Monday, November 21, 2011

Without Pants, There Should Be Rants

What do health care reform and a recent heart attack have to do with each other? Turns out not much, but I’ll get to that later.

I had a mild heart attack Tuesday, Nov. 8, in St. Louis. I was in the Barnes Jewish Hospital Tuesday through Friday, Nov. 8-11. Medication and diet and more exercise should prevent this from happening again. In addition to coming through this with few consequences so far (a few medications, lots of medical follow-up, some cardiac rehab), here are a few events that stick with me about the last few weeks:

  1. When I was admitted to the hospital, I was provided with a pair of blue elastic paper pants to wear while I was in the hospital. Anyone who has worn a hospital gown that closes in the back will appreciate what a great advance this is. I recommend that all hospitals adopt this procedure immediately. Demand it the next time you or someone you know is admitted.
  2. I had two diagnostic procedures (a cardiac catheterization and a contrast MRI), left after three days, and was told I should expect to lead a normal life with few if any restrictions. I wish I could recommend this type if outcome to anyone who has had a heart attack.
  3. One week after I left the hospital, I received a claim denial for the three days in the hospital.  Here was the reason: “Coverage for the requested services has been denied because we have not been able to obtain any requested clinical information from the provider to determine whether or not the particular services are considered medically necessary under the terms of the plan.” I knew that the claims would be approved but was angry that my insurer would send this out so quickly, and yes, I knew it was for certification and there are various hard deadlines for claims denial and appeal—but come on—what if my heart attack had been worse and someone else had to jump through the hoops necessary, etc. Anyway, by the time I called, certification had been given (at least so I was told by phone—I could not get an e-mail confirmation and am still waiting for a mailed reply (another annoyance—sending out the denial was easy, but sending a confirmation that the stay was certified seemed more difficult. Here I recommend persistence and a good knowledge of all the contacts available to help resolve situations (provider, insurer, administrator, employer, Vinnie who runs protection down the street (no--just kidding about Vinnie)).

And why does this have nothing to do with health reform and the Patient Protection and Affordable Care Act? Well, I have good coverage through my employer (despite the denial hiccup), I am familiar with health care systems and insurance, and as far as I can tell I will continue the coverage into the foreseeable future. In 2014, I might see some effects of health reform, but for this medical encounter health reform was largely irrelevant.

Which is probably why many of those millions and millions of individuals who have health coverage through their employers either are oblivious to health reform or are scared it will screw their good deals. Which is probably why it has been so easy to peck away at health reform’s problems and ignore its advantages, which for most will not kick in until 2014.

So, I am thankful for the insurance I have (and wish more workers could have the same), and I am thankful for my medical outcome, and I sure am thankful for the pants.

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