What happens when new and confused health care meets the expertise of modern data mining and product placement.

Day 0 and 1

It seemed like a zit, deep inside my upper cheek. It didn’t bother me much but then it turned into a little knot and then my cheek began to swell and then came the headaches. It was time to go to the doctor.

As a healthy individual in my early thirties, I was happy for the Affordable Healthcare Act. I saw it helping those who needed it and as a means of helping the system stay solvent. It was a C grade I was sure and the quality would suffer, but such is the consequence of spreading something to the massess, the quality degrades. So when I lost my job, I become an owner of a silver policy with a $100 subsidy and it was time to put it to use.

I went online and the website seemed confusing but ok and there I found my primary care physician. The physician was at my old address so I changed the address and physician. But nothing seemed to change on the screen. The change would come in a week it said. Fine I thought, I’m going to my parents’ tomorrow anyway, I’ll call and see this doctor for this lump and headache. I figured I’d call and make an appointment, or so I thought.

15 minutes on hold, they make an appointment for a nearby office, an hour and a half from my house and thirty minutes from my parents. Fine I think, I’ll do it, the headache is throbbing and the eye is hurting. I go to bed that night not actually sure if I’ll wake or not.

Day 2:

I wake and head to the doctors. The office is a large two story building without any clear signs. I wait in one line, get sent to another and then sent to another until I resemble a human ping pong. Finally, I am told that I am not in the network. The week to a month change was instantaneous, the person making the appointment never checked if I am who I am and if it is my insurance. So off I am sent with a phone number and 3 hours less to live.

I am exasperated but the day is young and not all is lost. I call this new doctor who on the website was taking new patients. On the phone it is a different story, they are not taking patients, the walkins are at 8am on Monday and next appointment available is in a Month. It’s Friday, I consider waiting two days.
“How long is the wait?”
“You could be here all day.”
“Thanks” I say and hang up the phone.
Almost defeated, I pick up the phone and call my insurance. A peppy call girl gives me the information to Urgent Care. Instead of $40 copay it is only $80, a bargain compared to the emergency room.
The Urgent care is only a half mile away, I feel almost cured already! Aside from this headache…

I arrive and I am told it is a 45 minute wait, no problem I think, I brought a book! I proudly give them my Obamacare Affordable Health Care Health Net card and they proudly tell me:
“Sorry, that’s not in the network.”
“I just called them and they sent me here.”
“I know, we keep telling them that. We are Urgent Care but we bill as Primary Care.”
I leave and look at the giant Urgent Care sign, and think of the strange double-speak of the sentence the receptionist just said.

I am defeated and when I arrive at my parents, the efficient data mining algorithms are there to inform me of my chances of seeing a doctor in the form of an advertisement mailer:
   “SMART Cremation Services.”

Well, at least something in this country is still efficient.

Update:
 Day 3
I go to the only urgent care center that is open on a weekend, listed on the HealthNet site. I am happy to see no cars in the parking lot and when I open the door three nurses are chatting in an empty waiting room. As I present my insurance card, a deja vu moment occurs: “Health Net is not in our our network.”
“Oh really? You’re on their website.”
“Well we are not in their network. Sorry.”
I head home and realize that there’s a 24 hour nurse line on my card. I call that number. I called it before and remember being told that I called after business hours. I’m not sure how that is possible with a 24/7 service. I call again and get on the phone with a customer service representative. She informs me that the nurse number on my insurance card is wrong. They can’t even put the right phone number on the millions of cards they print. I tell her everything that’s happened and she assures me that she will tell the supervisor. I highly doubt that as I wait to be transferred to the nurse line. After two minutes on hold, I am told that I am calling during off-hours…..

Where is that cremation card again???

Update Day 3 and 4:
My best friend happen to have antibiotics at their home but suggests I call his father in law who is a doctor who lives on a ranch near San Luis Obispo. Papa G immediately diagnoses me after I send him a selfie of my swollen face and prescribes an antibiotic. Success! I think. So I head straight for the Pharmacy.

I announce my name and birth date and they have no prescription for me. They take my number and call me back in about ten minutes that they found it on a voice mail and they will have it ready for me. I come back to pick up prescription and after they run my HealthNet insurance, they tell me that they are giving me the antibiotics without insurance.. it is cheaper to do it without insurance….

WHY DO I HAVE INSURANCE???

Papa G is texting me with updates.. I wish the good ol days of home doctor were back.. The problem seems to be not the doctors but the insurance companies and middle men. I thought that people not having insurance was the issue but now it seems to me the opposite, it was people having insurance which created the problem.

It seems to be a necessity of modern life, but somehow the inefficiency it saves and innovation it provides comes at an inconvenience that is sometimes hard to overcome and a cost that is difficult to justify. Even in this day and age, as the Pharmacist said it is still “good to have friends.”

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