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Meeting America’s Medical System

Don't get sick, dude.


View Work Trips 1997 - 2004 on GregW's travel map.

My cousin David, the pediatric surgeon was recently in Toronto to give a talk on the differences between the American and Canadian Medical Systems. I was unable to attend as I was working in Atlanta, Georgia at the time. However, I was able to get a first hand look at the differences just a few weeks later thanks to a bottle of Diet Coke.

Friday, June 18, 2004

I sat at my desk on a Friday morning trying to figure out how to link two databases that didn’t share a common key. Linking the databases was perplexing me. I looked away from my computer screen and grabbed my bottle of Diet Coke. The bottle was almost empty, so I decided to take a big gulp to finish it off. The Diet Coke, which had been sitting on my desk for about an hour, went down my throat in as a warm flood. Then it hit my esophagus, and suddenly I felt as if someone was trying to pull apart my rib cage. I had a pain in my chest like heartburn, only the worst heartburn I had ever had.

I leaned forward, trying to catch my breath. My chest continued to burn. Suddenly the world started to close in around me, my peripheral vision disappearing into white cloudiness. The tunnel closed

I was sitting at my desk, still working on linking those two databases. The sun was shining. Odd, I thought, because I was in a windowless basement room. No, I wasn’t in my office, I was in bed. I opened my eyes. I wasn’t in bed, I was on the floor, lying in the fetal position.

I stood up, uncertain of what had happened. It took me a minute of pacing to put it back together. I remembered the pain, I remembered feeling faint. I must have fainted, and fallen from my chair to the floor. I was sweating. I walked out of the office and to the bathroom to douse my face with cold water and try and wake up.

I caught a glimpse of myself in the mirror. The right side of my face was covered with red ink. Had I fallen on my red pen? I approached the mirror and realized that it wasn’t ink it was blood. When I fell I obviously hit my head on my desk (causing a growing welt on my temple) and then skidded across the carpet on the floor (causing the run burns running from my forehead to just above my cheek).

FaceFrontView2.JPG

“You need to go to the hospital,” Michael, one of my co-workers told me. I protested that it was nothing, a little scrape on my face. It wasn’t the first time I fainted. I have a low tolerance for pain, whenever I have pain I faint. No big deal.

I was scared though, of having to get in a car and drive an hour to the airport in Southern Atlanta to catch my plane later. Finally I assented; I would go to see a doctor.

I wasn’t sure how I went about this though. In Ontario, Canada (my home), I would just walk into a clinic or hospital and get treatment. At the end I would walk out and it would all be over. I knew that I would need to pay here in the Atlanta. I had insurance to cover it, but I’d never used it before and had no idea how to go about it.

I called the human resources number for my company. They informed me that I should get treatment and submit receipts afterwards.

I decided to try a clinic first as I knew my injuries weren’t that bad. Hitching a ride with Fernando, a co-worker, we went to the clinic around the corner. I walked in and the admitting clerk looked up at me. “Were you injured at work?” she asked.

“Yes,” I replied.

“Where do you work?”

I wasn’t sure what to say, or why she was asking. Should I say Cox, the physical location I was at when I was injured, or BearingPoint, the company which is signing my cheques? I decided on Cox.

The admitting clerk then explained that the clinic needed a workmen’s compensation release form pre-filed by Cox to treat me. She grabbed a binder and started looking through. No form, no treatment. We left the clinic and made our way to the hospital.

We entered an empty emergency room at North Fulton County Hospital. This was something I was unprepared for. One of the reasons I had wanted to go to the clinic was to avoid having to wait for hours to get treatment at the ER. That’s what would have occurred in Canada. Not, apparently, in Alpharetta, Georgia, though. After filling out some forms (which identified myself as a self-pay patient) and providing them with my credit card for the $US 250 deposit required for treatment, I was shown into an examination room.

I was hooked up to a heart monitor and blood pressure machine. A nurse came in and hooked me up to an EKG. “Ever had an EKG before?” she asked. I said I hadn’t. “No, you look pretty young.”

They needed to shave parts of my chest to put on the heart monitor and EKG pads. They dry shaved spots on my chest, leaving enough hairs that the pads hurt when they were being pulled off anyway. So, I get the pain of a dry razor being pulled across my chest AND the pain of someone ripping the hair out by the root. Excellent.

The Physicians Assistant came in to see me. She looked at the EKG while I told her my story. “Has this ever happened before?” she asked.

“I’ve fainted before when I got hurt, but the heartburn was new.”

“The heartburn pain, how was it, on a scale from 1 to 10, with 10 being the worst?”

I’d never had to rate my pain before. I wasn’t sure how to rate it. I figured that if 10 was the worst, that would be like pain that led to death, so it wasn’t that. Was the heartburn more painful than any other pain I had experienced before? I tried to think back to things that had hurt, but was drawing a blank on what the pain felt like. The P.A. was looking at me, and I felt I needed to say something. “Six,” I said, almost as a question. The P.A. nodded, apparently not picking up on the hesitation in my voice, or deciding my lack of pain rating skills weren’t really important in the grand scheme of things.

The P.A. left to confer with the doctor. After 10 minutes of waiting, the doctor came in. He asked the same questions as the nurse and P.A. had asked me about heart disease in my family, previous episodes of fainting and how I was feeling now.

“You had an esophageal contraction. Your esophagus, which is your food pipe, spasmed when you took the gulp of Coke. You have a sensitive Vagus nerve. For people with a sensitive Vagus nerve, when they feel pain, fear or even excitement, it can drop the blood pressure and heart rate, which causes you to faint. You sure you feel fine now?” he asked.

“Well, my face hurts, but other than that.”

“Okay, then, we are going to release you.”

I got a tetanus shot and was sent on my way. On the way out I asked about paying. “Oh, they will send you a bill.”

“Is there anyway you can tell me how much it will be?” I knew that eventually, on submitting the forms, my insurance would pay for it. But in the meantime my Visa card was going to get hit. I wanted to know what the price would be.

They couldn’t tell me, I would have to wait until my receipt got mailed to me.

FaceSideView2.JPG

Monday, June 22, 2004

I called the hospital to see about my bill. I gave the administrator my name. “Yes, a bill has been created,” she said. “You have no insurance?”

“I am a Canadian,” I explained, “I have insurance back in Canada.”

“Your bill is $678,” she said. Before I had a chance to say anything, she continued, “let’s see what kind of discount I can get you.”

“Discount? For what?” I thought. Maybe she felt sorry for me because I didn’t have insurance. Maybe it was policy to give discounts to people who don’t have insurance. Maybe it was because I was paying up-front and prior to 30 days. Maybe they figured I could have just walked out of the hospital and never paid a dime, so they might as well get something out of me. She never said.

“I can give you a 50% discount. That will take your bill to $339.”

9 July 2004

I sent off my files and reciepts to the health insurance company. The replied back with a refusal to pay, apparently because I need to send the information to OHIP first.

I checked the OHIP website. They have a very handy PDF form that you fill out on-line with all your information. Great use of technology. Then you print it off and mail it in. Not so great use of technology. Expect an answer in 6-8 weeks they promise.

Stay tuned for more great medical adventures...

21 December 2004

It is now more than 6 months since I had my fainting incident in Atlanta. The good news is that I have not had any repeats of the chest pain or fainting since that time. My face has mostly healed, however there is still a slight discoloration on the right side of my face beside my eye. I am hoping that it clears up in the winter - all summer I would be outside and the blotch would tan a different colour than the rest of my face. Without the sun, I am hoping that it returns to its normal colour.

It looks, though, in my recently obtained passport photo, as a big black blotch on the side of my face. I suppose that's what I get for getting an "arty" black and white photo instead of a colour photo. It makes my face look, though, like it is the surface of Jupiter with the Great Red Spot on it. Oooh, perhaps people will start creating crack-pot theories on what the blotch is! Alien moonbases and the like!

Unfortunately, the fainting was just the start of my troubles. The real pain has become the attempt to collect the $474.60 that I paid for the treatment in Atlanta.

I sent off my form to OHIP (Ontario Health Insurance Plan, the government insurance in Ontario) on the 24th of July. The form said I should expect payment in 6 to 8 weeks.

On October 12th, I still hadn't recieved any payment, and given that it was 12 weeks from when I had sent in the form, I felt I was justified in calling in. I called OHIP, and they informed me that my claim had been processed on the 8th of October, and I should expect payment in 2 to 3 weeks.

On the 8th of November (4 weeks from my last call), I called OHIP again. "Oh yes, you should definately get something this week," I was told.

2 weeks pass, and so on the 22nd I call OHIP again. "You haven't received anything yet?" the woman asked. I confirmed that I had not. "Oh, you should have gotten something by now. Darlene processed your claim, and you really need to speak with her, though. Unfortunately she is out of the office today. I will leave her a message to call you, though." That was Monday. The week passes without a call, so Friday, I decide to call back. Guess who's not around? Darlene! I leave her another message asking her to call me.

Finally she calls me on Monday. Apparently she had been out of the office for a week and bit because she was sick. Isn't that ironic? The health insurance lady was sick. Anyway, Darlene tells me, "What happened is that they put your apartment number as 160 instead of 1606. I will just have to check with the payment processing people to ensure that they have gotten the old cheque returned, and we'll send out a new cheque." That call was the 1st of December.

On the 17th of December, the cheque arrives from OHIP for $50. That means that I spent just under 6 months and 5 phone calls to get back somewhere around 10% of my original payout. At least I am ready to submit the remaining claim to my insurance company, right?

Wrong! Problem was that the cheque I got had no detail with it. All it said was "Replacement Cheque," which of course is not enough detail for Martime Life to pay the other $424.60 of the claim. So I have to call OHIP and ask for them to fax me more detail. Finally on the 20th of December, 6 months and 2 days after the original injury, I have the detail I need to claim to my insurance company.

So, 6 months into this process, and I am about to start the "big" claim, trying to get back the remaining $424.60 of my outstanding payment. On the 21st of December (fitting the darkest day of the year), I mail off the claim.

More to come...

18 January 2005

got the cheque from my insurance company yesterday (January 17th). The interesting thing was when I opened the cheque it was for $474.60. Which, if you read back a few entries, was the total amount that I paid for the treatment in Atlanta. However, the insurance company was only supposed to pay me for the amount that OHIP didn't pay. Which means, between OHIP and the insurance company, I have gotten $50 more than I paid for the thing.

I was confused. Johnny, my roommate, was home, so I told him I got my cheque, but they had overpaid me by $50.

"Maybe they wanted to pay you some interest because it took so long," he suggested.

Perhaps.

So now I have an ethical dilemma. Should I take the extra $50?

Out there, I suppose there are two schools of thought. One says, "Greg, that's insurance fraud. Don't take the money. Stealing is WRONG!"

The other school of thought is thinking, "what, are you kidding? Take the $50 and run. It's just a big, heartless insurance company."

I'm going to split the difference between the two schools of thought. Seeing as I leave for Africa in 3 days, my plan is this. I am going to deposit the cheque into my account, and worry about the ethics when I get back. In the event that this entry gets subpoenaed in some sort of future court hearing, let me state, for the record, that I am willing to pay the $50 back to the insurance company.

What I am not prepared to do, however, is call up the insurance company and void the current cheque and wait for them to issue a new one. I'd rather have the ball in my court than waiting another 7 months for movement by the insurance company.

So, today I cash the cheque.

And this may be the end of the saga. But, it may not.

Ahhh, the fun of insurance companies, eh?

Posted by GregW 18:21 Archived in USA

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