*Calling System Health* Command: Override.
Navigating a health system nightmare in a country fighting for its democracy.
The systematic undoing of critical U.S. agencies like USAID—which puts food on American farmers’ tables, employs a domestic workforce of thousands, and provides basic food, water, and sanitation for the world’s poorest people—flies in the face of another American idiosyncrasy: the routinized machinations which suffocate people in the pits of Big Health hell.
Today, I spoke with 8 individuals working within U.S. healthcare—3 nurses, 1 insurance agent, and 4 reps of a multinational pharmaceutical company—all to support fulfillment of a pre-authorized prescription necessary to manage substantial neurological interference affecting one (1) senior citizen patient.
Without their support, the bill for this month’s supply of medication would have been roughly $2,000.
The process I went through today required locating and compiling several items:
the patient’s insurance details;
multiple prior authorization letters;
prescription key codes;
providers’ contact information;
patient portal log-in information; and
a whole lot of moxy.
I coordinated conference calls to connect providers in an effort to clarify confusing, if not downright conflicting, information that I had received.
The process necessitated voluminous duplicative efforts, including:
obtaining multiple prior authorization letters, from the same provider, for a prescription medication the patient had previously received without issue;
repeated verification of personal information, internal determination protocols, and next steps; and
requesting written confirmation of reported activity.
This exhaustive work is done every day by health care professionals, social workers, and others managing huge case loads and just wanting to do a little good in the world.
The absence of records on patients’ portals containing useful information is surprising. But it is also consistent with the fact that correspondence methods in Big Health rely on antiquated fax and postal delivery mechanisms—methods of service known to have holes inherent in their underlying system’s architecture, for example letters getting lost or delayed in transit making it an impossibility for the intended recipient to have documents deemed necessary by the sender of that very letter.
The esoteric intricacies of this vast and convoluted web—which today connected me with the likes of Sarah and Alice and Jannel, and Rebecca and May and Sonya and Ashley and Grace—left me wondering: does it really need to be this way? Is this really the best way to heal the sick? Is there any wonder regarding the rage animating recent violent upheaval?
Health care is a human right—that mean’s it’s something everyone should enjoy, regardless of their ability to pay or traverse fraught customer service protocols. That system is possible, but it requires fighting for that better system. Fighting for Medicare-for-all, fighting to lower the price of prescription drugs through negotiation, international trade, and regulation, and most importantly, right now, joining the fight to protect a democratic system of governance that makes it possible to debate a better path forward.
Here are a couple organizations fighting that battle right now and who need your support are:
As a referral center, it is WILD how hard it is to track down information. We have teams that solely process faxes of healthcare records. Not to mention the fact that all EMRs are not the same, and rarely talk to each other. Each organization has countless systems that exist in a vacuum. Every single physician I know and work with is overwhelmed and exhausted at the prior auth/peer review process. Add in the fact that often these peer reviewers are not experts in the specialty and you add another layer. Thank you for sharing your experience!
So true. I know people in medicine who are leaving the field because they can no longer provide the care, they need to provide largely because of the insurance processes or lack thereof.