Cassie the Cog

“Right.  Uh huh.”  I was not exactly lying, but I suspect we both knew I was not really going.

 

“Could you at least take a look at my elbow?”, I asked.

 

“No, I am sorry.  I can’t.” she said.

 

“Ok.  Would you at least tell me what I should do with it?”

 

“No.  I am afraid I can’t help you.  I would get in trouble”, Cassie replied.

 

The problem with Health Care is not in Washington.  The problem with Health Care lies with me and Cassie.  And the problem with Health Care needs to be fixed by the people who are causing the problem, which would be Cassie and myself.

 

We don’t normally blame ourselves, but we should.  And this case is a perfect example. I suppose I should back up and tell you the story.  I will try to keep it brief.

 

I hurt my elbow.  Either I slept on it wrong or bumped it or whatever, but it swelled up and looked funny and I could feel the pressure.  It was a little sore but not really painful. I got home from traveling and decided to go to Convenient Care to get it looked at.

 

When you arrive they have you fill out the form that tells them who you are.  You have to sign the little privacy statement that you have never read a single word of.  And you have to present them with your payment in the form of your insurance card.

 

On the way back the nurse will weigh you and take your blood pressure and then they will ask you what is wrong.  I told the nurse about my elbow, and I showed her.  It was pretty big so there wasn’t much to explain.

 

“Does it hurt?”, asked the nurse.  “Not really, it’s more like pressure”, I replied.  “Do your muscles hurt?”, she asked.  “No, my arm muscles are fine...I am sore across my chest and back but not in my arm”, I said.  “Wait,,,,your chest is tight?”

 

I am a 55 year old overweight man, and I just told the nurse my chest was tight.  Realizing my mistake, I tried to calm her down, reassuring her I was not having a heart attack.  My comment was not untrue; my chest was tight but likely from sleeping wrong or using my cell phone too much or whatever.  She told me she understood but would need to consult with the doctor anyway and see if she would want to hook me up and check me out just to make sure I was ok.

 

The nurse practitioner’s name was Cassie.  She came in and sat down looking very concerned.  I told her my heart was fine: I was just there to have my elbow looked at.  Unfortunately it was too late.  She would not hook me up to anything or check anything out.  She wanted me to go to the emergency room immediately.

It turns out that the rules are such that she had no choice.  For some reason there was zero wriggle room in the rules and she could not even look at my elbow or recommend an ice pack.  She could not proceed in any way, or she would risk losing her job.  Cassie followed the rules.

 

I was a little upset, but like everyone I am aware of how dysfunctional our health care delivery system has become.  This was a convenient care facility run by BJC, which is a very large organization with multiple hospitals and clinics throughout the St. Louis area.  Cassie had an employer just like I do, and rules to follow or risk getting fired.

 

I did not go to the emergency room.  It was a Friday and I went home with my swollen elbow.  By Sunday it was still pretty swollen and tender.  My chest was still sore as well.  I knew I was not having heart problems but wasn’t sure how to go about getting care.  I would have to go out of town in the morning.

 

On Sunday I did go to the ER, to get my elbow looked at.  It is an expensive way to obtain care, but the out-of-pocket cost to me is $150.00 so I went in and gave them my insurance card and signed the privacy policy that nobody has ever read.  This was an SSM Hospital next to my house so their privacy policy is probably different than BJC’s but since nobody has ever looked at either we will never know.

 

I told the doctor the whole story and they hooked me up to a bunch of monitors for several hours.  They did a chest X-ray and took a lot of blood samples.  After all that they told me that my heart looked really good.  They didn’t see any issues.  

 

I asked about my elbow.  The doctor left and then finally returned with a syringe and a disgruntled look on his face.  He was followed by a nurse with a clipboard who wanted to know if I knew my name and date of birth and where I was.  She wanted to make sure I consented before the doctor performed the procedure.  The doctor rolled his eyes and apologized for the need to go through all of that. When she was done he stuck a needle in my elbow and drew off quite a bit of fluid.

 

When I got the bill from the ER the total was $3420.00, but the insurance company had discounted $2281.00, and they only paid $989.00, while I owed $150.000.

 

But we are all used to that.  It was the OTHER bill that made me mad.  The other bill was from Cassie at BJC.  They had charged me $79.00, and insurance had already paid their share.  They wanted my $20 copay.

 

I called BJC and told the lady who answered that this was an error.  I told her the story and I said I would just assume that someone made a clerical error and that there should not have been a charge.  She said she understood and would send it through the review process to get it corrected.

 

On Tuesday they called back from BJC and told me that they had completed their review and that the charges would stand and I would have to pay my $20.00 or face legal action.

 

If you know me you know what happened next.  I started melting down phones at BJC.  I “contacted” them on social media.  We went a little public.  A few short hours later they had already refunded the money back to Blue Cross/Blue Shield and I had several apologies for what they now term “a mistake which should never have happened”.

 

But until I went ballistic there was no “mistake”, except on my part.  Do we have to go to extremes to be treated like a human being?  Let me be clear:  I blame Cassie.  Let me explain.

 

My name is Jeff, and I had a problem with my elbow.  Cassie could have helped me, but she did not.  I would like to walk in and pay Cassie to look at my elbow and help me.  But an elbow does not generate much revenue.  Heart monitoring is much more profitable, and BJC will make much more profit from that.  Cassie did not act like a human being to me.  Instead she took on the role of corporate cog in the wheel.

 

You will tell me that they were just worried about my well being.  If that is the case why could they not have treated my elbow?  You can say they were right to send me to get my heart checked out but I will respond by telling you that they were in fact WRONG because the facts show that there was nothing whatsoever wrong with my heart.  Cassie was, in fact, wrong.

 

A human being would have looked at my elbow.  A human being would not have billed me when they did not provide any treatment.  Human beings would not create a $3000 bill and write off two thirds of it.

 

BJC is a large corporation, which exists to make money.  Like every other business, it is to their advantage to direct customers to the most expensive products possible, and they do.  We are taught not to argue with anything this large corporation tells you that you need to buy from them.  We are told that to question how much the bill will be is wrong.  And these large corporations take advantage of us every day.

 

We don’t even question the idea that we owe them money even if they do not provide any treatment.  They get paid whether they provide anything of value of not.  Cassie wanted to get paid $80.000 for spending less than 10 minutes with me, telling me she could not treat me.  That’s $480 an hour.  And even after reviewing the situation, BJC agreed that she should be paid whether she provided any value of not.

 

We have lost our damned minds.

 

Now, let me tell you the worst part.  I know you are going to think this is stupid, but I am about to be brutally honest here.  I will NEVER tell a health care provider that I am having chest pain, ever again.  NEVER.  And I am going to be very careful with all of my words when describing any of my other ailments going forward.  I will need to provide only the specific words that will manipulate them into providing only the specific care that I know that I need.

 

You can feel free to be critical of that decision but I will tell you that I am not the only one, and you know in your heart it is true.  We know it works for doctor shoppers and those looking to manipulate the system to get pain meds or whatever.  I am not looking for any of that, but I will use the same tactics to avoid unwanted and unnecessary care.

 

If Cassie was a human being I would not have to avoid telling her about the soreness in my chest.  I could be open and honest and we could discuss that AND my elbow and we could decide what to do and how much it should cost together.  But Cassie is not a human being.  She is a cog in a corporate wheel.

 

I came wanting a small, less expensive item.  Cassie directed me to a much more expensive item.  When I declined, she refused to do business with me at all.  They have no interest in selling the smaller, less profitable care.  They want to direct you to the more expensive care, whether you like it or not.

 

I don’t go to the doctor much.  I avoid it, and I wish I had avoided it that night.  The truth is that my elbow probably would have resolved itself anyway over time.  I still don’t know what is wrong with it.  It’s still a little sore.  The ER said I should follow up with an orthopedic specialist, in addition to a cardiologist.  I have done neither.  Why on earth would you send me to a cardiologist when you hooked me up to probes for several hours and generated all that data that showed a very healthy heart?

 

I know the answer, and so do you.  This is about money, not health care.  We will not fix our healthcare problems until we re-introduce humans back into the system.  And I will continue to avoid all interactions with corporate health care cogs who want nothing more than to send me a bill, whether they treat me or not.