Health Insurance Nightmare

As a response to a political appeal from the White House, I described my recent experiences with the health care system. I reproduce my letter here.

I had a terrible heart attack in Jan 2008. Afterward, I fell apart psychologically. I lost my job, my disability income and my health insurance due to my own inaction. By the time I had collected myself enough to try to get these things back, I had a long way to trudge through the system to get access to health care services I desperately needed.

Getting my job back was easy. Merely getting in touch with my company did the trick. Getting health insurance and disability benefits turned out to be a lot more difficult. The medical carrier refused to take me back until open enrollment. This was six months away at the time I got in touch with them. It turns out they reversed themselves later, but as a result of the first decision, I found myself dependent on the County of San Mateo for my medical care.

San Mateo has pretty good coverage for medically indigent people. But lack of funds means that the doctors and staff are faced with huge workloads. For example, there are two cardiologists on staff for the entire county. These two doctors are both excellent physicians. The care I received from them was very good. But getting to it was difficult. The county pays classified staff poorly. As a result, people with a lot on the ball tend to move on to greener pastures. Those left try hard, but the combination of high workload and high turnover means there are many deficiencies in services supporting the medical work.

It took me many weeks to get to the point with the process at the county where I could have an angiogram done. This was performed under contract at a non-county facility, since the county medical center lacked the equipment. In fact, it was at the hospital I had been brought to when I had my heart attack. The result of the angiogram showed signs of ischemia. The examining doctor recommended bypass surgery. Partly due to my own missteps, but also because my insurance company wouldn't take me back, I had been living with a very dangerous heart condition, and with a difficult path to get to needed care.

This was in January of 2009, one year after my heart attack. I had applied to get my health insurance back the month before. Just before I was to have my surgery, the private insurance kicked in. My surgery, scheduled through the county system, was to be at the same hospital I had the angiogram at. The surgery was to take place on a Saturday. That week, I went in for pre-surgical orientation on Wednesday. They were letting me know things such as the fact that my hands would be tied when I woke up from the anesthesia. (This so I wouldn't try to remove the breathing tube.) Half way through this process, one of the nurses who was delivering the orientation got a phone call from the HMO. That hospital wasn't under contract to them. They refused to pay for the surgery if I had it there.

The hospital I was sitting in when I got the news was the one to which I had been taken the year before, when I had my heart attack. I was later told by the doctor that saved my life that I had a 25% chance of survival when I was wheeled into the ER. Watching this guy bounce around like he was on springs, leading a team of people who were all trying hard to keep me breathing was immensely reassuring at the time. I felt huge gratitude to these doctors, nurses and staff who had cared for me so well. What's more, I trusted them and the hospital they worked at implicitly with the surgery I thought I was about to undergo. The change in plans was huge shock.

I turns out I retained the same surgical team at the new hospital. In fact, the new hospital was their home base. This meant the delay was only for a week, the time it took to schedule the operating rooms. Though I kept my doctors, I have a strong impression that the change would have been forced by the HMO whether or not I could have retained the same team. If a new surgical team had had to evaluate my history and condition, the delay could have been much longer. As it was, an extra week's wait did mean an additional risk of something going badly wrong with my heart before I could get the surgery I needed.

That's my story. I'm still on disability recovering from the bypass. I have an ablation surgery coming up. It will be at my preferred hospital, since in the meantime, the HMO has been switched to the one associated with that hospital. This makes me pinch myself a bit to make sure I'm not dreaming. I want to be sure it's not one of those dreams where events seem almost real when you are asleep, but which reveal themselves to be complete nonsense when you open your eyes. I only wish this were nonsense and not the cold reality I actually experienced.