I got up this morning and made a bunch of phone calls, FINALLY, including one that necessitated another phone call, to our pediatrician’s terrible referrals clerk, who asks in a challenging, bet-you-can’t-answer-THIS-one tone for things most patients would not know (“What’s the NPI number?” “Is she also a specialist in X?”) and then acts as if she is literally unable to write the referral without ME PERSONALLY providing that information to her, even if I have successfully answered all her other questions (the practice’s address, phone, fax, email address; the doctor’s first name and last, and specialty). The previous holder of her job had no such trouble, asking just the doctor’s surname, the reason for the visit, the name of the practice, and the day of the appointment; sometimes she’d say “You don’t happen to have their fax number, do you?,” and if I said no, she’d say “No problem, I can find it!” She NEVER asked me for the NPI, presumably because THAT IS NOT SOMETHING PATIENTS GENERALLY KNOW. I look back wistfully upon those happy times.
With another call, a receptionist claimed she could not let me make an appointment for my over-18 child, because of HIPAA. I have gone through HIPAA training twice, and this is not a thing. With only a few exceptions, ANYONE can make an appointment (or refill a prescription, or pick up a prescription) for ANYONE: I can call and make an appointment for my mom, or for my spouse, or for a friend, or for an elderly client/neighbor, or, yes, for my 20-year-old child. HIPAA prevents information from going THE OTHER WAY: the receptionist/clerk may not tell ME anything about the person on whose behalf I’m acting (unless the person in question is my minor child, or unless the office/pharmacy has a document from the person saying it’s okay to tell me things): they may not tell me how long its been since the person’s last appointment, or what kind of appointment the person is due for, or what prescriptions the person is taking, or their recent test restuls. But I may tell the receptionist/clerk anything I want: I may say the type of appointment I’d like to make for the person; I may give the person’s full name and address and insurance information; I may tell the receptionist what the symptoms are or which prescriptions need to be renewed. And the receptionist may schedule the appointment / leave a note for the doctor to renew the prescriptions, without needing to go through any sort of vetting process to make sure I am authorized to make these requests. But I know the futility of arguing with someone who is trying to enforce a rule they didn’t make and think they are required to follow, so I gave up without protest.
I ALSO made a call I THOUGHT would be terrible, and certainly there is still time for this to turn (as with so many other insurance issues) into a long SERIES of frustrating calls—but at least my FIRST call went quickly and easily. Here was the situation, if you enjoy a little empathetic cringe: I had in my hands (1) a bill from my doctor and (2) a letter from my insurance company instructing me not to pay it. (The doctor had apparently asked for a certain type of bloodwork that was not covered under the doctor’s contract with the insurance provider.) I had to call the doctor’s billing department and explain this. (WHY IS THE PATIENT EVER EVER EVER USED AS A MESSENGER BETWEEN DOCTOR AND INSURANCE COMPANY???) And the person I talked to was just “SIGH it would be nice if they would tell US these things! Okay, I’ll take care of this, you should be all set, just call us back if you see anything else about it!” (But my guess is that when they opened the file they DID see that the insurance company HAD notified them; I don’t think they would have canceled it just because I said so. I think they send out the bills on purpose anyway, because a certain percentage of patients will accidentally pay them.)
This batch of calls reminded me how satisfying it was to have Rob make all his own calls before he left to stay with my parents: he was astonished by how LONG everything took, and by how one call could lead to SEVERAL MORE calls. It’s also satisfying to think that at some point all five children will be taking care of all of their own calls/appointments. That’s going to be even better than when they all started taking care of their own seat belts.
Ah, the pain and tedium of being an adult!
My oldest eased his way out of lockdown with way more competence than I expected, given the number of things he had only recently gotten a handle on before March 2020. So that was a relief.
But there are still more new things he needs to do, stuff he’s not resuming but instead doing for the first time, and I am trying to let him learn on his own but also trying to make sure he understands that you should always assume a new process will be slow, expensive, and complicated. Especially if not understanding with make life harder for me, too.
I worked in a hospital billing department and Lorraine, I think we all need a Lorraine!, said to never ever pay the first bill you get from the hospital. I’m in charge of the bills and I’m sure my husband would flip, but I always wait until the second notice from any medical establishment and check each line item to make sure it was billed to the insurance properly. The only one I always feel like something fishy is going on is the optometrist. What is the point of vision insurance if they are able to nickel and dime you all over the place?!
I truly hope they start teaching HIPAA in school (maybe in health class?), because the misunderstanding of what it is is SO WIDESPREAD and UNHINGED that I’ve seen everything from “I can do whatever I want with my health up to and including harming others and you can’t so much as mention it to me!” (NO) to “No one but me can ever be involved in or informed of my healthcare no matter what!” (ALSO NO).
Anyway, at my last job I was once named HIPAA coordinator for the last week of a colleague’s maternity leave for boring and hilarious reasons, so I try to bring that up whenever possible and that usually solves it.
I would be happy if everybody learned that it is HIPAA and not HIPPA.
Yesss, whyyyy is the patient expected to provide so much information and logistical management? And now they contact you EVERY POSSIBLE WAY about your upcoming appointment. Call to make it, get an email to confirm, get a text reminder, get an email asking for a review etc etc. I don’t like the phone either but I would happily deal with NOTHING BUT phone calls for consistency’s sake.
THIS: “WHY IS THE PATIENT EVER EVER EVER USED AS A MESSENGER BETWEEN DOCTOR AND INSURANCE COMPANY???”
Also, good on you for making all those calls!!!! I know Very Well how painful and stressful they can be. Especially when people make them MORESO than they already are.
If I were in your situation, and also if I were a person whose personality / ability to make phone calls would allow me to do so, I would have called back the HIPAA enforcer pretending to be the child in question. “Why yes, my name IS William and I AM 20 years old, why do you ask?”
I COMPLETELY agree that both providers and insurance companies (but moreso insurers) send incorrect bills with the hope that they will be paid without question. I also believe they make it intentionally circuitous, redundant, and frustrating to fix or change anything, so people will just give up and pay them. I am suspicious, vigilant, and distrustful of pretty much any interaction with an insurance company — and I have excellent insurance! American healthcare is such a scam, and there are too many people whose health and/or finances are ruined by it.
The system is terrible. Fortunately, nearly all my medical experiences are routine, but the instances where I have had to review the bills had me wondering why these confusing and misleading practices have been allowed to continue for so long. It really does feel like a big scam the medical/insurance industry has perpetrated against the American public.
I spent 90 minutes one morning last week making overdue appointments for my 2 kids and myself. I felt very accomplished when I was done, but then felt a bit deflated when my husband didn’t give me appropriate praise/recognition for doing those tasks.
One of the things I am most grateful that my wife handles is medical appointment for the younger kid, who is medically complicated. The older one is less complicated and handles his own routine appointments.
I used to work for a medical staffing company, and I can tell you it takes about fourteen seconds to apply for an NPI number, and approximately negative two seconds to look one up. That clerk is lazy.
My kiddo is 14 so I keep encouraging/forcing her to speak up more at appointments so she can figure out how things play out in the world. She always gets the most frustrated when I haven’t prepared her for a question they ask, and I’m like, but you knew the answer? I guess this is anxiety.
Yes this.
There’s a website. I’ve worked in healthcare my entire career. I’ve had it bookmarked since I was 21 years old. This clerk is being completely asinine asking a patient to provide this.
not sure if this is correct, but I was told that the reason you cannot make an appointment is that you may be verifying confidential information. For example, if I call an OB/GYN and make an appointment for my daughter, I may be confirming to myself that she is in fact a patient of this person who is known to give out birth control willy-nilly. That just the fact of them acknowledging my daughter is a patient can send the world spinning. Which it might for some moms.
I swear quantum physics and how HIPAA works seem to be the least understood concepts in all the world…
And the First Amendment!
Solid addition to the list!
My hat is off to you for making those calls. I made two calls today – for ONE issue – which is still unresolved… *sigh* And the world wonders why we dread making these calls.
My husband was unimpressed with the calls I made to day (scheduled school physicals, made eye appointments and requested a sample contact bc daughter1 ripped her last contact, registered at new church, registered for religious ed (including locating all baptismal and communion dates), AND scheduled all bills to be paid that would be due while we are on vacation.
I hurried to comment and hit enter instead of finishing my thought.
So ***I*** am praising you for handling all of these things with grace and humor (for your readers). I often use these kind of posts as a pep talk for myself!
Any time I read anything about dealing with health insurance companies, I say a little thank you that we don’t have that system here. IT JUST SEEMS SO STRESSFUL. Like, I am stressed on your behalf just reading this.
The insurance system is the absolute worst here. With my first baby I was on hospital bed rest for 30 days. Each day one of the high-risk doctors visited me, whoever was on rounds. Apparently, I discovered much later, each one of them had rated my case differently, low risk, medium, and high. And I figured this out because each day one of them visited, I had a charge, but it was different depending on who was there that day. All they did was ask me did I have any bleeding or contractions (uh, I would have mentioned that to someone) and one of them would briefly feel my legs, ostensibly to check for swelling or clots. Infuriating.
Even better than when they all started showering on their own.
Even better than when they all put themselves to bed,
Even better than when they all started making their own lunches
Oh my gosh, the day I was released from that humid prison of shampooing and conditioning waist-length curly hair. So, so good.