Okay, let’s get a couple of things out of the way.
First, I have terminal cancer. This week I learned it’s even more terminal than I had thought. Three forms of malignancy are now competing to kill me—bladder cancer, metastatic transitional cell carcinoma, and colon cancer. I don’t mean to complain, but this seems like overkill to me. I try to keep a good sense of humor about it, but it literally hurts to laugh.
Second, I love my doctors, nurses and clinicians. They are kind, caring, wonderful people, each and every one of them. I do not have enough superlatives to describe them.
But the machinery of the American medical industry? It’s got to go.
Last year the Carr household racked up more than $10,000 in out-of-pocket medical expenses. As a matter of routine, I pay bills practically on receipt, opening up those lovely little window envelopes, of which lately there have been many, and sending out checks every Sunday. I’m really good about it. Honest.
I never had any trouble with the accounting side of medicine until about six months ago. I walked into the lab I use for my blood work, did the usual check-in thing, and then went to sit down. Moments later, the clerk called me back up to the window. “Mr. Carr, you have an outstanding balance. Would you like to pay that today?”
I was confused. “I pay my bills religiously,” I said, “and by that, I don’t mean that I get down on my knees every time I write a check and pray that it doesn’t bounce. I mean that I pay upon receipt.”
The clerk frowns. “Well, I’m showing an outstanding balance.”
“Are you saying it’s past due?”
“It’s from last month,” she says defensively.
I nod politely. “Right, but that doesn’t mean it’s past due. Have you sent me a bill?”
Now she’s getting annoyed. “My system doesn’t have that information,” she said coldly. “But I am supposed to collect any outstanding balances before new services are rendered.”
She motioned to a new sign affixed to the wall behind her. It said, “Any current balances must be paid in full before new services are rendered.”
Now I was getting annoyed. “Look, are you telling me that this lab is no longer going to rely on paper billing? That from now on the policy will be to demand cash on the barrelhead?” She said that wasn’t the case. “Good,” I continued. “Then I’m not going to pay you now for a bill you haven’t yet sent me—because if I do, then when you do send me a bill, then how will I know it wasn’t for the charge I just paid in person? And if I pay in person, I won’t know whether it’s the amount my insurance has authorized. So, to answer your question, no, I would not like to settle my balance. What’s next?”
What was next was that she was displeased with me, to say the least. But she didn’t send me away. I got the blood test, the results of which told me that my surviving kidney was panting but still in the race. One week later, the bill for the previous test showed up, minus what the insurance had disallowed. I paid it.
The following week I went to see my urologist, whom I’d visited before with no trouble. But this time, I was subjected to the same treatment I’d received at the blood lab. I found myself standing there defending myself like I’m some kind of deadbeat for not having paid a bill I had not yet received—in front of other people waiting impatiently in line behind me.
One week later, during a follow-up visit, I had to have the same conversation with the same clerk. I again said “no” to the demand for payment and again got away with it. In due course the bills arrived and I paid them.
Recently I opened up a bill from a different medical provider, and was about to write a check when I noticed a note hand-written in red ink on the bottom of the bill. “Please call immediately so that we can discuss settling your account.” What? I checked my payment records. The bill I was holding was a duplicate of an invoice I had paid in full the previous week, and I had written that check the very week I’d received the bill. Mail from Tucson now has to go to Phoenix for processing, which adds at least two days to the delivery time. Do the math and what you come up with is that when the clinic had not received my payment within about three days of sending out the original bill, it immediately dispatched another one dunning me for payment. And I almost paid that duplicate bill unnecessarily.
Yesterday, the day before I was to see my new oncologist for the first time, I received a call from a nice young man in the cancer institute’s financial department. He was calling to let me know that my co-pay would be $66 and that I should come prepared to pay it at the counter. Now, by this point in my life I have been through dozens and dozens of doctors’ appointments. Every one of them came with a co-payment that was due at the counter. Did the institute really think I didn’t know that I’d have to pay for the treatment? Of course it knew. That wasn’t the point.
The point is that the bean counters running these institutions have made a cathartic strategic breakthrough. Dunning people for payment when payment is past due doesn’t work. That led to this idea: Let’s try dunning them when the bills are currently due. My guess is that not only is the new tactic working, but that it’s inspired the latest innovation, as evidenced by that preemptive strike from the cancer center: Let’s dun people for payment before payment is due! Yeah, that’s the ticket! And so they do.
My affection for the business and bureaucratic side of medicine also was not increased by four other observations and incidents this week.
For one, when you’ve been diagnosed with anything like what I have, you become much more cognizant of each tick of the clock. Time wasters stand out in stark relief. One of the forms I had to fill out at the blood lab was an authorization to send my results to my new oncologist. The form demanded not only his name but his address, phone number, and fax number. Realizing I would need to look this up and that this would take some time, I stepped aside so that the person in line behind me could get served. Upon seeing this, the clerk in front of me gave me a bored glance and said, “I can only serve one customer at a time.” Which was her way of saying, “Fill out the damned form. People are waiting.” So I did. I told her I would have to call for the fax number and she said she didn’t need it.
Ten minutes later I get called back up to the counter. The clerk tells me there is no doctor at the address I have put down. I assure her that the doctor does work at that cancer center, the address of which has not changed in years. She shrugs and assures me there is no such doctor and no such address. I take the form from her, call the number listed on it, verify the address (which was correct) and hand the form back to her. At this point, the clerk holds her hand out like she wants the phone, which I had not yet disconnected. I give it to her. She asks for the fax number. I give the form back to her and she fills in it without a word.
Hey, no big deal. I was happy to assist.
Observation number two: My referring urologist told me my oncologist would need to see my last two CT scans, which had been done at two different locations. Apparently there is no system for accomplishing this task; instead, it falls to the patient to physically go get them. So I did, calling both locations to get the records and then driving there to pick them up. When the oncologist put the most crucial of the two scans that I’d brought him into his computer, the program refused to load. This information absolutely has to be in hand prior to tomorrow’s consult with a surgeon. So, back to the CT lab I schlep to pick up a second disc. Did I mention I have only a short time left to live? I get the disc and take it home. Guess what? It won’t load either. Now at my home computer, and with no time left to go get a third disc, I investigate further and find that the auto-load program is inoperative but the correct viewing program can be loaded from the CD manually. Tomorrow I will demonstrate this procedure to my new surgeon.
Hey, no big deal. I am happy to assist.
Observation number three: When I arrived at the cancer center, there was a big reception desk staffed with about a half dozen workers, each of whom was seated. The patients stood. That’s right. Perfectly healthy desk clerks were seated comfortably, while skeletal, hairless chemotherapy torture victims stood waiting patiently, some of them holding heavy oxygen equipment. I don’t know about them, but for the record, yes, I do experience some pain when I’m standing, and I did.
Observation number four: On the way into the cancer center you pass through a lovely memorial garden, which has numerous plaques on stands scattered through it. Care to guess what is on the plaques? Oh, yeah. The names of dead people.
I’m sure the dedicators meant well. Of course they did. But the experience does set a tone. Hello. Welcome to our cancer center. Please take a moment to stop and read our testimonials.
So let’s break this down, shall we? What lies ahead for me is to fall into the clutches of a medical machine that tends to view me as a financial liability with legs, which will then gobble me up, taking over what little remains of my life, at the end of which the best I can hope for is to be a plaque in that memorial garden. Which won’t happen in my case anyway because my wife and I don’t have a big bank account and I’m not that swell of a guy.
Alternatively, I could tell them to go stuff it.
What would you do?
I’m going to have to give this some serious thought.