Here Comes Trouble: Stories from My Life

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Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

December 31st, 2009 12:44 PM

Blood Money 2010: Healthcare in America

Ask patients who need lab work done how that all works out today in America, and then imagine where this trend is going in the future. It’s blood money paid up front and in full or patients must take their chances. Getting laboratory tests or other medical testing done has become a special challenge for most of us, and forcing us to buy the defective financial product marketed as health insurance coverage is not going to change that. It’s going to get worse.

Patients who needed lab work used to routinely have blood drawn in doctor’s offices or in laboratories shared by several doctors within one practice group. Unless you needed to be fasting or had other special instructions leading into the test, what your doctor ordered was usually done on the spot. Getting results was a matter of waiting a day or two – and sometimes having a bit of worry – before the doctor would call and discuss your test results. Little did most of us know that was a bit of utopia.

This morning I appeared at a Quest Diagnostics center here in Maryland where my doctor sent me to have blood work drawn. Dutiful patient that I am, I had even gone on-line and registered, set an appointment and printed out my instructions before fasting in preparation. After driving in icy and snowy conditions to the Quest office nearest my home, I was told that the lab no longer accepted my particular Blue Cross insurance plan. Embarrassed and frustrated, I retreated to the waiting room.

My husband, who has Medicare and a supplemental Humana plan, was also on hand for his lab work, and his processing at Quest went as smooth as silk. No denials or waiting when you have that government-run Medicare it seems.

The office staff told me I could go across the street and try the LabCorp facility – my only other choice to get lab work done without being in-patient in a hospital. So off I went, doctor’s orders in hand, not wanting to waste the fasting time or try to miss any work to reschedule another day.

At the LabCorp office, there was one person working the entire facility this morning. She moved between drawing patients’ blood and collecting their billing and insurance information. When she looked at my orders, she first said she normally doesn’t accept doctor’s orders written on Quest forms. I apologized and tried to explain. She cut me off and said she needed my insurance card and picture I.D., which I handed over. I also noticed LabCorp posted a sign saying they need a credit card on file so that any charges not covered by insurance can be charged to the patient immediately. I took a picture of the sign as it offended me that I must pay up-front for testing supposedly covered by an insurance policy for which I pay up-front every single month which is supposed to provide me some health security.

The LabCorp tech sent me back to room two. I waited for her to join me and draw my blood. I pulled my left sleeve up to get ready. But here she came with a print-out in hand to ask me if I had ever lived at the address shown. I said, “yes.” She then told me I owed an old co-insurance amount of $10 to LabCorp from 2006 and that I had to pay it before getting my blood drawn today. I asked if they took checks. She said they take credit cards or debit cards only. I left the blood drawing room and went back to the front desk where she took my debit card and processed the $10 payment. Then we went back to the blood draw cubicle and she drew four vials of my blood. If it were not for my apology for bothering her with Quest labeled doctors’ orders or my profuse politeness with her as she dunned me for my old bill, she would not have spoken to me at all. This lab technician/receptionist/bill collector clearly is annoyed by the process too and must insulate herself by withdrawing. At least that’s what I told myself. I wished her a happy new year and left.

So, I had my blood drawn but had to visit two labs and leave my debit card information to get it done. And I have what many would think is good coverage. I have few choices. Like millions of us now and millions more who will be forced to by the defective financial product that is for-profit private health insurance, my options for getting care are totally determined by my insurance company and the large medical corporations that control much of the health delivery system. The issues of the monopolies that exist in lab testing and other medical testing are not even touched by our health reformers in Congress. This is yet another layer of the unfolding tragedy for American patients. My doctor was only a pawn in this transaction, as far as I could tell. She just sends patients off to one lab or the other and awaits the results. Her office operation doesn’t have to handle lab details anymore, and her conscience never has to be tickled when a patient is unable to get insurance approval for testing or cannot cover the costs with cash or credit.

Blood money. That’s all it is now. It’s not medical care. Patients pay up-front for services they aren’t even allowed to review in advance. We don’t even get the legal right to see the full extent of what we may be agreeing to pay with those in-advance of service authorizations of payment. No price list, because the prices vary so wildly from one negotiated rate to another – like airline seats bought through various booking agents. But this is life and death stuff. Don’t like it? Then don’t play the blood money game, and you won’t get the care.

They’ve got us all in a very tight legal and medical bind. We are quite literally at their mercy. Our blood, their money. It could be otherwise. It could be Medicare for all – our money, our health, our blood. But who would that profit?

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