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Life at the intersection of health and mental health: Today I lost it

February 18, 2014
by Sue Bergeson
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I was driving to an appointment with my Uterine Cancer surgeon and got a call (yes, I pulled over to take the call) from the nurse at my breast cancer oncologist’s office who told me I had to call the people at the lab where they were doing my oncotype so they would do the test and release the findings.

Why?

Six phone calls later after completely losing it over the phone I discovered that somehow someone checked some box somewhere so that I had to verbally confirm the test because of the cost involved – even though they had confirmed that my insurance paid 100% of the cost as a routine part of treatment.  There was no risk to the lab, coverage had been confirmed. There was no cost to me at all. No copay, no additional overage to pay …nothing.

Huh?

Yep, when I finally got to the right department, the lab person explained that they had to have my verbal “OK” that I would pay for the process no matter if the test was completely covered by my insurance and had absolutely no copay. The doctor’s office said this was ridiculous and made no sense and they had not checked any mother loving box. It didn’t matter. The test would not be completed until I agreed that I would pay the nonexistent bill for the test.

This is the test that was supposed to determine whether I was to have chemo or not. Everything was on hold for the results of this test.

There is a lot of stigma out there about living with a mental illness but it seems to me that often our systems are the things that are sick. Having to make six phone calls to confirm that I would pay a nonexistent bill before releasing the results of a test that might make a decision about my future seems, well, crazy.

I think about this issue a lot. I am perhaps more aware of the importance of forms, documentation and process within huge systems than others because of my work within a large managed care company. (Please remember these blogs are just my thoughts and are wholly unconnected with my employer and do not represent them in any way.) Because of my job, I am aware of the many, many conversations that occur as good people are trying to do the right thing by attempting to either streamline forms and processes to make it easier for providers and consumers or – again, out of the same attempt to do the best they can for people – create more forms and more questions and more processes.

Being a part of many of those conversations, I am aware that almost every single time there is a positive intent behind the creation of the systems that the intent is not focused on making things easier for the system but making it easier to make good/fast/thorough decisions for the consumer/provider. And trust me, this is not an easy place for a long time advocate to get to. From my involvement in conversations about processes, my perception is that there is always a tension between good and thorough decisions and processes (longer forms and more intense processes) and fast and streamlined processes (making sure the process is not onerous and a barrier for the consumer/provider.)

As I think about processes like the very strange one I went through around getting my oncotype and those I have input into within my workplace, I always ask myself the following:

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Sue Bergeson

Serves as the Vice President of Consumer and Family Affairs for a large managed care company

@@BergesonSue

Sue Bergeson is a behavioral health consumer and a family member of behavioral health consumers...