Note: I’m dedicating this blog post to my
Canadian sister-in-law who thinks the
U.S. system is far better than Canadian.

Is it only the very sick who suffer in our US Health Care system? I had been wanting to explore this for some time, and it is still on my list since it’s not my theme today either.

I’ve also wanted to address the issue of Pharmacy Benefit Managers (or PBMs), which I imagine you have all heard about. Because I’m involved with following state bills in my legislature this issue crops up a lot. I recently saw an article whose title said it all: “Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies.” Policy wise that is a bigger issue than it would first seem. But that’s not my tale here either.

I just want to tell you my own tiny story, not dramatic in terms of sickness or denial of medical treatment but still something at which you can shake your head and think “that’s ridiculous.” Further it’s ridiculous since my story is one of a (presumed) healthy person.

I belong to one of the numerous “Health Networks” around the country. Like many it uses the “MyChart” online patient portal, allowing patients to access their health information or test results, as well as being a communications hub with providers and appointment setting tool. These types of networks often have a few hospitals and medical centers across their served region offering various locations and providers. [Mine boasts over 750 providers – a factoid to remember as I continue my petite saga.]

Being in Southern Oregon, mine is not situated in a large metro area, but neither is it rural. Among the many towns and hamlets that it serves, it also includes a couple sizable cities and several smaller ones. Thus, in collective vernacular the location is “not in the sticks” (meaning nothing derogatory about the ‘sticks,’ since that describes areas from which many of my own relatives hailed).

Pushing Prevention

No surprise from someone who writes a blog called “Aging with Pizzazz,” preventative health is important to me. Regular readers know I believe in good movement and exercise, eating well, looking after mental health, boosting physical well-being with supplements and getting plenty (maybe more than my fair share?) of sleep. Aside from that my luck has been holding regarding any diseases.

Long story short here, as my long-winded mother used to say, I tend to be pretty healthy. I currently have no complaints and no known problems. On the other hand, I like to stay on top of things.

Granted, good health can’t last forever, unfortunately, and it’s a juggling act between timing of prevention and medical intervention. That’s why (some) testing can be helpful and of predictive importance. Thus, I recently responded quickly to this un-named health network when they reminded me it was time for my two-year mammogram. I appreciate the newer 3D equipment that doesn’t produce so many false-positive results as in the past, and as such less stress. So, I immediately attended to their directed chore.

Focusing on that screening, it made me realize that I wanted to pursue a couple other tests and scripts. At first, I had a list of 5 items but removed the prescription for a scopolamine patch which I had tried for motion sickness long ago with not much success; yet thought I’d try again. With a trip on the horizon, I was considering giving this a retry until further reading about serious side-effects (especially for those as they age) convinced me to try a newer natural alternative. [The subject of motion sickness and remedies is for another blog post.] That brought my list of requests down to four.

I didn’t really care if I had an in-person appointment, telemedicine or even just a script response via MyChart. Nothing at all fancy or sophisticated, my list consisted of:

1. Lab test (blood panel, including A1c)
2. Refill prescription for a new autoinjector – such as Epipen or generic Adrenaclick
3. Prescription for Cologuard (used before, and written about here)
4. Referral to a network provider or elsewhere for dermatology scan

Simple enough, right? Not quite right.

Finding Service

Both on MyChart and at the partners office website, it said that I could set up an appointment online. That’s fine, I do a lot online. But the choices were confusing.

It asked, “why are you coming in,” but allowed me to choose only from these options:

1. Screening Mammogram (which I had just done)
2. Immunization
3. Sports Medicine
4. Lab Appointment (but “only with an order from a provider”)
5. Southern Oregon Pediatrics
6. Joint Replacement Education
7. Find Care Now (which was basically for emergencies)

No option was provided to make a simple appointment. In no way did this resemble the waiting rooms I used to sit in as a kid until the GP could see me for my latest sore throat (and send me packing with advice and a nice home remedy). Aside from the obvious wrong selections of pediatrics and joint replacement, I hit the others trying to see if I could somehow schedule a date. No luck.

I finally went to the local partner’s office website where several of the network providers practice. Under their names it said, “Schedule Now.” If you guessed that I could not ‘schedule now’ you would be correct. Instead, after repeated tries, it said I must call a different number for new patients. [BTW, I’ve been with the network for 10 years and used their providers on multiple occasions, including in-person and by telemedicine.]

That phone number brought me to someone who politely assured me that this was “the place I was meant to be,” and my only way to make contact. Who knew? I didn’t mention that I tried (and failed) to leave a message for my listed provider on the area of MyChart claiming to be just for that. Anyway, good deal. Right place.  Finally some results.

Finally the Right Place?

My health care network has a great deal of turnover. I had never actually used one of the MDs there, and instead only visited the FNPs (Family Nurse Practitioner) who generally had more open calendars for appointments and tended to take more time with patients. MyChart had my account listed with a physician. However, I found out that was not quite the case.

Turns out all the FNPs with the network were no longer in my area – none. And I was told I had never ‘established a relationship’ with one of the doctors, so I would have no one to attend to these simple needs.

The physician listed on my account at MyChart (and who had been receiving my mammogram results) was still there, but no longer taking a ‘new’ patient. Remember I’ve been with the network for over 10 years. The only way I could get even a simple prescription filled (one of which was just a refill and two just preventative measures) was to make an appoint with one of the other docs. OK. I give.

I had one choice in my area. Well, at least there WAS someone in my area, as opposed to the many health deserts around the nation with no hospitals and very few providers of any kind. As this was early September, I hoped I might be able to get in before the end of the year.

Next open appointment? July. I’m not sure the person on the other end of the line could translate my response through my guffaws.

But not to worry. If I had the appointment on the books and then called the office with an ‘emergency’ I could request a “same day appointment” and (maybe) get some help, like with the EpiPen refill. OR if I said I had blood in my stool, perhaps I could get a referral for Cologuard. I cut her off when she started to explain I might consider a colonoscopy instead. (Check out my resources below as to why – at this point – I did not favor a colonoscopy.)

The problem is, as I told her, I HAD NO EMERGENCIES. I was taking preventative steps. Nor did I want to pretend I had such an emergency. I did not even have any signs or symptoms of problems. Ah, well good for me, but basically out of luck.

The best she could do was put me on a cancellation list so that if something came up sooner than the almost 10 months away, we could see if I was blessed (my word, not hers) with an appointment. Happy and grateful to currently be healthy no doubt, but I’m not impressed with how the health care system is handled.

Second Part of the Story

Soon after my experience noted here, my husband received an UNSOLICITED letter from Cologuard and Aetna (our Advantage program, separate from the health care network above). It said they had ordered him a test kit that he would receive in the next day or two.

Now we are similar in age and on the same plan. Neither with pre-existing conditions or complications. We had both used Cologuard a couple years back also around the same time as each other. Both with good results. Thus, I figured, “oh, my letter will come soon and then I won’t need to worry about my network.” So, I waited.

No letter. Finally, I phoned Aetna, laid out the question and asked about the discrepancy. After going to talk to a supervisor a couple times, the phone rep basically concluded ‘well each case is different.’ I wish I had asked if they were giving a preference to male clients or discriminating against females. There was obviously no real explanation. Was it strictly randomness? Is that a good approach when trying to deter disease or promote health? I made my opinion known on their survey.

Aetna phoned back several days later about my survey and complaint. Well, good for them. Did they have a reason to share? No. Were they ready to remedy my concern by sending me a kit too? No.

Instead, the rep said they could file my complaint and then informed me that I could get a kit by making an appointment with my doctor. (Ha.) Therefore, in regard to the latter, I could spend time and money on an office visit that my husband didn’t need to pursue, and further I could wait 10 months to do it. Did they believe that wasting my time with a phone call possibly improved my opinion? Think again.

Final Thought

It appears that if you aren’t totally hooked into the medical industrial complex in the U.S., your care is like a sweepstake where you may win or lose if you are trying to find occasional care for prevention. That is unless you pay out of pocket for concierge or private providers.

All I know is that my minor story is truly insignificant in terms of health and disease or outrageously poor care. Yet, I realize that if this is what I have faced, I worry about those who are very ill, in health-deserts of rural or inner-city areas, less educated, and with fewer resources. It’s something to consider as Medicaid (and Medicare) have become such political issues.

—

Picture credits: Wheel of fortune Image by Starline on Freepik
Doc with open arms showing confusion Image by Benzoix on Freepik

—

Resource:

How Mammograms Look at the Older Breast… and New 3D Options | Sixty and Me

Considering A1c. Normal Lab Test – NOT – Aging with Pizzazz

Considering Colonoscopy: Colonoscopy at 50. At 65. But what about 75?

Considering Cologuard: Lions & Tigers & Colon Screening —— Oh My [Options & Alternatives]

Share This: