About Us
Mission Statement
Rules of Conduct
Remember Me

Healthcare Odyssey
Author: TriSec    Date: 03/10/2018 12:42:38

Good Morning.

Some months ago now, my aunt sold our ancestral home in Saugus and decamped for "God's Waiting Room" in Southern Florida. I have not set foot in my hometown since the day we left the house for good.

But nevertheless - we pocketed a tidy sum from the transaction (to the tune that a significant portion of Javi's college will be paid for, cash on the barrelhead) and we were able to instantly erase the mountain of debt we had been pecking away at since the Great Recession.

With a little disposable income now, I had decided going into the winter season that I'd at least check out ye olde Lasik surgery and see if they couldn't fix the ol' peepers. Our story begins in January of this year.

I attempted to secure a screening appointment with TLC Laser Eye Centers, right here in Waltham. Except their website sucks. On two ocassions, I was able to go online, request an appointment, and even get a confirmation email on return. Both times, on the day before my appointment, they called me to cancel due to a "conflict". After the second failure, I sent them a strongly-worded email deriding their online system, and never heard from them again. Due to my limited daytime availability, this process took 3 weeks, with no result.

Starting over, I moved on to The Lasik Vision Institute in Burlington, MA. After getting burned in Waltham, this time I picked up the phone. Couldn't have been easier - I got an appointment within 5 business days and I trekked up to the mall to see what they could do for me.

Alas - nothing. Due to my condition (Kerataconus) and my propensity for Keloid Scarring after chemotherapy, the risk was too great and they thanked me for my time. No knock on this provider, as I had no way of knowing that would be a contra-indication.

Now deep into February, I moved on to plan B. Two decades ago, I briefly tried hard contact lenses. I couldn't stand them, and wore them for only a couple of months before giving up. I literally had one good day with them - May 9, 1996. And the only reason I remember is because that was Maria's bridal shower. We have pictures to prove it. It actually still annoys me to this day, since I could see better with the contacts.

Reaching out to the Ophthalmic Consultants of Boston, again here in Waltham, I got an appointment and had a lengthy exam. The young doctor felt she could help me easily.

Then we talked insurance. Days before my visit, I called my PCP to secure a referral. It took them several hours to figure out that I didn't actually need one. But then the provider is actually out-of-network, and it would be covered by my secondary Eye Med insurance.

But then the doctor tells me that only the initial exam is covered. Due to the way OCB does business, the fitting and lenses are not covered through Eye Med. This is due to a questionable practice called "unbundling". The physician bills her services under one provider number, and the Optical Shop bills their services under another. Because of the complex coverage rules, these are considered two separate services and each is deniable because of the way Eye Med's benefits are set up. However---if the fitting and lenses were billed together, "bundled", insurance would pay, no questions asked.

So again - the doctor wouldn't touch me, and gave me yet another provider in Boston that would bill the way the insurance wants it.

At this point, I had had enough. I let it sit for 48 hours, but because I have the resources and had actually planned that my initial Lasik idea wouldn't be covered anyway, I decided to stick with OCB and pay for my fitting and lenses out-of-pocket. Now that appointment will take place in another month, the first week of April.

So - I've spent four months here trying to get my eyes fixed. All this because I need to pass an annual physical in order to drive a bus, one of the requirements is a vision test. At 20/45 in my left eye, that's not enough to pass. (And it wasn't enough to pass last year. I failed the first time, but then spent several days studying the standard eye chart so I could "pass" when I tried again.)

I spent 30 years in the healthcare business before I started driving. I know this stuff. Hell, I helped write some of it back in the '90s when a significant merger happened here in this city.

I can only imagine what John Q. Public thinks when they have to leap through the Five Fire Rings of Fornax just to get an office visit covered. I'd wager the propensity to just give up and deal with the condition must be strong, no matter what the long-term health effects might be.

Many have derided "socialized medicine" as the wrong way to go. They cite the lack of availability of certain kinds of care, and the lengthy waiting periods that are often associated with it that run counter to our style of "on-demand" healthcare.

But overlooked is who is paying for it. Thus far, I've waited three months for an appointment for a minor, yet vexing condition. At the end of the day, I'm going to pay for it myself.

I think I'd be happy to head north of the border, wait those same four months, but then get my services PAID IN FULL.


   Perma Link

Share This!

Furl it!