Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation
The forms we all sign as patients before we are admitted to the hospital or have surgery are inadequate and inaccurate. You know the forms. Those “assumption of risk” and “assignment of benefits” forms that supposedly disclose all the things that might happen to you during care so that the hospital can say you knew full well that you might be terribly injured or that you might not survive. These same forms say the hospital will be kind enough to bill your insurance company for you but that anything not paid by the insurance company for any reason will be your responsibility to pay – even if it’s thousands and thousands of dollars.
The forms need a “Bum’s Rush Clause” added to them.
I hate to even say this because I already think these forms require patients to give up most of the rights we may have in any other financial transaction – and receiving healthcare in America these days surely is more a financial transaction than a healing one most of the time. But the lawyers do need to add a line or two to the release forms. Though impressive in the way they make sure patients have little legal protection either from bodily harm or financial ruin, the forms fail to disclose who is calling the shots that may well determine the success and certainly the course of your hospital stay and your full recovery.
I had major surgery this week. I signed the forms pre-operatively. Even as I worried about having the surgery, missing time from work, and trying to bounce back as quickly as I possibly could, I worried at least as much about the inevitable unexpected bills that will somehow not be covered by my insurance that I will need to pay.
As I was being wheeled away from my husband and into the impressively adorned operating room where some kind soul’s bones were waiting to take the place of mine where a tumor had taken hold, I saw new faces in operating room scrubs and wondered if each face represented a separate billing center or if they were all covered under one billing source code or another. I hoped they wanted me well. I was glad when the mask went over my face and I could depart this world for a few hours under anesthesia.
Another time I’ll chat about being an in-patient and how that experience is so horribly different than being in a place where my care and my health is actually the priority. I was scanned for my bar code so much I was amused a bit by it. No one needed to ask my name. I just stuck out my arm when anyone entered the room to save them from having to ask and waste time with any niceties. I tried never to ring a call button. That just makes hospital staff mad. I got so thirsty sometimes when my water ran out, and I worried about my catheter bag getting too full.
My doctor hadn’t written the order for the post-op PCA pump for pain medication until she visited my room hours later and saw I didn’t have one. By then my pain was ramping up as the general anesthesia wore off, and I had succumbed to asking for some pain meds. But it was near shift change time, and it took two-and-a-half hours before the pump was set up and running.
On the day after my nearly six-hour surgery, I sensed I was getting a bit of the “bum’s rush.” You know how you can feel it when someone just really wants you to go even if you weren’t quite done, for instance, at a restaurant? This felt sort of similar. Suffice to say there were some medical concerns that made me uncomfortable about going before someone checked them out – and I had not been examined by anyone that morning. One doctor asked me if I wanted to go home, and I said, “If I am ready, of course.” But at that point I hadn’t even been out of the bed since surgery.
I could tell my young but seemingly competent nurse was concerned about some of the same things I was worried about, but she and I were both shut down from further investigation. The only delay allowed was when I sprang a leak – blood was gushing everywhere. It was making a real mess for housekeeping to have to clear away, so as I tried to put my street clothes on, I threw my hospital gown on the pool of blood. Once the bleeding had stopped, no one tried to help me clean up, so I tried to do it myself. The bewitching hour was coming and I didn’t want my nurse to lose that extra lunch pass.
The ride home was horrific. The force of the turns and the speed and the stops in the car made the pain nearly unbearable. I wanted to just pass out. When I got to the door, my husband handed me the mail. In it was a letter from my insurance company approving the surgery and the length of my stay. Two days. My insurance company had no way of knowing how I would feel or what my medical condition would be after two days, but that was what their letter said I would have. And that dictated when the hospital’s “bum’s rush clause” would be put into play.
Since the hospitals and doctors aren’t likely to take on the insurance companies too frequently lest the insurance companies show them less-favored status in future payment decisions, I think patients deserve to know when the bum’s rush will begin – and we deserve to know it as soon as our doctors and our hospitals do. I hope that until we achieve a healthcare system that operates for the good of patients and our health instead of one that operates for the providers and their wealth that we at least get better disclosure of what is really going on.
Soon as I am able, I’ll keep fighting to achieve a progressively financed, single-standard of high quality care for all – something that honors me as a patient and helps me be more bold in helping my doctor decide when I should be discharged not the insurance company in advance.
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