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Dizzying Loops of Government Health Care

As the political candidates make more and more promises this election season, please add a very large grain of salt to any promise for government sponsored health care. The following is an account of how I spent my morning:

At 6:00 am I called the central appointment scheduling at the National Naval Medical Center in Bethesda to schedule a follow-up/pre-op appointment for my daughter. I did this because when I tried to make the appointment last week, the call center clerk told me my daughter’s doctor’s appointment template would not be available until today. The clerk who took my call today informed me that she could not make this appointment because it had to be made with the clinic directly. Of course, I had specifically asked the doctor, the orthopedic clinic technicians, and the front desk personnel how I should make my follow-up appointments and they had all told me to call the central appointment scheduling. Nonetheless, this call center clerk told me I must call the clinic and she gave me a phone number. When I called this phone number I was directed to “press one” to schedule an appointment. I did so. This directed me back to the central appointment scheduling number where the same clerk again said I had to call the clinic. I spoke to the call center supervisor who confirmed that his clerk could not make this appointment. In fact, he told me that he didn’t see anything in the system that showed my daughter was entitled to care so the clinic had the option to refuse to see my daughter but probably wouldn’t since they had seen her before. He had no idea who had taken my call last week and insisted that it was not one of his employees. He said I must have called a different call center. I only have the phone number for one call center. I only know one number to call. He had no idea how I could have called his call center number and spoken with someone that didn’t work for him. He had no interest in helping me obtain appropriate care for my daughter. His only concern was for his call center employees and stonewalling any attempt for me to get help through the call center as I was told to do by the orthopedic clinic. Please note this was all done before I had my first cup of coffee for the day. I think it was only by the grace of God that my response was no harsher than a tersely spoken “Thank you very much.” At this point I am in an infinite loop. I call the central appointment scheduling center that refers me to the clinic that refers me back to the central appointment scheduling center.

Being somewhat resourceful, I call the phone number on the doctor’s business card. This takes me to the voice mail of the nurse manager for my daughter’s doctor. You cannot leave messages at this number. This number directs you to call another number for all patient concerns. I call this number and actually talk to a real person. He tells me he cannot help me. He is just the front desk receptionist and is only there to answer phones and direct the calls to appropriate people. He directs my call to “the person who can help me”. My call is directed to the voice mail of the nurse manager who directed me to the front desk receptionist who routed my call back to the nurse manager. This is infinite loop number two.

I do have a fax number for the clinic. I faxed a letter with a plea for help to the clinic. The fax did not go through. The clinic has been open for over an hour, but they have not turned on their fax machine. I called that nice front desk receptionist and he directs me to the office with the fax machine. The young lady on the phone sounds somewhat helpless as she tells me she is not sure why the fax machine is not accepting faxes. She promises to give my name and number to the nurse case manager. It has been over an hour and I have not heard anything.

I did find email addresses for both the nurse case manager and the doctor. I emailed them both.

I have no doubt the doctors, nurses, therapists, and other health care providers at the National Naval Medical Center in Bethesda are top notch. I also know that accessing these providers for anything other than routine health maintenance is a Herculean challenge. In addition to a follow-up appointment with her doctor, my daughter needs pre-operative physical therapy. The Tricare referral system cannot get her into this therapy for at least three weeks. This experience is not unique to this facility. In fact, the National Naval Medical Center is by far the best-run military medical center I have ever worked with in the last twenty-seven years. This includes the time I spent as an active duty Air Force physician. I assure you the nightmare scenarios I have seen at other facilities make this twilight zone experience of infinite loops seem efficient.

I am not sure what the answer is to make sure every American gets access to the health care he needs. I do know that putting everyone into a government run health care system will ensure that no one gets the health care he needs.

UPDATE: I didn't realize that when my fax machine gets a busy signal or no response, it tries again later. Several hours after I tried to fax my plea for help getting an appointment my fax successfully got through. My written plea must have sounded pretty desperate because I have had three phone calls from different clinic personnel wanting to help me. I now have an appointment scheduled. As I said, there are some great folks providing very good health care at NNMC. It is just the bureaucracy that governs access to this health care makes me feel like a solid stone wall is between me and the care I or my family needs. The only way to reach this care is to climb over or tunnel under the wall.


Barb, sfo said…
INSANE! I hope you are able to navigate through that quickly so she can get seen by the doctors she needs.
Jim said…
"I am not sure what the answer is to make sure every American gets access to the health care he needs. I do know that putting everyone into a government run health care system will ensure that no one gets the health care he needs." -- Quoting Dr. Hunnell

I don't have any easy answers either, Dr. Hunnell. I can tell you that there is a very obvious reason why it is that more and more Americans are talking about socialized medical care, the particular merits or faults of socialized medicine notwithstanding. That reason very much centers around the enormous costs associated with private health insurance. Case in point (and I sure hope the following link works on this web site): Here in New Jersey, the monthly premium for a Blue Cross Blue Shield HMO with a $30 co-pay that covers a single family is $1,584.30.

Keep in mind that the HMO mentioned above is a basic plan that doesn't cover the entire cost of prescription drugs, and which requires a referral if the insured wants/needs to see a specialist. In addition, the cost of those monthly premiums are rising at a rate that far, far exceeds the rate of inflation, not to mention the pay that an average wage earner is actually bringing home. That being the case, it should come as little surprise that more and more American families are living without health insurance. As Catholics, I believe we are compelled to find a solution to the problem facing the medically disenfranchised this country -- and we need to do it pretty quickly!

I apologize if I rambled on, Dr. Hunnell, but this is an issue that strikes close to home and my heart. Thanks, also, for picking another great blog topic. I hope you will continue to write on the problems the working poor and others in the US have gaining access to quality health care. I will continue to pray that your daughter receives the prompt care that she needs and deserves.
Rosemary Bogdan said…
Great post. I have so little patience with bureaucracies. Sure hop we can find a solution for the uninsured in this country and not have a nightmare like what you experienced only magnified.
Janette said…
Darn- I have never had the experience you have had! We have been associated with the military for the last 26 years. My daughter and son both joined as well. We have never had the loop that you found (my son was delivered at Bethesda).
I am not saying it does not happen. I just seem to get around the loop (like getting around the loops on ATT)
On the other hand-
My BIL was going into Chemo at a fine medical center in Tucson. He is not military- he was in a loop for days. He was admitted and got the chemo. (Seems doctors often forget to talk to hospitals there). When he got home and had complications he was directed to the emergency room. He waited there, with every sick baby and illegal alien, for about 6 hours- bleeding from his nose.
They did admit him at noon the next day when a bed was open.
Fortunely he was insured.
When my dd showed up at a hospital and had forgotten her ID card she was treated as "uninsured". She had her appendix and a fallopean tube removed in the emergency room and turned out to her college dorm two hours later. Tri-care had a fit and later paid very little for her "visit". Of course that did not help my daughter much!
I think that if you have not been out in the "other world' for a year or two- especially in growning areas- it might be an eye opener. I have had four family members die in the last two years (including the above BIL). I can assure you, I counted my lucky stars that I have the military care system!
PS- My school system offers first year teachers $35,000 in pay AND the honor for them to pay $650 a month for the basic family plan for insurance.
Catholic Mom said…
I am very grateful to have the military health system once I gain access to it. As I said, there are some great health care providers in uniform. It is gaining access to these providers that is the issue. I've been a civilian physician for many more years than I was a military physician so I know the grass is not necessarily that much greener in the civilian world. I practiced in California in the heyday of the HMO there. My experience in California was that the HMO's that replaced Medicare were the most onerous to deal with because they were combining the Medicare bureaucracy with the HMO corporate bureaucracy. I will post more on this topic soon. The point of this post is to warn those who are longing for a single-payer federally managed health care system that there is already one of those in place for the military and it is not the panacea they are hoping for.

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