Friday, April 20, 2007

Crappy In-Network Insurance Schemes

We have Aetna insurance. They will cover 90% of my surgery if I see an in-network surgeon or 70% if I go to an out-of-network doctor.

I got a recommendation from my primary care physician for an in-network doctor. Then I got a recommendation from a friend who knows a doctor that's performed surgery on a friend of my friends' and my friend's neighbor. (The doctor also saw my friend but did not prescribe surgery.) This doctor is not in my network. Let's call in-network doctor "Doctor A" and out-of-network doctor "Doctor B."

I made appointments to see each doctor, A and B. I saw B first. I felt like Dr. B. was very pragmatic, obviously knew what he was doing, and probably extremely competent based on reputation (both first-hand and from the cover of a magazine he has framed with this headline "Best Doctors in NY").

Dr. A. was 45 minutes late to see me. That put me off. And his exam room was cluttered -- furniture from the 1920s was sloppily filled with supplies from the 80s. This also put me off. It's all I have to go on at this point.

But Dr. A turns up eventually and is very kind and I liked the way he manipulated my lower leg and knee. He has a very reassuring touch. He asked me if I was in pain (N.B. Dr. B did not). And he took my complaint about calf pain so seriously that he arranged for me to see a surgeon right away to get an ultrasound. He wanted to rule out a possible blood clot. This all made me really like Dr. A.

Then I had to decide between the two. Dr. A with his crappy office but gentle bedside manner and Dr. B with his nice office and arms-length patient-doctor relationship.

Cut to the next week when I will be having a follow up with each doctor. I needed to get in touch with Dr. A's office to find out when my appointment was. For some reason, when I was there the first time they hadn't written it down on an appointment card. I actually realized that then and should have spoke up.

Here's what happened when I tried to get in touch with Dr. A's office (and for context, Dr A has an office in Manhattan and an office in New Jersey. 212 is the area code for Manhattan.).

Thursday 3/29/07

I called Dr A's 212 number in Manhattan. NJ picks up. But it takes us both a minute to realize I'm calling from NY and they are in NJ. I explain why I'm calling and this woman tells me that she cannot see the NY appointments. She told me to call the NY office back on Monday.

Monday 4/2/07

Monday morning. I called the 212 number. NJ office picks up. Woman tells me (again) that they can't see the appts for NY. I said I knew that, and reminded her that they told me to call back on Monday. She said they don't know Olivia's schedule and to try after 1:00.

3:00 pm 4/2/07

Called 212 number again. NJ picks up. I state why I'm calling. She says she remembers talking to me in the morning. I said, "So you remember telling me to call back after 1:00." Receptionist says, "Well OBVIOUSLY she's not IN, MA'AM."

Tuesday 2:15 pm 4/3/07

Answering service picks up and says they cannot take non-emergency calls. Said to call back after 2:30.

Tuesday 2:55 pm

Answering service picked up again. Said Olivia should be there from 1:00 to 5:00 but is not picking up.

Questions for Dr A:

How much money is one surgery worth to your practice?

Why do you have an answering service that doesn't take messages?

Why won't the NJ office take a message for Olivia?

Does the your staff realize that patients are customers? That as customers they have a choice in providers? The staff must feel pretty comfortable if they can just out of hand cause you to lose out on the revenue of this surgery and the potential revenue from recommendations.

Luckily, we can afford to pay the 29% premium so I never have to deal with the people at Dr A's office!

1 comment:

Uta said...

Good for people to know.