When the Health Care System Lets Us Down

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This story is about a young man I know who began working in the IT department of a local hospital. His mother also worked in the same hospital. He was skilled, excited, and committed.

Eventually he was promoted and saw other opportunities. He wound up in the billing department. Then, this is what he found.

His job was basically to tell patients that their insurance company has denied insurance coverage. For things like colonoscopies, biopsies, radiation therapy, and many other treatments.

He also had to tell them that they would have to pay for a CT scan at their hospital or clinic, knowing that at other clinics the same test was hundreds of dollars cheaper.

This young man did this day after day, speaking to patients who lived in his own community. He had to listen to their frustrations, their helplessness, and he had to be the single voice of rejection when he had no power to change or alter the outcome.

He also had to lie, withholding information that would have helped, and did so as part of his job.

It wore on him. It saddened him and infuriated him. After a time, he left the job and the hospital.

Nurses Face Similar Challenges

On a day-to-day basis, nurses work within a health care system that controls everything from medication, length of stay, to how many patients they care for on a shift. And each day, choices are made, choices that are narrowed by the "rules" of the system and the insurance of the particular patient.

While changing the health care system may be daunting and mired in political posturing, on a one-to-one basis it is possible to extend compassion and caring in every interaction with patients, family members, and co-workers.

There is nothing generous about saying no. However, there are opportunities to reach out and find a work-around. The frustration that nurses feel is also experienced by teachers who want to help students when the educational system ignores what they need.

The more personal nurses can reach into the dilemma of their patients, the greater chance they will find some way to help.

Be Your Own Advocate & Rely on Others to Help

From my own experiences and that of others, I believe that most people know little about how the U.S. health care system and insurance works. There are few absolutes in insurance; in fact, every decision can be appealed and many are eventually served without financial risk.

This document from the Patient Advocate Foundation provides some guidance for appeals, but seriously, when confronted with an urgent diagnosis, it is difficult to think straight.

In reality, the best insurance is a social network of people who love you, care about you, and can get information for you when you need it. Believe me when I say that you, too, have lots of resources you can bring to the table in an emergency.

Without question, relationships that are close, trusted, and reliable are each a kind of health insurance. Our friends and family members don't have access to MRI machines or laboratories. But, they can help us get there, help us fill out forms, and find others to help us understand what we cannot understand.

The Johns Hopkins Center to Eliminate Cardiovascular Health Disparities has studied the many factors that contribute to people not receiving the care they need. These include everything from geographic location to not having the right insurance, not having transportation, and not having the time off from work to see a doctor. Social isolation carries with it the highest risk.

For now, as the whole health care system struggles to meet the needs and demands of our communities, we each must support each other, reaching out to our neighbors and friends to be an ongoing extension of care.