“If you don’t change how things operate around here, you will be out of business in a year”
The district director looked at me. He let out a long breath.
“I understand,” he said.
There comes a time when someone has to address the 800 pound gorilla. Or to be the one that stands on the side of the parade pointing out that the king is naked. When the time is ripe - and I mean really ripe -when the answer is so obvious and so clear, instantaneously, everyone in the room agrees with you. And not only agrees with you, they are eager to implement a strategy to obliterate the problem.
But…is it enough? Is it too late?
Back in the 80s I worked in Greenville, SC for a large engineering company. I was in my late 20s and married. Like most people my age we were in the nascent stages of building a family. We had just confirmed that we were going to have a second child.
Of course, health insurance is important for any family at this stage of their lives. I had signed up for an HMO plan…it was the cheapest plan the company offered, but it paid for practically everything. The HMO was set up sort of oddly. The plan was administered by a local full service clinic that handled everything. We were required to go to the clinic that treated all patients. If a specialist was needed we would be referred to him.
I was on the phone with an administrator at the clinic trying to figure out what I needed to do. Most certainly we would need an obstetrician among many other things.
“Well, before we assign your wife an obstetrician, we need to get your case approved” the lady on the other end of the phone said.
I was just a bit stunned and confused. “I…I’m sorry, what did you say? Did you say you have to get my wife’s case approved?”
"Yes, that’s the procedure. In fact, we have to schedule an appointment with the clinic to officially verify that she is indeed pregnant. Once that is done, her case will be reviewed by the board. We will then schedule her an appointment with a partner obstetrician."
I was still a little flustered. “Ma’m. I don’t understand why you need to do all of this. How long will this take?”
“The entire process takes about 6 weeks” she said very business-like.
I was flummoxed. “Six weeks? Six weeks? Do you understand what you’re saying? Do you understand what you’re doing to us? My wife is already two months pregnant. You’re telling me that we won’t be able to see an OB doctor until her second trimester? Do you see how this doesn't make any sense?
Also, let us make the appointment. I guarantee the appointment you set up will not work and we’ll end up having to reschedule, adding even more delays.
Also, we already did the pregnancy test. Are you guys still killing rabbits? This will be our second child. We know how this works.”
The woman completely understood, but was powerless to help us.
“Ma’m,” I tried to be as calm as I could. I tried focusing on the first order of business: To get a prescription for some supplemental vitamins for my wife. “You’re going to make us wait 6 weeks before we can get them. Could you…could you at least let me know the OB’s name so I can short circuit this process and go ahead and get the vitamins?”
“Sure, I can do that.” So, we at least got the OB doc's name.
Later, on another occasion, I sat in the examining room for 45 minutes waiting for the doctor to waltz in at any moment to get me checked out. I had already sat out in the waiting room for almost an hour. This had happened again and again at this clinic. When he finally showed up, I didn’t even wait for the formal greeting.
“Doc, you guys have got to stop this. I waited and waited and I’m tired of the waiting.” I ranted a little longer as the doctor listened patiently - with an almost perceptible amount of empathy. The more I ranted, the more his initial smile melted into a frown.
“Johnny, I understand. If you don’t like it I recommend you change insurance companies.”
A doctor who was part of the clinic who only saw patients with this certain insurance company was recommending I change plans. And he wasn't the only doctor to say this to me.
I had already complained to the Obstetrician about the red tape the clinic had set up. He absolutely knew what I was talking about. He already had several patients from the clinic and had received the same complaints.
“I know what you’re saying”, the OB doc said. “I think you should change insurance plans.”
That was it. Something had to be done. If I could see the handwriting on the wall, surely the insurance company could see it, too. Right?
But, what if they couldn't? What if they were run by stodgy bureaucrats who didn't care about the fact they were dealing with humans? What if they really didn't care?
Insurance companies are, well, companies. Surely they desire to run at a profit. It was so plain to see this insurance company was going south. I didn't need to see their books. I didn't need a profit-loss statement. I didn't need to talk to the CEO to figure this out.
I walked into the District Director’s office and shook hands with him. He was all smiles and seemed eager to hear what I had to say.
He listened attentively to all my grievances. Long wait times. No pediatricians on staff. Red tape for a baby doctor was intolerable and unacceptable.
“So, what would you like us to do?” He asked. He seemed sincere. He was sort of a laid back person so he was a tough read.
“I want all of these issues taken care of. There’s no reason in the world for a pregnancy to have to be reviewed by a board of doctors, nurses, janitors, whatever.
I want access to pediatricians. If you don’t have them on staff, you need to allow us to go out and get one.
For my wife, I want access to a gynecologist. My wife refuses to use your clinic GPs for this.”
The Director leaned back in his chair, smiled and chuckled and said the most astounding thing. “Yeah…my wife won’t use the doctors here either. We have to pay for an outside gynecologist for her.”
After a few more minutes of discussion we pretty much wrapped it up.
“Listen,” I said, “I don’t want to see this clinic or the insurance company that supports you to fail. I want to see you all succeed. If you don’t change how things operate around here, you will be out of business in a year”
“I understand” he said. “We’ll see what we can do.” We shook hands and I left.
“Hi. This is the Hillendale Clinic."
“Yes?” I asked.
“We just wanted to let you know that the board met to discuss your criticisms and solutions. We’re going to implement all of your suggestions.”
“That’s wonderful!” I said. “So when will the new plan be available?”
“We are near the new re-up period. So you should be able to get a pediatrician then.
“Great! So, what did you do about the red tape for pregnancies?”
“Oh, yes. We took care of that too. Pregnancies will bypass the board for approval. Your wife will immediately be referred to an OB doctor. And you can make your own appointments.”
I thanked the person and hung up the phone. After a few days of cogitating on all of this, I realized I needed to go ahead and start calling some pediatricians. I needed to find out who had open slots.
When I called, this is what I heard from practically all of the pediatricians:
“I’m sorry but we’re booked up. The phone has been crazy with calls. You might want to try Dr. So-and-So. He might have some openings.”
I had no idea how the news had spread so quickly. But, boy did it ever! It was like a flood gate had opened up.
Now, I am sure I wasn't the only one to complain. I’m sure many others called and complained, too. But it wasn't until I sat down and explained things in as plain a language as I could muster did something seem to click with the Establishment.
Unfortunately, the story doesn't have a happy ending. Within a few months of all of this, I left the engineering company and embarked on a new adventure in Houston, TX. Two years after I left, I read in the newspaper that the insurance company filed for bankruptcy and had shut their doors. I guess whatever they did was just too late.
Well, maybe I bought them that extra year.