Friday, July 04, 2008

"Follow up visits" are a scam

I remember my mother doing something really funny when I was maybe ten-years old or so.

At that time, we didn't have an HMO or a "co-payment." We simply went to the doctor and paid the bill. It was $30 for the office visit. More expensive stuff got handled by my dad's health insurance. You went to the doctor when you were sick, and you paid the bill. You didn't go to a "primary care physician" and get a "referral" and then burn gas at $4.00 a gallon driving all over hell's half acre. The doctor was in the neighborhood. There was very little paperwork involved.

Anyway, my mother - probably the most laid-back gentle person I have ever met, non-confrontational perhaps to a fault - had a bad cold or something. I don't remember the details, but it was something minor. The doctor gave her a prescription. When the pills ran out, she was still sick, and so she called to see if the doctor would call in a refill for her. He said that she would have to come in for a visit.

So, off she went. They weighed her, took her temperature, and the doctor looked into her throat, and guess what, he gave he a refill on the prescription. The doctor spent a couple minutes with her, I suppose to "confirm" that her throat still hurt. Oh yes, and the final extraction - the money from the wallet on the way out.

My sweet, kind mother who never criticized anyone, like most people I suppose, didn't like to feel scammed or taken advantage of. When the doctor decided to renew her scrip (as she had asked him to do in the first place), she asked "Why did you make me come in for that?" He stammered a little. My mother's reply was non-verbal (she re-enacted for me). She looked him in the eye, cocked her head a little, raised an eyebrow, elevated her right hand to about chest height, palm up, and rubbed her fingers back and forth against her thumb in a "money-grubbing" gesture.

Upon my mother's recounting of the tale, I was howling. This was so utterly out of character for my tiny and demur mother that it made me roar with laughter. My laughing made her laugh, and our gales of laughter only fed on one another to where neither of us could speak. With tears streaming down my face, I gasped: "Did you really do that?" She could only nod her head up and down through the tears. "Well, what did he say?" I sputtered. After managing to be able to speak again, she replied: "He just looked at me with his mouth hanging open." More gales of laughter.

I guess the doctor didn't like being "called out" - and from someone like my mother, well, that's the last thing he expected.

Today, a lot has changed in the medical business. We now have HMOs, huge insurance companies, and a bureaucracy that rivals the Pentagon. But one thing hasn't changed: it is still a business. And in any business, the more product you can move, the more money you make.

Take, for example, the instructions on the back of the shampoo bottle (the very fact of which makes about as much sense as having directions on the gas pump: "1. Remove nozzle from pump" - yes, thank you! - or the menu in braille at the drive-up ATM machine). They soberly exhort us to "rinse and repeat." Now, is this because we really need to lather up our hair a second time, or is it because if everyone were to do this, the company would increase its sales by 100%?

Well, anyway, a couple years ago, I had shingles - no, not the kind you put on the roof, but rather the leftover virus from a childhood case of chickenpox that sometimes manifests itself years later as sores. They were on my head, and it caused my entire cranium to throb mercilessly, like Fred Flintstone's thumb after an unfortunate meeting with a concrete mallet.

So, off to the doc I went. He diagnosed me right away and gave me a prescription. He told me there was well over a 90% chance that the pills would fix me up, and that I should start getting relief very quickly. He told me to make an appointment for a week down the road as a follow-up. OK. I don't go to the doctor very often, and I never had shingles. So I trust the guy.

Actually, I felt much better in a couple days. My shingles were nearly gone upon my "follow-up." But I follow the doctor's instructions, and show up. He spends about 15 seconds looking at my head. I tell him I feel better. Good. He shakes my hand. That's it! Well, not exactly. I had to make my way over to the window and pay my co-payment. Another co-payment. "Uh, shouldn't this be covered under the last co-payment? I mean, this is the same illness. I was just here last week." The reply: "It doesn't work that way." I see. "Rinse and repeat."

Fast forward to this week. Mrs. Hollywood had a "follow up" visit from her minor surgery a couple weeks ago. You would think I would have smelled a rat. But no. We go meekly to the doctor like lambs to the slaughter, because the doctor knows best.

But guess what? We didn't even see a doctor! Grace was weighed, her blood pressure checked, we waited in the hall, and saw a nurse. The nurse asked how Grace was doing, had a very quick look at her. Mostly, she just asked Grace if she felt OK, and scribbled her responses in a pad. That was it. Off we went to the window again, and were asked for another thirty bucks. I pictured my mother rubbing her forefingers and thumb back and forth together, only this time, I wasn't laughing.

"Um, why isn't this covered under our last co-pay?" I asked. And this was the clerk's answer (no lie!): "Because it's not on the global." The woman looked me in the eye and said: "It's not on the global." I wanted to say: "Look, lady, it most certainly is on the global, if you bring me a globe, I can pinpoint precisely where this shakedown happened right down to the latitude and longitude." But, I avoided the giving voice to my thoughts (another benefit of the clerical collar - it forces me to behave) - so I just stood there looking bewildered, handing over my debit card for my fleecing.

Of course, Grace knew exactly what I was thinking (one of the benefits of brainsharing) and we both knew this was another "rinse and repeat."

Well, there is to be no repeat.

As the CEO of the Hollywood Family, I have enacted a new family medical policy: "No follow-up visits." Any exceptions to this policy must be based on reason, not flimflam and not an appeal to "the global" or any other bureaucratese.

Yesterday, we got a chance to enact the New Policy. We took one of our five feline members of the family, our only girl "Athena" to the vet. She has been vomiting lately, and has lost some hair. We don't think it's anything serious (and she has been improving over the last couple days), but just to be sure...

We had her examined and ran a couple of tests (we should have the results tomorrow). Medical care, even for animals, isn't cheap. But it is part of the responsibility that comes with being a pet owner. We were given some pills to give Athena for nausea (and I'm happy to report she has not thrown up in two days, and we have not had to give her any meds).

After the doctor left, the nurse/technician came back into the little room. She said: "We need to make a follow-up appointment for two weeks from now." Mrs. Hollywood and I were laughing together by mental telepathy. And entire non-verbal conversation happened in the span of milliseconds. I asked the nurse: "Um, why is it that we need to bring her back in two weeks?" "Well," came the reply, the nurse stammered like a telemarketer who has been bumped off script: "we want to check to see if she's vomiting or anything." "Oh, okay," we replied, nodding obediently. Of course, the real communication happening via brainwave had the words: "cold" and "day" and "hell" in them. The only way they will know if she's vomiting is if they ask us. They want us to pay so they can ask us a question.

If Athena's tests come back clean, and if she is no longer throwing up, why, why, why on God's green earth should we burn gasoline at the rate of $4 a gallon, take time away from my work, only to have someone take Athena's temperature, ask us if she's throwing up, and then get paid another office visit fee? I mean, if she is not feeling better, we'll come back. But if she is better, it's just a shakedown.

And yes, I know there are exceptions. There are always exceptions. But once again, in the "good old days," you stopped going back to the doctor when you felt better. When I get my brake pads changed on my car, I don't have to come back in two weeks and pay them another thirty bucks to make sure it's working. And I would say brake pads are pretty important.

No, indeed. My mom had it right. The medical business is a business - even with the best doctors. The doctors are themselves locked into a bureaucratic system, a world of forms and fine print, of legalese and bureaucratese, an Alice in Wonderland world where "because it's not on the global" is an acceptable answer to a question asked by someone who hasn't a clue what a "global" is. There are a lot of fingers in the pie, and every finger wants a cut. What used to cost thirty dollars is now a "co-pay" of thirty dollars at least twice - not counting the hundreds of dollars that are billed, largely unseen by the customer, to the insurance company, who passes along the costs to our employers, who then must pass that back along to us in reduced salaries owing to spiraling insurance costs.

"Rinse and repeat."


Stacy McDonald said...

Great post! That's why we started looking into more natural methods of healing and not instantly believing "everything the doctor says." I could tell you stories!

Also, you might want to consider We've been members for years. If you want to know more, James can give you the details.

Brian P Westgate said...

So, umm, what's a global?

Fr. Gregory Hogg said...

Fr. Hollywood,

Maybe the receptionist was saying "Glow-bull." Perhaps they have some strange bovine object that lights up when follow-up visits will be covered at the same expense. That would also explain all the b.s., would it not?

BTW, what part of Akron did you grow up in, and when? I served Good Shepherd on Triplett Blvd. in the early '80s. One of my favorite memories of that time was the Simon and Garfunkel concert at the Rubber Bowl. We could hear it perfectly from our back yard...

The unworthy priest,

Fr. Gregory Hogg

Thursday's Child said...

That was post was just too good! Amazing how they never have a proper answer to your questions, isn't it?

Anastasia Theodoridis said...

Now, then, to be fair, it is the doctor's moral (and for all I know, legal) responsibility to follow up and make sure you are okay.

Maybe s/he just shouldn't CHARGE for it.

Yup, there are a LOT of greedy docs out there!

David said...

I believe we have a new phrase to wear out that means absolutely nothing.

Why not use it at church meetings? When someone asks a question, see if they are paying attention by responding, "It's not on the global". Watch hilarity ensue as people stare blankly first at you, then at each other!

Anonymous Lutheran said...

Fr. Hollywood, I can't agree with you this time. Just because symptoms go away, doesn't mean the problem is really gone. And, secondary problems can arise as a result of the original condition, which don't manifest symptoms until later but would be best treated immediately.

I've been seeing a new trend with the introduction of computers into the examination room, and I really like it. It used to be that the doctor would see you for 3-5 minutes, return to his office to dictate a bunch of stuff, which would later be typed by an office worker and put in your file.

But nowadays, more and more doctors are sitting there in the examination room typing a complete record of everything they did, often commenting on it out-loud as they go. The brilliance of this is (1) more doctor time, and (2) it gives you greater insight into exactly why you're there and what the doctor is doing.

Father Hollywood said...

Dear Stacy:

That's really intriguing! Thanks for sending that along - I had never heard of them. Imagine that! Christians taking care of the needs of fellow members of the body of Christ. Now, where I have read about that before? ;-) Thanks again.

Father Hollywood said...

Dear Brian:

You tell me, and we'll both know. That should have been my next question, but at that point, I just wanted to take my lumps and get out of there.

Mrs. Hollywood and I were just discussing "the global" and Lion Boy piped up: "Daddy, what's a global?"

Sometimes real life is like a Mike Judge movie. In fact, if there's ever a sequel to Office Space, I grant Mike Judge to use "on the global" - just so long as I get a mention in the credits.

I don't know what a "global" is, but I know it means I'm getting ripped off.

Father Hollywood said...

Dear Fr. Hogg:

Indeed. Or as we might say in Latin: "Bubulum Stercus." Or as we might put it in the LCMS: Bull Ablaze!(tm).

I grew up in Cuyahoga Falls (where my dad still lives). He retired from Goodyear Aerospace - and sometimes worked in the Airdock near Triplett Blvd. We used to attend the annual "Acme Zip" game at the Rubber Bowl (a dollar a ticket). The Rubber Bowl was one of the first stadiums (stadia?) in the country to have astro turf.

The only concert I attended there was a show by the Grateful Dead, Tom Petty, and Bob Dylan.

I also saw my high school, Walsh Jesuit, crush the heavily favored St. Vincent-St. Mary Fighting Irish at the Rubber Bowl with a surprise 3rd down "quick kick" and a breakaway run by Al Bouldin (also in the early eighties).

Good times. But I don't miss the snow!

Kepler said...

Father Hollywood,

You must delete this post immediately! If the doctors or - worse yet - insurance companies figure out that we little members of the hoi polloi have figured out their little scam, they'll figure out ways of making us pay.

I can just imagine a scenario in which I didn't go in for a follow-up, and then the sitation got worse. The insurance company could turn around and say, well, since you didn't go in for a follow-up visit, where the doctor could have caught this, we're not going to pay anything on it.

Nyaah, nyahh, nyahh!

Father Hollywood said...

Dear Thursday:

What? "Not on the global" isn't a straight enough answer for you?

Father Hollywood said...

Dear Anastasia:

There is probably also the fear of lawsuits driving a lot of this as well. I wouldn't mind it so much, but don't tell us the "co-pay" is $30 when it's really $60. The system is in dire need of streamlining. I could barely find a parking spot and the waiting room was nearly standing room only. It's just crazy.

Father Hollywood said...

Dear David:

I'll have to try to work "on the global" into a sermon. Boy, that's going to be tough. Drew Carey might even struggle with that one...

Father Hollywood said...

Dear Anonymous:

I don't entirely disagree with you. Sometimes, the follow-up is needed. But remember the boy who cried wolf? This "one size fits all" approach is just silly - which is why we had a lot less such nonsense in the "good old days."

In my wife's case, she didn't even have a second of "doctor time," the staff seemed confused as to why she was even there, they ran a medical test that was based on a biological impossibility, but then charged us a second co-pay because it was (let's all say it together...) "Not on the global."

don't get me wrong, I think Grace's doc is top-notch - but they aren't driving the system any more. It's a bureaucracy that, if it made use of the Cyrillic alphabet, could have come out of the Soviet Union.

Father Hollywood said...

Dear Kepler:

I can foresee just that kind of thing. Insurance companies are big on collecting premiums, but they sure don't want to pay out anything.

The HMO system has brought us a lot of unintended consequences - as has socialized medicine in Canada.

Scott Diekmann said...

The best way to avoid the co-payment is to avoid joining an HMO in the first place (although you might not have a choice)! Find yourself an ethical physician that is in a solo practice. You'll be more likely to receive the care you need and avoid the care you don't need. I have a bit of experience with such things.

Scott Diekmann D.D.S.