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This Is Healthcare

  posted on:  August 24, 2017

A True Story

Imagine a patient, we’ll call her Sam. Sam recently spent seven weeks in the hospital. About five weeks into her stay, it was finally starting to look like Sam would be able to go home soon. The only thing in her way was the need to obtain the necessary home care equipment—a biPAP and home oxygen—and training on how to use said equipment. “This is the easy part,” said the case manager in charge of these tasks. He promised Sam that he would have a medical equipment supplier and a plan for her within a few days

Five days later, the sales rep from the medical supply company selected by the case manager came to the patient’s hospital room to introduce himself. The sales rep told Sam that he will be bringing the equipment to her room the next day to show her how to use it. If things went well, Sam could go could be home in two days.

The following day came and went, the sales rep never showed. “I”ll be in touch tomorrow,” he says when called by the case manager.

The next day, another no show. This time, Sam’s spouse called the sales guy and learned that, suddenly, the supply company decided that it could not supply the equipment because, “the patient still has a trach.” A capped trach that has not been removed so that it can be used for an upcoming surgery, but I digress…the really question was, did anyone have any intention of informing Sam or the case manager of this change?

After a few phone calls and some other scrambling, Sam’s case manager was able to procure a medical supply company willing to deliver the necessary equipment the very next day. Two days later, Sam was home!

Why does this story matter?

No harm was done to Sam, so what’s the big deal? Actually, there was harm done to Sam. Financial harm, that is. The careless medical supply company not only cost Sam’s insurance company two additional night stays, two very expensive nights, but it also increased Sam’s out-of-pocket expense as Sam’s insurance plan has coinsurance. Insult to injury, Sam’s insurance plan also has a limit on the number of days the plan will cover for LTAC stays per plan or calendar year. This mistake will prove really costly in the future if Sam requires LTAC care again.

 

Why should Sam or her insurance company have to pay for the mistake of the medical supply company?

 

Here is another thing to think about, something that impacts all of us: this is one reason (of many) why our healthcare costs, the money actually coming out of our pockets, continues to rise. This kind of mistake—which, let’s be honest, happens a lot—costs money and when added to the cost of the other wasteful medical spending that is happening all over the country, it becomes money that someone needs to pay for. As we all know, that someone eventually becomes us, the consumers.

This is (my) healthcare. This is our healthcare.

 

I am not a healthcare professional. I am not a doctor. I am not a nurse. I am not a social worker. I am simply sharing the information learned from my own experience. Your experience is going to be different. 

By reading, and if you chose, utilizing any information, tips, etc. found on On Caring and Grief you are doing so at your own risk.

Opinions expressed here on On Caring and Grief are mine and mine alone.