Wednesday, February 24, 2016

It Shouldn't Require a 500-lb Gorilla to Get Good Care

Those of you who follow me on Facebook already know my wife was thrown from her horse on Monday.  The short of it is that other than a cracked rib and a possible crack in her sacroiliac, and some serious muscle edema and soft tissue damage, she is otherwise OK, but will need some rehabilitative therapy before she can come home.  Mostly, you'd describe it as a level 10 pain in the ass, literally (reduced to level 5/6 today).

In talking to her case working regarding transfer to Rehab, she said she was waiting on the insurance company to respond (Aetna).  Figuring I could at least rattle a cage, I called the customer service number on the card.  I asked when Aetna might be able to complete the prior authorization for her transfer.  He looked it up and told me "we just got that in today at 12:05", and later told me "since it is not marked urgent it could take 7-10 days to process" (these are quotes as best as I recall them). And I also learned that if it was marked urgent it could take 48-72 hours.

So I called my employer's benefits center, and with their help, was able to get someone else on the line who gave me better, but still not awesome information.  "It normally takes a few hours, at most two days" she said.  Based on this situation, she and I determined that it was a) unlikely that she would be transferred today, but likely that it would happen tomorrow. I had our representative, a virtual 500-lb gorilla with a great British accent stay on the line with us while we had this conversation, just so she would know that she was being monitored by someone other than just the patient or their representative.

It shouldn't take this kind of effort to get an answer to the simple question: When will this get done.  I don't care about service level guarantees that are so long as to be completely f*****g useless. There's a 24-hour delay in this service that is completely unnecessary. That's a hospital bed being used wastefully, a patient not being cared for at the best level of service, a bed gone waiting somewhere else where she could have care, and all because why?

I don't care really.  I can put a number on the increased costs of care in this kind of situation that is directly addressable within the payer's nearly complete control, and as it so happens, there's something I personally can do about this as well.  It shouldn't require a 500-lb gorilla to get good answers, and it shouldn't require a day and a half to approve good care.

I went into this situation with low expectations on the administrative side, and unfortunately, they were pretty much met as expected.  Look out folks, I may be setting my sights on a new target.

Target 223 Savage 10FP 5 shot closeup

-- Keith

P.S. In further news, I must have rattled the right cage.  She was transferred today.

1 comment:

  1. It would be interesting to determine the cost to the insurance company of one day, two days, 7-10 days in the hospital--presumably she wouldn't be discharged home!--and compare that to the cost of those same days in rehab. Still might be able to determine the value in getting into rehab immediately in the number of days that might follow, perhaps a faster recovery when it is not delayed, etc.

    Keep up the good work on all that you discuss in your columns. We appreciate it very much!