who handle his paperwork? Another story entirely.

(Also, imagine you and I fist-bumping. I didn't have a complete, not nearly, removal of my thyroid, but I can only imagine. I'm tired enough as is, regularly, while medicated, with 30 percent rendered useless via radioiodine therapy. BigHank53, you also receive, albeit for different reasons, a terrorist fist-bump.)

Scott, mate, that tiny voice which tells your doctor that you need an expensive appointment every year to get your regular script filled isn't "conscience", it's "greed".

Funny thing is, when I was trapped by that volcano in your neck of the woods, it was "six pounds," "six pounds," "six pounds," for scheduling, appointment, and prescription respectively. (That's what I remember at least -- the shock of it may've rendered me an unreliable witness.)

[SEK]

(And I suppose it seems like I contradicted myself here: my new PCP does want me to see an endocrinologist every year, which I'm not keen on doing, but it's not a bad idea for me to see one every five years, which is why I went along with my new PCP when he suggested it.)