Friday, May 1, 2009

Anatomy of a broken healthcare system

A chronic leg injury flared up for me during an attempt two weeks ago to run the first 10k of this young running season and, after not being able to walk all weekend and getting gentle pressure from my wife, I decided to make an appointment to have it looked at. Called monday morning, and got an appointment within the hour...which is were the efficiency ended.

The Dr. sent me to a Radiologist down the street to have x-rays (which would be the third time i've had x-rays done of my legs in the last 3 years) and said he'd refer me to an orthopedic specialist. That was all Monday.

Five days later, the referral came IN THE MAIL, while I spent the week limping and wincing. But when I called that doctor to make an appointment, I was told that they don't take my insurance (Cigna).

So Monday (9 days after the injury) I found a doctor that did, and called my PCP back to make a referral to THAT doctor. And scheduled the next available appointment, which was today (13 days after the injury).

Went to the doctor today, and they couldn't find my xrays on the website that the radiology office uses, so we did that again (4th time). This doctor wanted me to go have an MRI.

Called my insurance company, and asked them if I needed a referral for that (I do). They advised that referrals for MRIs go through a company called MedSolutions, and that the doctor who ordered the test had to call for the referral.

Called the Ortho office back, and they said they couldn't ask for pre-authorization from Cigna until I made the appointment, and that it requires 5 business days for that process to happen.

Called MedSolutions to see which of the list of facilities would be in-network for my plan and got a fax machine.

Called Cigna back to get the actual phone number (after looking, and not finding it on their website).

Called MedSolutions and was told that they can only look up facilities by tax ID#, and that the doctors office should call with that info.

Called the Ortho office back and they said that they still needed me to call first, but happened to know that one of the local facilites honored my insurance.

Called the MRI facility and made an appointment for next Wed (18 days from the date of my injury)

Called the Ortho office back and told them when my appointment was. They advised that they needed five BUSINESS days, and that they couldn't promise me that the authorization would get done in time.

In the end, I'll be lucky if I have a diagnosis 3 full weeks after I injured myself, all the while i've been limping and in pain. And the lesson I learned is that next time, I'll just go to the emergency room.

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