Within 20 Miles of Texas

I had a doctor's appointment last Friday. I was hoping we'd be able to schedule the surgery for one day this week and I wanted to be prepared by knowing which surgical facilities were in the network.

I just can't see what's on that little iPhone screen, so I called United Healthcare's customer service number. The automated system wanted to know whether I wanted a medical doctor, a mental health doctor, or something to do with substance abuse. None of those options were right. I wanted to locate a "surgical facility" or maybe a "hospital". Like an idiot, I tried to explain what I wanted to a machine. Like a bigger idiot, the machine decided that it couldn't help me and offered to connect me with someone who could. Hurray!

Well, almost hurray. I don't think the human had much understanding of what a "surgical facility" was, either. So I decided to hone in on "hospital". This should have been my first clue, but for some reason, it wasn't. The young lady asked for my zip code and then told me that the nearest one was Baylor in McKinney. That's good to know, except that my doctor is in Plano and I thought he would probably want to use a Plano facility. I told the young lady that I wanted to find a hospital in Plano.

She gave me another option in McKinney.

No. I want to know what is in the network in Plano. Plano. Not McKinney. She finally offered me one option. Now, it's important to note that there is more than one hospital in Plano these days. There's the HCA hospital, Presbyterian, Baylor, and Harris Methodist - and that's just off the top of my head. Of course the one option she gave me was the one I don't really want. (Great place to have a baby or a hang nail - anything more serious and it's not where I want to be.)

I told her I couldn't believe that was the one and only option in Plano. She told me she was looking for all hospitals within 20 miles of Texas.

What????? It suddenly hit me that she had no clue where or what Texas is. It's a state, not a city, you silly girl. 

I had to ask, "Where are you located?"

Did I get a straight answer? No. "There was nothing in your zip code so I looked for 10 miles and then 15 miles and now I look for 20 miles within Texas."

"I don't think you know anything about the geography here. Where are you located?"

She clearly didn't want to answer that question. She almost started to cry. "I'm doing my job. I'm providing you with information you ask for."

"I understand that. I'm not unhappy with you. I'm unhappy with your answer. Where are you located?"

"I'm in the Phillipines."

Well, Geez Louise. No wonder she doesn't understand why "within 20 miles of Texas" is a fairly dumb thing to say.

"I want to speak to someone in the United States. Can you transfer me to someone in the United States?"

Well, clearly she couldn't. I think she transferred me to the New York State Department of Health. Knowing they couldn't help me and not having the time or patience to navigate their automated system, I gave up and called back. This time I selected the option for making a payment. Surely the payment information doesn't go through offshore people. When the young man answered, I started that conversation with "Where are you located? Are you in the United States?"

The short answer was "I'm offshore."

"What number do I have to call to talk to someone in the United States?"

The short answer was "I don't know."

And by that time we were at the doctor's office. And as it turns out, the surgery won't be until after we return from the UK in February so I really don't need to worry about UHC's in-network nightmare. By that time I'll be rid of United Healthcare and on the Blue Cross/Blue Shield plan. And I'm happy to report that when I called BCBS to make my payment, I got someone in the United States who was able to set me up on auto-draft. (I'd asked the folks at UHC to set me up on auto-draft but they were unable to do that. Just as well.)

Can't wait for February when UHC will be out of my life. That will be almost as big a relief as getting my knee scoped.

Set Up for Failure

I've figured out why the Marketplace Health Plan I initially bought was so cheap. In most cases, they'll be able to collect the premiums without actually paying any claims. Here's how it works: This policy has some "not so fine print" which indicates that if you go to a specialist without a referral, you will pay a higher co-pay. Typically $40 more. (That's $40 the insurance company doesn't have to pay!) If you go to an out-of-network specialist (or any other doctor or facility) you will be responsible for the ENTIRE bill. And furthermore, it will NOT apply toward your deductible. (There's a whole lot of stuff the insurance company doesn't have to pay!!)

To be forewarned is to be forearmed - or so they say. When I went to my in-network primary care doctor, I expected him to refer me to a specialist that was in the network. But that's not what happened. And if I hadn't spent the two days prior to my appointment researching all the doctors (turns out there were two) in my network, I would have accepted that referral and gone happily on my way only to go into shock when I found out I would be responsible for the entire bill - which could be sizable considering that I've seen an orthopedic surgeon, had x-rays, I'm waiting on an MRI and may have arthroscopic surgery on my knee. 

Fortunately for me, I've been around the block a time or two with insurance companies. By the time you're over 60, you pretty much know most of the tricks they use to keep from paying your claim. I WILL navigate these shark-infested waters because I understand that I have to use a network facility and that the doctor must make a referral beforehand. Lots of phone calls and staying on top of people. But it will save me money in the long run.

But what of those poor souls who are finding themselves insured for the first time? I think they'll go along to their primary care doctor and get referred to an out-of-network doctor or facility. They won't understand exactly what happened that caused them to be responsible for the bill rather than the insurance company. It's like letting the insurance company off on a technicality. Then the general consensus will be that "this Obamacare is a load of crap". And in this particular instance - that would be a correct assessment. But the blame should be resting squarely on the shoulders of the insurance companies who chose to implement those plans in that way.

I'm fortunate that I found out about the deficiencies of this plan early while it's still open enrollment. I got my insurance agent to put me in a different plan - one that has more provider options and doesn't require referrals. (Yes, I pay almost twice as much for it, but I think it's going to be well worth it.)

No Choice

I really want to get my knee fixed. I don't want the pain that plagued me in San Antonio to go with me to England next month. So on the drive back from San Antonio, I thought I'd start checking to see which doctors are on my plan so I can make an appointment and maybe have a bit of relief by February.

It hasn't gone well. The website for United Healthcare was probably built and maintained by the company that originally did healthcare.gov. This site just doesn't work. No matter what I typed in, it returned zero results. I couldn't even find my cardiologist on it (although I have been assured more than once that he is indeed in the network). I finally found one orthopedic surgeon. However, I knew that doctor. He fixed the pain in my neck 12 years ago, but he doesn't do knees. I decided to call his office on the assumption that if one doctor in the practice is "in network" some of the others will be, as well.

When I got through to the knee doctor's scheduler, she wasn't at all sure about the insurance plan. She promised to investigate and call back. She got back to me this past Tuesday.  It seems that the doctor who does the knee replacement surgery is NOT in the network. Furthermore she told me that the three doctors who are in this particular network (out of about a dozen in the practice) were "hand picked" by United Healthcare to be in this network. Other doctors were not permitted to "opt in" and if a doctor chose to "opt out", he or she would be opted out of EVERY United Healthcare plan. Interesting stuff.

But in speaking with her and giving her the numbers on my card I made another interesting discovery. I had been assigned to a PCP (primary care physician). She also told me she thought I had to have a referral from my PCP in order to see a specialist.

I once again tried the provider website and the "find a doctor" feature still didn't work. However, I was able to confirm on their website that my plan did require me to have a referral from the PCP before seeing a specialist. I also learned that if I did not have a referral or if I chose a doctor outside the network, that I would be responsible for the ENTIRE cost of any treatments and office visits. Wow! That's serious. There is absolutely no margin for error here.

I decided that the first thing I needed to do was make an appointment with the PCP. The website did explain the reason for the referral system. Boils down to "no one knows your healthcare needs like your primary care doctor." What a load of bollocks! I've lived in this body for 60+ years and I know it better than anybody. But I am now in the position of asking a doctor I've never met to refer me to a doctor (my cardiologist) I've been seeing for the past nine years, or my OB-Gyn whom I've been with for 25 years. What a monumental waste of everyone's time! Well, maybe not everyone - the PCP does get a fee for his services.

Anyway, I called the PCP shown on my ID card and was told that there was no Dr. Westbrook at that number. They also indicated that they'd been fielding a number of calls for the non-existent Dr. Westbrook. I called the customer service number and after waiting an hour on hold, I got through to someone who attempted to change the doctor. I asked that she confirm that the doctor did in fact exist before she switched me. Problem was that it was lunch time and she was getting either no answer or the "we're out to lunch" recording. I told her she could confirm it and call me back when lunch was over. She told me she wouldn't be able to do that because of high call volumes. She gave me the names and numbers of two doctors and left me to confirm their existence. Guess what? One number was no longer a working number and the other one belonged to a nurse practitioner, who knew the doctor in question, but wasn't associated with him. I had apparently signed up for a plan with no "real" doctors.

After another hour on hold, I was given the names of three doctors and was able to confirm that at least one of them existed and was taking new patients as long as they weren't on Medicare. But in all the excitement I'd forgotten to find out about the orthopedic doctors. Another call, another hour long wait on hold and I was sent a twelve page list. I went through the list to eliminate the doctors who were more than 50 miles away. Then I went through it again to see which doctors did knees. That brought the list down to eight doctors. I also wanted to make sure these doctors did knee replacement because that's the worst case scenario and I really wanted to avoid being referred more than once. By Wednesday evening I was only able to confirm that one doctor on the list actually did knee replacements. I would have to wait until Thursday morning to see if there were two. Still, two is not much choice.

I called United Healthcare's customer service number again. Only a 30 minute wait this time. But I really wasn't happy that two days of research had produced only one name. The call center rep made the mistake of telling me that not all doctors had opted in to the plan. Bad mistake - remember what the woman in the doctor's office told me about United Healthcare hand picking who was on the plan? The customer service rep said "that just isn't true". Girl, you work in a call center answering a phone. No one informs you about policy. Why on earth would I believe you over someone who works with a multitude of insurance carriers for multiple doctors? Short story - if there is only one doctor in my area then I must use that doctor. All I can say is he'd better not screw it up because I will come after the doctor and the insurance company that didn't allow me any choice. I asked if I could be moved to a different plan, one that had more than one doctor. She told me it didn't matter whether the plan was Bronze, Silver, Gold, or Platinum - the doctors were all the same for "marketplace" customers.

So it would seem that the insurance companies have managed to pervert the intentions of the Affordable Care Act. (Yes, it's affordable, but you'll have trouble finding a primary care doctor and you'll only have one specialist to choose from.)

The next call was to my insurance agent. "Get me out of here!"

"It will cost you twice as much."

I don't care. I don't want this. I want some choices. And I don't want to work so hard. I went to the PCP doctor yesterday and his first two referral choices were NOT the guy on the plan. If I hadn't known who is on my plan, I would have been stuck paying the entire bill. Although the one guy on the plan hasn't phoned me back to make an appointment, so we'll have to see. But if I stay on this plan, and it's determined I'll need surgery, I guess it will be my job to co-ordinate the facility and the anesthesiologist to make sure they're in the plan. And right now, my fear is that they won't be.

Small World

Usually when we go to San Antonio on New Year's Eve, I book us into a flashy restaurant for dinner. Someplace like Boudro's or Morton's where we can have an elegant (translate expensive) meal to finish the year in style.

I didn't do that this year. Boudro's tends to rush you a bit on New Year's Eve and we went to Morton's last year and found that some of the other people in there were behaving so obnoxiously that it was difficult to enjoy the meal. We figured we'd see what was available when we got there.

The short answer is nothing. We couldn't make a reservation anywhere. Not even in our own hotel - which actually had a pretty good offer running but failed to mention it when we checked in the day before and was sold out by the time we found out about it. But it was not the end of the world. We decided to just wander around and graze - have an appetizer here, an entree there - we sure weren't going to starve.

We started off with potato skins at Waxy O'Connor's. Someone remind me to never order food there again. We'd had a bowl of soup there a couple years back and it wasn't good. The food had not improved. We moved on.

We arrived at County Line BBQ. We've eaten there before and the food was good. Not elegant, but good. We were told it was about a 20 minute wait. While waiting, we struck up a conversation with another couple who ended up inviting us to join them. Turns out James is an instructional designer/courseware developer and Sylvia left teaching to run after-school programs in Houston. Mark and I both have instructional design/education backgrounds so we had plenty to talk about. In fact, James believed he attended a session I was presenting at an ISPI (International Society for Performance Improvement) conference in either San Francisco or Anaheim some years ago. Small world.

We had an enjoyable dinner with them and then went on to watch the fireworks. But it's so crowded around Hemisfair Park that we lost them before the evening was over. Not to worry - we had already exchanged emails and phone numbers and I got a Happy New Year message on New Year's Day!

Then on New Year's Day while it was raining, we were playing darts. When we got tired of playing, a couple invited us to share their table. Turns out they're also from the Dallas area and that Judy and I have a friend in common. More emails and phone numbers. It's a small world after all!

(That song will be stuck in my head for days!)

It's Not About the Pizza

Once again Mark and I went to San Antonio for New Year's Eve. This time we stayed at the Wyndham Gardens. Once again we had those pushy pizza peddlers stuffing their flyers under our door each night.

At least the front desk took this seriously, unlike the folks at the front desks of the Marriott and Hyatt who looked at me like my hair was on fire. There is a sign on the door that indicates that soliciting, handbills and trespassing are prohibited, so the folks stuffing these things under the door are in breach of hotel rules even if they aren't breaking the law.

But here's the real problem: There are people who are neither employees, nor guests of the hotel who are wandering around where the guest rooms are and the hotel has NO IDEA who they are, when they are there, or where they are. I really don't care about pushy, pesky, pizza peddlers. I care about murderers, rapists, thieves, and kidnappers.

This is the deal - if they can't keep out the people with the handbills, how are they going to keep out those other elements? I understand that axe murderers and thieves can check in as guests. I'm not so naive as to think that a background check should be required to rent a hotel room. I'm just asking hotel management to keep people who aren't employees or registered guests confined to the lobby, restaurant and other public areas and out of the guest bedroom areas. Too hard? It would seem so. At least in San Antonio.

Not Vehicle Friendly

We went to San Antonio because it's warmer than Dallas. Not by much, only 10 degrees or so. If it's relatively warm in Dallas, the weather is perfect. But if it's in the 20s or 30s in Dallas, it's only going to be in the 30s or 40s in San Antonio. And that's cold in San Antonio.

The San Antonio natives don't like it either. They shut down the river taxis. They only run the tour boats in the evening when they have big crowds out on the Riverwalk. But when it's cold outside, and overcast, and a bit drizzly - like it was this past week - you don't really want to ride the water taxi, or the double-decker bus, or the horse and carriage anyway.

In the past we just walked it and didn't worry much. But this year, given the apparent lack of cartilage in my knee, walking wasn't much of an option. Had I known my knee was going to hurt like it did, I wouldn't have booked a hotel so far out on the Museum Reach. But I had no idea. Not to worry, we had a car and there are always taxis.

Attempting to drive around is how we discovered that San Antonio is not a vehicle friendly city. You have to pay to park everywhere - even at your hotel. We got stuck in the Rivercenter parking lot. You pay inside the mall and then put your ticket in the machine on your way out and the gate swings open. At least that's what happens in theory. In fact, we put a twenty dollar bill in the machine and ended up with 14 one dollar coins in change. Then the machine took our ticket but didn't open the gate. We pressed the call button and the young lady told us that the computer showed that the gate had been lifted for us. We assured her that it had not and asked her to raise the gate. She told us to wait just a moment and went on to do other things. After two more call button presses and 15 minutes, we finally got out of the Rivercenter parking garage. Normally, we would have walked there and not worried about parking, but I just couldn't.

Then we wanted to go to the Mercado. The only free parking lots (for people who want to eat at one of the restaurants) were full. The paid parking was for a full day and ranged from $5 to $8. We didn't want to be there all day. We just wanted lunch. We found some metered parking, but it only took coins. Since this was before our visit to the Rivercenter Mall parking garage, we didn't have enough coins to park. Again, normally we would have walked to the Mercado, even in the cold and drizzle, but my knee just wouldn't allow it.

First up for the new year - find a doctor and get the knee fixed. I made a few phone calls on Friday so hopefully, it won't take months to get an assessment. Second - I think next year we should go somewhere warm. Really warm. Not just warmer but warm. 

Be It Resolved

That sounds so official. I tend to avoid traditional New Year's Resolutions and stick with goals. My resolutions are more like a To Do list. Last year it was my goal to see at least 24 movies, (which I did - no more, no less) read at least 12 books, (I think I got in 18) read the Bible (I read the Common English Bible with the Apochrypha and finished a few days before the end of the year.) Mission accomplished.

I'm planning to stick with those same goals for this coming year, but I wanted to add some others. I've been thinking about some loftier goals, but haven't figured out how to determine when they've been met. For example, I resolve to eat healthier. I resolve to drink more water. I resolve to be more organized. I resolve to be a better person. And these are just some of the reasons I'm not really in the habit of making traditional New Year's Resolutions.  Healthier than what? How much more water? How will I know I'm organized? How will I know I'm a better person?

It's taken me back to my days in corporate training. I'd meet with the manager requesting the training to determine what the objectives of the course should be. Invariably, they would say they wanted the course participants to "know" something. Well, fine. How will we know that they "know"? So if my goal is to be a kinder, gentler person - how will I know that I've met that goal? You see the problem?

So instead, I'm going to focus on things that are quantifiable. I'll try to drink eight glasses of water each day. (I've been told I need to drink 11 - but that's someone else's goal for me - mine is eight.) I'm going to clean out all the closets in the house by the end of June. (I've already done the one in the back bedroom.) Better, kinder, and gentler? I'll have to let you know.