Healthcare Rant: When Quality Care Goes Wrong

As I've been dealing with many difficult health issues this past year, the U.S. healthcare reform debate has fallen below the Nicole radar. It surprises me that I've avoided it, as my career is in healthcare administration. I know it's an important time in my field, but seven months of unemployment have kept me out of the trenches. Despite a very concerted effort, I have not been able to find work in my field. Although I have skills that would be portable to many other fields, I don't want to give up what I love. I believe that quality care should be available to all people, regardless of their ability to pay. While it's true that many healthcare organizations offer charitable care to the needy, it seems like many people in need fall through the cracks.

I am currently insured through my husband's employer on a plan with Cigna. The plan provides excellent benefits at a low cost for in-network providers. I am extremely lucky to have $5-10 copays, and very reasonable coinsurance. Unfortunately, the Cigna network has been fairly limited in both the Atlanta and Wasatch Front areas. In Atlanta, I couldn't use Emory facilities in network (while working for Emory, and promoting their Campaign Emory fundraising). In Utah, 90% of Intermountain Healthcare facilities are out-of-network for Cigna. This is frustrating to me, as I'm a previous 4.5-year employee of Intermountain. I believe in their Mission, Vision, and Values, and want to support them with my healthcare dollar.

My previous positions with Intermountain were as an assistant to a medical director at LDS Hospital, and as a Patient Service Rep in Accounts Receivable Management. I have also worked for City of Hope Cancer Center, Prime Healthcare Services, and University of Michigan Medical Center. I have experience in customer service, billing, coding, transcription, Joint Commission an AOA accreditation, physician credentialing, training, research, and have processed countless financial assistance applications. I have participated in executive-level hospital management meetings. Although I am not an expert by any means, I can confidently say that I am qualified to have an educated opinion on what works in healthcare, and when healthcare goes wrong.

Case in point: My daughter Rosie has been sick for a few weeks with kidney problems. My otherwise lively child has been mopey and lethargic, and complains of pain daily. On Christmas night, Rosie was very sick and begged me to take her to the hospital. We left our family holiday party an drove to the IHC Provo Instacare (which is in-network with Cigna). I advised the Instacare registrar that I had submitted a financial assistance application to the Lake Park and Creek Plaza billing offices a few weeks prior, and was unable to pay a copay. The Instacare flat out refused to see her without a copay...so I ran out to the car, grabbed a Christmas card, and paid her copay with the Christmas cash I got from my grandma. And what happened then? They took her blood, scanned over the results, and told us to go across the parking lot to the Utah Valley Regional Center Emergency Room immediately (which we later found out was out-of-network).

The ER registrar was a little nicer, especially when I brought along the copy of my recently-completed financial assistance application. We sat in the ER waiting room for over an hour, and spent a few more hours in the ER room 9 (which had a broken recliner, and no other chair available). After 4 hours, they said her urinalysis showed that she had inflammatory cystitis. If the Instacare would have taken 5 extra minutes to take her urine, she could have gotten on antibiotics and saved us a 4-hour ER visit and copay.

When we arrived at Instacare, it was a few minutes before they were closing at 9 pm. They happily took us back to the room, but pushed us back out the door in 5 minutes.My question is: "If they were going to send her to the ER, why did they take my gift money to pay a copay for a "visit" that didn't really end up being a VISIT?" Luckily these visits happened before the end of the year, because we'd already met our deductible. Had this happened a week later, we would have been slammed with deductible fees.

A few days later, Rosie had another ER visit. Her symptoms had worsened, she had a high fever, and I drove her back to the UVRMC ER (still not knowing it was out-of-network). The doctor wasn't sure why she was in so much pain and guessed that she had kidney stones or appendicitis. He ordered an abdominal CT scan to see if the problem was GI or urinary. After 3 more hours of sitting on room 9's broken recliner, we found out that her scan was fine. Rosie got a pain pill, some "orange pee" pills, and a stronger antibiotic. Since then, we've been following up with a non-IHC pediatric urologist and she's doing much better.

I was going to just sweep this experience under the carpet, but then earlier this week I received several IHC financial assistance rejection letters. Besides the recent hospital visits, I had some outstanding bills from all of my sleep apnea visits. Apparently we are slightly over the National Income Poverty Guidelines (remember my husband is a struggling regional airline pilot?) Despite our unmanageable debt from student loans and my 7 months of unemployment, we do not qualify. When I called the billing offices to get more information, I was told that our income was slightly too high, and our balances were not high enough for them to make an exception. Gee thanks.

I know I'm not the only person to have an experience like this. After going through it personally, it has really lit my fire to get back into a position where I can help avoid situations like this. I'm going to keep working on my medical coding certification, which I've been working on from home to keep myself busy while looking for work. It's time to make my voice heard. I've been in both hospital management, and also at the receiving end of a "charity" denial. I hereby recommit my effort to apply for all the positions I am qualified for. I need to be a part of my field again.