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Sunday, October 25, 2015

Shards of health care, continued

I began recounting my own misadventures as a patient on June 19th here: 'The U.S. healthcare "system" in one word: "shards." The story continued on July 28th in "Healthcare shards update. More sand in the gears," followed by "Shards of health care update" on August 21st.

Since then, I've just been rocking along with my radiation oncology treatment in Pleasant Hill. I'm now 3/4ths done, scheduled to complete my Calypso IMRT tx on November 10th. Not much to report on the administrative/EoB/(non) coordination-of-care front of late.

Until late this week. Relatively minor things, but frustratingly head-scratching nonetheless.
But, first, backing up from that a few days. I went to Walgreens earlier in the week to pick up my two long-time maintenance meds refills. My co-pay came to "$0.00." I can only surmise that I've hit my BCBS/RI $4,600 max OOP for the year. I joked that "I'm going to go see every doctor in Contra Costa County between now and December 31st." Seriously, though, I've now found a new PCP, and will see him on November 19th, at which time I will see about getting full-panel bloodwork and UA done straight away (I will not be using Theranos).
Thursday a bill arrived from "John Muir Medical Imaging" (a 3rd party imaging vendor independent from Muir) from whom I'd not heard since they screwed up the billing on my July endo-rectal coil MRI, regarding which they'd sent me a bill for $2,925, asserting that my insurance claim had been denied. Turns out they'd used wrong physician order number to submit the initial claim. They then informed me they'd re-submit, and not to worry about it. "Just ignore the bill."

Fine. I never gave it another thought. Hadn't heard from them again until this week.

The new bill said "Past due amount, $9.60. Final notice. Failure to remit immediately will result in this being sent to a Collection Agency."


I went to their online payment site, entered my HSA account number, and immediately paid it. There was no "comment" field via which I could let them know what I thought of this.

I waited a while, then cycled back around to the login. "Amount due: $9.60."

I called their customer service number to inquire. "Yes, we see it in the system. It's showing as 'pending'."

Just to be sure, I explained that I'd had payment problems before using our HSA account because because [1] it's in my wife's name (different last name, and through her employer) and [2] the billing address is a P.O. box in Walnut Creek, not our Antioch street address. I also noted that "you people are now threatening me with Collections over $9.60. My wife and I have never had a Derog, our Bureaus are completely clean."

She assured me that they would not send me to Collections over $9.60.


I'll have to log in yet again to see that the payment cleared. I've recently remitted nearly a thousand dollars in OOP to my RadOnco facility. I'm not about to blow off $9.60 chump change. I have been fastidious in remitting my legit balances.

That was Friday morning. After my Calypso tx, I had my weekly meeting with my oncologist. We discussed the FloMax thing, and decided it was time to try it, to try and mitigate the up-every-two-hours-all-night urinary hassle resulting from being so baked by the tx.

He wrote me a scrip. I recall thinking "OK, uh, no e-Rx here, 'eh? Whatever."

They use MOSAIQ, an Oncology EHR system.  Interfaced to their Elekta RadOnco equipment. Below, my Elekta Calypso x-ray bug zapper.

The MOSAIQ EHR is ONC Certified, but, still, I got a paper scrip.

Which would shortly come back to bite me in the butt.

I showed up at Walgreens in Antioch at 12:45 pm and handed in the Rx. The clerk looked at it, entered it, and said "it will be ready at 2:15."

I showed up again at 3:05, just to make sure I'd given them enough time.

"I show that this prescription could not be processed. It was not dated." They indifferently refused my request that they call the doctor and resolve the situation right then. His number was right there on the scrip. They would "have to fax them for a response."

I posted my reaction a bit later on the Walgreens Facebook page (I've found that publicly rubbing vendors' noses in their BS on social media typically works better than going through their "customer service" web and phone channels).
I just got jerked around at your store in Antioch California (Hillcrest location). I'm going to take my Rx business henceforth to one of your competitors. I am under treatment for prostate cancer. Today my radiation oncologist wrote me a prescription for FloMax. I took it to the pharmacy, the clerk took it and told me it would be ready about 2:15 PM. I came back a little after 3 PM, and was told that the physician had not dated the prescription, so I could not pick it up. Ok, stuff happens. I replied "fine, his phone number is right on the prescription. Call him." I was told that they would have to fax a request over to the physician's office and wait to hear back. The last time I checked, this was the 21st-century, not the 20th. This is not acceptable customer service. They told me they "could not call him." That's crap. Make that "would not call him." I am in my seventh week of radiation treatment, and I don't feel like running around back-and-forth all day trying to get a simple prescription filled.

This little episode will also go on my blog, at, where I chronicle my misadventures in the healthcare system from time to time ("Healthcare Shards") during the course of my writing about health information technology issues.
In less than an hour, there was a response.
Hello Bobby, I am very sorry to hear of the trouble that you've experienced. I've documented your concerns and forwarded this information to management for review. If you'd like to receive a response, please Private Message your contact information. Thanks -Monica
To which I replied.
My contact information is quite public. My principal email is My home phone hard line is already in your system. My cell phone number is [xxx–xxx–xxxx]. It is now nearly 6 PM on Friday evening, I guess I will not be hearing from Walgreens in time to pick up this prescription tonight. I am not happy about this. I held off going with this prescription as long as I could, but now I feel like I need it. But, owing to the indifference of one of your employees, I will have to do without it for yet sometime to come. This issue could have been proactively resolved by a simple phone call when it became noted that the date was missing. A phone call would have taken less time than putting together and sending a fax and then waiting for and processing a reply.
To which they responded, also on Facebook:
Thanks for the information @ Bobby Gladd. I've updated your case with; your contact information and your feedback and asked for a response as soon as possible. - Belinda
Since then, crickets. No phone calls, nothing in my Walgreens portal in-box.

I suppose now I will be apprising my RadOnco people of this when I arrive at daily tx tomorrow, and will be asking for a new, properly dated scrip.

I will not be taking it to Walgreens. Moreover, after my initial visit with my new PCP next month, I'm gonna ask that my routine meds orders be re-written and routed elsewhere. There are both a Rite-Aid and CVS closer to the house anyway. This doc is on Epic, so I know he can do e-Rx.

But, wait! There's more!

Frustrated, I left Walgreens (where they were not offering flu shots) and headed over to CVS on Lone Tree Way, where I'd gotten a flu shot last year. Handed the pharmacy clerk my insurance cards.

"Well, Mr. Gladd, it seems that BCBS will pay for the vaccine, but not for the injection. So, effectively, it's not covered."

I'm not making that up.

"Can I just drink it?" I joked.

I paid the $54.99 retail. Had to have it. I'd wasted enough of my Friday chasing my tail, and was feeling very tired by that point. For one thing, I'm going to  Minnesota next weekend for my grandson's "Senior Day" final home football game at St. Olaf. Feeling pretty zapped these days from all the radiation. Whatever protection a flu shot might provide while sealed in a plane with a bunch of coughing and sneezing kids, I need it.

"Won't pay for the injection."


They were out of the flu nasal spray alternative (which would have been covered), so it was a shot or nothing.



Jus' for grins, I logged into my account on the Walgreens portal.

Okeee-dokeee... No phone call, to either my cell number or hard line. No email notification. Probably a weekend shift hand-off disconnect. I suppose if there's still time to get the Rx tonight, I will first need to call them to verify so I don't waste yet another 45 minutes or so and a couple bucks worth of gas.

Nope. "The pharmacy is now closed."

My wife's advice?


Everyone who has to engage the health care non-system as a patient has his/her tales of frustration (recall my citing of Steve Brill?), even a prominent physician like The Incidental Economist's Aaron Carroll, MD.
Trapped in the System: A Sick Doctor’s Story
September 23, 2015 at 8:00 am, Aaron Carroll

We spend a lot of time talking about various metrics of quality or access in the American health care system. The problem with many of them is that they rarely seem to capture the issues that people face in dealing with care. Although many metrics are improving, problems remain that still seem insurmountable...

lived in constant fear of not being near a bathroom. The half-hour commute to my job often necessitated a stop on the way to work because I feared I would lose control of my bowels. My wife could tell you many stories about how I made innovative use of my babies’ diapers in cases of emergencies.

But a number of years ago, after I found that drug after drug didn’t work, my gastroenterologist suggested an older immunosuppressant. I’m a doctor, and I recognized it as a drug often used to treat cancer. It carried with it some significant side effects, most notably a small chance of myelosuppression, in which your bone marrow shuts down and produces too few blood cells.

That horrified my wife. But she didn’t appreciate that this was, to me, a small price to pay for the opportunity not to be constantly worried about my proximity to a toilet. I weighed the benefits versus the harms. I decided to give it a go...

The medicine is old and it’s generic. It costs about $80 for three months even though I haven’t met my deductible. But this story isn’t about money. This is about the nightmare of how hard it is for me to get the drug.

Every three months, I run out of my medication. In order to get more, I need a new prescription. In order to get the prescription, I need to have lab testing to prove to my doctor that I don’t have anemia. This all sounds simple, and it’s the same process every three months. But it’s never the same, and it’s never easy.

Let’s start with the lab testing. At various times, my insurance plan (which is excellent, by the way) changes which laboratory facilities it will cover fully. Often, these are not labs that are housed in the huge health care system for which I work. I often have to go elsewhere to have my blood drawn. If I change facilities, I have to get a new prescription for the labs, since they can’t share with one another.

Further, even though my lab orders are good for a year — and I need to have them drawn basically forever — the labs recognize them for only six months. So sometimes I have to get in touch with my doctor and get a new lab order. Often, they send over the old order, because they think it’s good for a year, in which case I have to go back to them and ask for a newly written one, because the lab won’t recognize the really-still-valid old one. Worse, they often just fax the order to the lab itself, thinking they’re helping me, so that I don’t realize they sent over an old one until I’m already there, and it’s too late.

After I get that sorted out, I have my blood drawn and analyzed. But because the laboratory and my doctor are in completely different health care systems, the lab results won’t show up in my doctor’s electronic database. I have to beg the lab to remember to fax over the results — using paper — which it often fails to do.

My next step is to check if the pharmacy I use is still under contract with my insurance plan. The medication I use needs to be ordered at a mail-order pharmacy, because my insurance won’t cover it at a local facility. My insurance plan has changed its mail-order pharmacy of choice more than once in the last few years, which necessitates that I inform my physician about the change.

I also have to open a new account with the new pharmacy and give it my payment information so that it can process everything once it has the order from the doctor. I do this before getting the prescription called in because I don’t want anything to get slowed down. This is a good time to explain that I can’t do much else ahead of time because the pharmacy and the insurance plan both know I have a three-month supply of the drug and won’t authorize me to get more too much in advance.

It’s at this point that I try to get in touch with my doctor, previously through a phone message, and more recently through an online site. If I’m lucky, which usually isn’t the case, the doctor will already have the lab results. If not, I have to go back to the lab and beg it again to fax over the results...
Read the entire article. See also his follow-on post "Answers to your questions about “Trapped in the System: A Sick Doctor’s Story”."

Dr. Carroll seems to be a good guy. I follow The Incidental Economist daily, and I really like his "Healthcare Triage" YouTube series.



Well, finally got my scrip. There's a prominent sign on the pharmacy wall adjacent the check-out area advising patients that all who get new prescriptions are now required by state law to engage in a "consult" with the pharmacist prior to leaving.

The cashier rang me up. $0.00 balance due. She handed me the Rx.

"Bye. Have a nice day."

Whatever. Not that I needed or wanted a "consult."

More to come...

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