Here's a letter to my medical insurance company about my recent experiences.
First, a small matter, before I get to my real complaint. When first looking for a gastroenterologist I consulted Blue Shield’s provider list on its website and found a doctor close to my home. I call, I make an appointment and then I double check the address. I had noticed that the area code for this doctor was not what I had expected for an office close to downtown Los Angeles, but you never know, do you? It turns out that this doctor’s office is close to LAX, not downtown. Not only is this doctor’s office about as far as you can go from my house without falling into the Pacific, the woman to whom I spoke had worked at the current address for eight years. In case you misread that let me repeat it. She had worked at that office for eight years. When I then called Blue Shield to discuss this, after making an appointment at a doctor’s office close to my home, I was told by your representative that, well, some doctors simply do not let Blue Shield know that they have moved. Now, again, let me be clear (and I said this to your representative) the doctor I had first called had been at their current address for a minimum of eight years. I then pointed out to your representative that I have never paid the doctor out by the airport a single penny of my hard earned money. I have been paying Blue Shield many hundreds of dollars every month for a very long time. I did not point out that during the time I have been a member of Blue Shield I have visited doctors a total of, maybe, three times. Could be four. I leave it to your accountants to work out the outrageous profit your company has made from this one membership. With that enormous sum of money your company has not been able to maintain accurate telephone numbers and addresses for the doctors who are part of your plan. This is not – and here I use a metaphor entirely appropriate to the case – brain surgery. For crying out loud, with all the money you have pouring through your company can you not employ someone to maintain your roster? Now, this should, of course, have prepared me for what was about to happen.
I had stomach pain, I went to see Doctor Kwok Leung Chung whose address is 711 West College Street, suite #510, Los Angeles CA 90012. The appointment was on March 26th 2009. I liked Dr. Chung. He recommended a CT scan of my abdomen. He recommended a facility for the procedure. His colleagues assured me it is a Blue Shield participant for PPO plans. I make an appointment for March 31st 2009. I’m all set. I arrive for the procedure in plenty of time. My name is called. However, my name is called not for the procedure but for an administrator to take me to her desk and inform me that Pacific Alliance Medical Center is not a Blue Shield participant. The administrator is kind enough to let me use her telephone, despite my warning her that I am calling a medical insurance company and that I will, therefore, be on the telephone for a very long time. She graciously allows me to continue. I am, indeed, on the telephone for a very long time. Longer than it would have taken to get a CT scan. The length of this telephone conversation leads to the administrator’s supervisor coming and standing over me and insisting that I relinquish the telephone to her subordinate. I refuse with a rather curt hand gesture, a gesture forced on me by the fact that, just at that moment, after what seems like years in the wilderness, I get a person at the Blue Shield end of the telephone. As I begin to relate my story to the Blue Shield representative I notice that the supervisor who so covets the telephone I am using is now shadowed by a security guard. Yes, in a hospital where I have an appointment to deal with a painful ailment, where I am using a telephone offered to me by a member of the staff of that hospital, I am being barked at by an irate supervisor who has called security. Meanwhile, at the other end of the telephone the Blue Shield representative has checked on the status of Pacific Alliance Medical Center and she assures me that, yes, it is an approved facility. I turn to the irate supervisor. I tell her that Blue Shield insists that her institution is a Blue Shield participant. She barks that it is not. I tell Blue Shield that a woman at Pacific Alliance Medical Center has just barked at me that it is not. I then sit at the very kind subordinate’s desk, whose telephone is clamped to my ear and find myself in a very bad sitcom. In one ear a Blue Shield rep is loudly insisting that PAMC is a blue Shield participant and the irate PAMC supervisor is barking that it is not. The security guard eyes me with malevolence. It goes like this: Blue Shield – Yes it is. Irate PAMC supervisor – No it isn’t. Blue Shield – Yes it is. Irate PAMC supervisor – No it isn’t. Blue Shield – Yes it is. Irate PAMC supervisor – No it isn’t. My ailment, my appointment, my large and unerring payments to Blue Shield, the fact that this is a hospital where my health should be the primary concern, none of these things matters to anyone. At this point they hardly matter to me. In this hospital where I was to receive medical attention I am sat between the representatives of two institutions whose sole concern seems to be that I should be bled of as much money as possible and preferably in an institution other than the one where I have my appointment because the barking supervisor is solely concerned that she will not, must not, cannot possibly be seen to be permitting a potentially delinquent patient to be treated for the ailment which troubles him. After all, he’s enough of a lowlife that all he can afford is Blue Shield and any respectable institution, clearly, would never accept that kind of person. In fact, he’s such a lowlife that he has had the temerity, the gall, the sheer effrontery, to use a telephone offered to him by one of the employees entirely of her own free will and that alone is reason enough to call security. And then Blue Shield hangs up. However, let’s get to the real problem here. Well, allright, it is a major problem that anyone is treated so shabbily in a medical facility, but Blue Shield can hardly be blamed for the putrid manners of Pacific Medical Alliance’s barking warders. Right, the real problem. The representative of Blue Shield, the person who is paid by me to do such things as keep the roster up to date and check which facilities are, in fact, members of the Blue Shield group, is telling me, over and over again that Pacific Alliance Medical Center is a Blue Shield facility. Oh, sorry, ignore that bit about the roster. I’m living in a dream world. Finally the Blue Shield rep gives me the names of other Blue Shield facilities where I can get a CT scan and I leave Pacific Alliance Medical Center trailed by a security guard. Oddly, he was quite physically small and was wearing a reflecting vest which suggests that he was more of a parking lot attendant and only a part time heavy. Still, the idea that a patient at a hospital who is clearly trying to mend a very broken situation should be subjected to that kind of treatment is outrageous.
I set up an appointment at St. Vincent’s Hospital for a week later, April 7th 2009. Remember that I have a very sore abdomen and I have now spent considerable time having nothing done about it through no fault of my own. Now comes the good part. St. Vincent’s performs the CT scan with professional courtesy, with an obvious concern for my health and well being and their incompetence is slightly in the future and therefore does not impinge upon my feelings of relief at getting the thing done. I go home and I wait to see Dr. Chung. While I wait I receive a letter from Blue Shield. Or at least I believed it was from Blue Shield, but, of course, I live in a dream world where the companies to which I pay ludicrously large sums of money actually keep accurate rosters and which perform the functions for which I pay them such as, well, I don’t know, a medical insurance company that can tell me where to go to get fully covered procedures, hospitals that care for patients instead of running parking garages and throwing people out of their facilities when the traffic flow ebbs. How was I to know that the sheets of paper with the letterhead of Blue Shield California, contained in a an envelope emblazoned with the name and symbols of the Blue Shield Corporation was, in fact, from someone else? How stupid of me. Did I mention the contents of the letter? I appreciate the brevity and conciseness of the letter, by the way. It avoided any sort of courtesy, you know, the little things that a member who pays through the nose for the incompetence and abuse through which I had so far suffered might expect. I really liked the way the letter stated baldly that I was an idiot who had actually believed what he was told by Blue Shield, that the facility at which he had had a CT scan performed was covered by Blue Shield. Because, stated the letter, St. Vincent’s is not a Blue Shield approved facility. So, there I am, still in pain, stupidly believing that I have now started on the path to some sort of diagnosis, and, indeed I had. I’d simply failed to do it at a facility covered by my medical insurance company, despite the fact that I had been told that it was an approved facility while I was sitting being barked at in and ultimately thrown out of an unapproved facility. Am I making myself clear? Is there anything in my story so far that you do not get? Is there something in all of this so far – there’s more, oh, there’s more, I just want to be sure you are with me here - is there anything you do not follow? And, may I ask, is there anything in all of this of which Blue Shield of California can be proud? Because you need to find some pride in your work now, before this final chapter. You’ll not find anything salvageable here at the end, trust me. With my teeth gritted I called Blue Shield. Do you know the agony of spirit that descends on the average person when they realize that they have to call their medical insurance company? Imagine, then, the sheer, blind, gut-wrenching torture of the soul I suffered as I called Blue Shield, letter in hand, after the hell I had already been through. I was shaking. This is not metaphorical. I was physically shaking and close to tears. I informed the first human I talked to after talking like a moron to a machine – will you please reinstate button pushing, it is demeaning to have to talk to a machine and particularly one that only understand every third thing you say. I have no doubt the system you have saves money, after all I have yet to encounter any action, procedure or regulation associated with your company that is meant to do anything but save money, but I cannot imagine why having callers push buttons would weigh heavily on the bottom line – that I wished to speak to someone who could actually fix my problem. She kindly put me through to someone, a supervisor. I assume she was not shadowed by security though I’ll bet she works where they charge a lot for parking. Sorry, where you charge a lot for parking. She was very nice and she was very helpful. Fire her now before she costs you money.
I explained my predicament. She checked. St. Vincent’s Hospital had sent the wrong ID number to Blue Shield. No, no, wait, I’m wrong. They had sent the wrong ID number to a company called NIA. Apparently CT scans at St. Vincent’s are overseen by a third party, NIA. NIA had sent me the letter which had left me shaking. Now, here’s where it gets tricky, and I write as someone who runs a business. NIA sent the letter under Blue Shield letterhead. There is no indication on the letter I received that anyone other than Blue Shield is responsible for this final, humiliating debacle. When you, or anybody else, sends something out under your name, you are responsible. I asked for two things from Blue Shield’s supervisor. Firstly, that she would guarantee that the procedure at St. Vincent’s was performed at an approved facility. Secondly that I receive a written apology from either Blue Shield or NIA for the letter which had sent me into an apoplectic state. She was even kind enough to call NIA and find out that they had no intention whatever of apologizing and I can understand that to some degree. St. Vincent’s had sent them the wrong information. So, I want an apology. As I stated to your representative, I know how reluctant you are to give apologies because you fear that you then open yourself to a lawsuit because you may have, by that very apology, admitted fault. Of course, any sane person hearing or reading of what actually happened to me cannot but conclude that Blue Shield, St. Vincent’s, Pacific Alliance Medical Center, NIA and Doctor Chung’s office are entirely at fault to one degree or another. If I may digress, this very defensiveness on your part is indicative of the road, the very degraded, potholed, deeply corrupted, purely profit driven road, down which the likes of Blue Shield have taken the health care business in this country. I have no hesitation in stating my disgust with your company, in stating that if I ran my business the way you run yours, I would starve to death and my child would be taken into care. I have a succinct way of putting it: I’ll bet the CEO of Blue Shield couldn’t tell my clavicle from my anus. Nevertheless an apology would be nice. In my dream world – that little corner of my psyche where doctors tend to patients and hospitals put any surplus back into the institution which serves the people who come there for help – I have this pathetic little fancy. I sit with my coffee once in a while on a balmy morning and I imagine an employee of Blue Shield (he arrived at work this morning to find that Blue Shield had taken away the barriers and parking is now free and he discovered that there’s someone who now makes sure the roster of providers is up to date and the home page of the website actually has the telephone number of the company right there, big as life, so that, as often seems the case, when the rest of the site other than the home page is unavailable, a person can talk to a machine that does not understand him) and that employee sees John Lee’s letter of complaint and he decides that Mr. Lee should not be charged for the services he has barely received. Mr. Lee lives in dreamland, doesn’t he? Mr. Lee is a hopeless romantic who still thinks that doctors and hospitals are for helping people with their medical problems. Poor Mr. Lee, he’ll never maximize his profits, he’ll never leverage so much as a coffee bean into a cup of Joe. Mr. Lee will go through life believing that he’s OK because he actually does know the difference between his clavicle and his anus. What a sap. Because, despite the fact that the CEO of Blue Shield is wiping his clavicle, that CEO is driving a really expensive car.
You’ll be glad to know that I’ve recently had a colonoscopy which went smoothly, so to speak, so I wait with bated breath for your evasive reply and for the results of my biopsy.