Carefirst II: Carefirst redeems itself, sort of

Posted on 08/08/2015 in misc

With the blood strip issue taken care of it was time for my wife to make an appointment with a new endocrinologist, as her existing doctor in Richmond is out of territory and thus out-of-network. I'm not sure why having more doctors to choose from should dramatically raises the price of insurance, but apparently it does. The search engine on the doctor search at extends 30 miles. My wife called every single doctor within 30 miles. Not one of them was accepting new patients, or they weren't accepting pump patients. So of course, this meant Michelle had to call Carefirst customer service again. They basically told her tough luck, drive farther for an appointment.

I work in web design, and I found the 30 mile limitation on the search interface curious. It would seem to be in the insurance company's interest that Michelle find a doctor without a lot of hassle. So I suspected that the 30 mile thing was not a random choice by a web developer, but a carefully considered choice by Carefirst. But in the meantime, we were not getting anywhere with Carefirst customer service.

So I resorted to Twitter.

Carefirst tweets

That got me an @reply from Carefirst within 30 minutes that they were going to call me, and a call about 30 minutes after that. The woman that called couldn't be more unlike the front line CSRs if she tried. She was knowledgeable, and it was clear that she wanted to help. She also confirmed my suspicion that the 30 miles search radius meant something. If they can't provide an appointment within 30 miles, they need to let you go out of network at in-network rates. So anyway, she got a nurse caseworker involved, and they decided that that Michelle staying with her current doctor in Richmond made sense from a continuity of care standpoint. After the nurse confirmed that Michelle really couldn't get an appointment within 30 miles (by calling every doctor herself) they put together a case to present to some review board. I imagine this review board being comprised of stuffy 55 year old white men in suits, but I really have no idea. They approved Michelle going to the doctor in Richmond that she had been seeing for years.

Yay, right? Nope. The practice in Richmond refused to bill Michelle as in-network at their normal Blue Cross rates, because it would set a bad precedent they might have to allow for other patients. By the way, that practice is Virginia Diabetes and Endocrinology, so keep that in mind if you are looking for an endocrinologist in Richmond. At this point Michelle was down to about 10 days of insulin, so she asked them to renew her prescription for a month so she had time to get an appointment with another doctor. They refused, although they'd be happy to fit her in as a full retail patient and charge us $600 for an appointment.

America: 3rd world healthcare at first world prices!

Anyway, the nurse caseworker from Carefirst found Michelle an Endocrinologist in Fairfax, 50 very congested miles away, that would fit her in the next day. So Michelle had to leave at 9 AM for an 11 AM appointment, not getting back until 2 PM. So at least she has insulin, and a doctor, even if getting to an appointment will require taking a day off of work. I don't live out in the middle of nowhere. There are 3 full-service hospitals within 15 miles of my house. There are just no endocrinologists.

The endocrinologist shortage in this country is critical. The nurse told Michelle Carefirst figures they only have 25% of the endocrinologists they need. And whose fault is this crisis? Basically, it's the insurance companies. They only allow specialists like an endocrinologist 20 minutes per patient, where as they figure they need an hour to do their job properly. You have to become an internist first, then do two more years to specialize as an endocrinologist. You aren't going to make any more money as an endocrinologist, so there is no financial incentive to take on an extra two years of medical school debt, so doctors simply become internists. It makes perfect sense for the doctors. Unless they have some weird fascination with the pancreas or other glands, why become an endocrinologist when an internist will be just as financially rewarding a career, with two less years of training and two less years of school debt.

So what is the answer? I suspect internists will have to start taking up the slack, hiring diabetes educators, and becoming the first line of care for diabetics. I also suspect they won't want to do that. I suspect healthcare for my family will only be a bigger pain-in-the-ass in the future.

If you are a web design firm in Canada and need a very talented digital strategist / biz dev guy, give me a call. I'll move to Canada.

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