SOL Tuesday: In a medical quagmire

            In mid-January, I took a Cologuard test. That’s the at-home screening test for the eminently treatable colon cancer that you can take if previous colonoscopies have been uneventful and you have no risk factors.

            I did not expect the e-mail that I received a week ago that reported the test was positive. Helpfully, the e-mail shows my test result (Positive) and the normal test result (Negative). That was a shock. I immediately e-mailed my doctor, let’s call her Dr. J., who replied that I should see a gastroenterologist and asked if I had one. No, I did not. So she responded, not with the name of anyone, but with a phone number, and the note that she didn’t know who was available.

            Without having the name of a doctor, I decided to resort to my friends, first e-mailing a friend who I knew had a GI doctor she liked. When I called his office the next day, one of the first questions I was asked was about insurance. When I said Medicare and a supplemental, I was told this doctor did not take new patients on Medicare. (This is a recurrent problem. When my longtime doctor retired six years ago, the doctor she recommended also did not take new patients on Medicare. Many doctors will grandfather in their current patients once they go onto Medicare, but won’t take new patients. Why? They don’t get reimbursed enough?)

            Daunted by the thought of calling the four or five other doctors recommended by friends and being told they didn’t want new patients on Medicare, two days later I called the number Dr. J. had given me. After I explained my situation — I’d gotten a positive result on a Cologuard test and Dr. J. had recommended I see a gastroenterologist — the person I was speaking to said the earliest appointment they could give me was: mid-July.

            I was aghast. “This isn’t a routine situation,” I said. “That’s six months from now.” The person was apologetic, but firm. There was nothing earlier. After I ranted a little bit, she asked if I was willing to go to another location. That’s when I learned I was speaking to the GI division at the Mt. Sinai location where Dr. J.’s office is; she’s in the geriatric practice at Union Square. Of course, I could go to another location; in fact, if she could find someone at Mt. Sinai Morningside, that would be even better, as it’s only a few blocks from my home.

            I was transferred to Mt. Sinai Morningside, and eventually to the office of Dr. M., where I was told I could have an appointment at the end of April. Well, three months is better than six months, but it still felt like a long time for me to wonder whether I had colon cancer (a 4% chance) or only precancerous polyps (51% chance) that might turn into cancer in the next three months. I ranted a little bit here as well, and the scheduler suggested that I could see whether my doctor could speak to Dr. M about seeing me sooner.

            So I e-mailed my doctor the same day to report the situation. She said she would reach out to a colleague for suggestions.

            There was no news on the weekend, of course, only increasing anxiety over now thinking I knew the name of my death and wondering whether I’d have enough time to finish all the writing I want to get done.

            Monday I received notice of a new message on my Mt. Sinai MyChart page, a badly designed website. It read: “Earlier appointment offers are no longer available for NEW PATIENT on Thursday April 27, 2023 at 10:00 AM EDT.” Who sent this to me? What did it mean? Was there some time recently when I might have gotten an earlier appointment, but that time had passed? Maybe this was only a form letter, but couldn’t they have at least inserted my actual name instead of the bland “NEW PATIENT”? It felt so disrespectful.

            In addition to fear of what further tests might reveal, I was now beginning to feel helpless, as well as angry. I called Dr. J.’s office and spoke with one of her staff. What is going on, I wanted to know. My message would be passed on to the doctor, I was told. Half an hour later I got a call from the office manager. She was very apologetic, said she was doing everything she could to see about getting an earlier appointment. She was in touch with the office manager for the GI division. Again I ranted about how outrageous this felt, how helpless I felt — surely this wasn’t standard operating procedure for someone who’s gotten a positive Cologuard test.

            The office manager then gave me the phone number for something called “physician access,” schedulers who could make appointments for any doctor in the Mt. Sinai system. Was I willing to go anywhere in Manhattan? Of course, I practically shouted. She also gave me the number for “patient relations” should I want to make a complaint.

            I immediately called physician access and got an appointment in three days(!) at an easy to reach location. There was a brief glitch when I googled the doctor’s name and did not find him listed at the Mt. Sinai location where I’d been told his office was. I quickly called back physician access and was assured that he did indeed exist, and at the location; he was new, so no doubt the website had not been updated.

            I called  the office manager back to thank her for her help. But I also wondered, why couldn’t I have been given this number to begin with? How exactly did the bureaucracy of this immense hospital system operate? Surely the stress and anxiety of the past week could not be good for my health — don’t all the wellness articles say “AVOID STRESS”?

            What could Mt. Sinai do better? I think it’s far too easy for people who work in an institution to forget that others, patients in this case, do not know how the institution works or, when it’s as big as a large urban hospital system, how all of its parts fit together. Perhaps a little booklet that explains clearly, even with graphics, where your doctor works, how that center or division or clinic fits into the overall system. And especially, where and to whom to go for help for the variety of issues patients might have. 

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It’s Slice of Life Tuesday over at Two Writing Teachers. Check out this encouraging and enthusiastic writing community and their slices of life every Tuesday. And add one of your own.

SOLTuesday: Bureaucracy

I should have all my dealings with bureaucracy on Tuesdays. It will always give me a Slice of Life story to tell.

            One of my husband’s retirement benefits was a flexible spending account that reimbursed him for his Medicare Part D premium. He had never made a claim because he hated filling out forms, but in 2015, he decided, with my help, to find out the procedure. Then he went into the hospital. Then he died. A couple of months after that, he got a letter reminding him that he had until the end of May to make a claim for 2015. Okay, I thought, I’ll do it.

            I called the phone number on the letter, got sent a claim form, called to make sure I was filling it out correctly and also to make clear to the woman I was speaking to that this claim was for my dead husband, so please don’t make out the check to him.

            Of course, a few weeks later comes a check made out to Jack Robbins.

            Again, I called, and at this point I learned that Jack’s flexible spending account was administered by “a third party,” not the benefits office of the company where he had actually worked. And while I had notified that company (let’s call it Company A) that he had died, that information had never been sent on to the “third party” (let’s call it Company B). I was then put on hold while a benefits person at Company A got in touch with a benefits person at Company B, and, I thought, conveyed the proper  information to Company B.

            I then went back to Company B, where I was told that not only would they send me a check for that premium reimbursement as soon as the computers had all the right information, but that I was also entitled to that same survivor’s benefit. How would I get that, I asked? We’ll send you the information to set that up, I was told.

            This was all six months ago. I waited for the information to come; it never did. Life intervened, and this all went to the back of my mind. But the new year reminded me that this was a very loose string. So I called Company B today.

            The woman I spoke with was very helpful, and even offered to direct deposit the reimbursement so I wouldn’t have to wait for a check. But in looking up how to set up an account for me, she saw that the computer still showed an active account for Jack. Could it be that Company A’s computer had never properly sent the information that Jack is dead to Company B’s computer? Jenna, Company B’s representative, said she would look into it and call me back within two days. Maybe I will have a Slice of Life Thursday. 

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It’s Slice of Life Tuesday over at Two Writing Teachers. Check out this encouraging and enthusiastic writing community and their slices of life every Tuesday. And add one of your own. 

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Yet another writing challenge. There are no rules for this one about what constitutes an essay, so in case I don't get another more traditional-looking essay written this week, this will do.

Slice of Life Tuesday: One More Successful Call to Bureaucracy

As a retiree, my husband set up a Flexible Spending Account a few years ago, but never got it together to use it — and it's one of those accounts that if you don't use the money each year, you lose it. Last fall, when he got a reminder letter that he had until May of this year to use it or forfeit it, he said we should look into this and how to get the money. Well, of course, we never got around to it, and the reminder has been in my pile of to-dos for months.

            Today I finally called the benefits office to find out what exactly I need to do. After 25 minutes on the phone talking to two people, I learned that the FSA only covers premiums for Medicare Part D, and that amount is on Jack's Social Security 1099. (If I'd read the reminder more closely, I'd have known that, but who reads every word on a form letter.) Filing a claim is easy.

            I'm rather glad Jack isn't here because it would have been really hard not to say "see how easy this was? how much money did you give back to McGraw-Hill because you are so bureaucracy-resistant?" At least it's one more thing I can cross off my to-do list and remove from my mind.