The Best Outcome

6

[At this point in the story, I return to the medical system after having been kept from it since the age of thirteen at my mother's behest. So before I talk about those experiences, I think I should first bring you up to speed with the then American Medical System as it was before the Twenty-First century...]

Freedom!

Freedom from having assigned doctors (by the government), freedom from making payments (defined by the government), freedom from any significant oversight by the government. The American Medical System of the Twentieth Century was all about freedom from the bonds of government in return so one could be 'helped' by private institutions with the best outcome their only goal. Not by penny pinching dictated by the government!

Ultimately, though, the nose of government still poked in under the tent in local ways. Such as requiring all children receive an education and requiring a minimum number of vaccinations for those children before they enter the school system. Such vaccinations would, then, require the child visiting a doctor and thus the parent would have to pick one. How the parent picked one was based on chance, such as browsing the phone book/directory under the category of 'doctor'. After wading through the listings for the 'Drain Doctor', the 'Lawn Doctor', and 'Car Doctor' the parent may give up hope until directed by a friend or other source to look under the category of 'physician'. Under 'physician' the parent would then choose a name at random and call the doctor's office to find out: If they were a doctor that treated children, If they were accepting new patients, and How much a visit would cost (which would be a secret based on what type of insurance coverage you'd have).

American Health Insurance companies are there to help you through such times. With luck, you have been assigned an insurance company by your or your spouse's job. If not by that, then perhaps your father's or mother's insurance company will cover you and your children, at least for a little while. But if you should find you don't have insurance coverage, you can always buy a private policy off the market, if you think to and can afford to. If for some reason you still don't have any insurance coverage, fear not, medical professionals will always take cash (cost to be determined after the fact on a per patient basis). If for some reason you can't afford the cash option, or the medical professionals in question won't accept you as a patient no matter how much cash you have, then you can go to the government for help and best of luck to you.

But let's say you have insurance. This can be a great help as they can save you from looking into the phone directory for a 'physician', leaving you with a list and no clue as how to pick, instead they'll give you a list of 'their preferred doctors' from which you can cluelessly pick. As you comb through the names you can then call each doctor's office to find: If they were a doctor that treated children, If they were accepting new patients, and If they still accepted the insurance coverage you are lucky enough to have. Many times they won't as they've gotten sick of dealing with one private insurance company or another.

Once you've selected a doctor and that doctor has agreed to see you, you can then make an appointment that suits the doctor's schedule. If you don't have a job which allows you to leave in the middle of the business day to suit the doctor's schedule, then you can go back to doctor hunting. But if you have an understanding job, then you can use the given time & date to arrive at the doctor's office. Should you be late or not show up, the doctor's office will charge you for their time as their time is precious. Should you arrive at the doctor's office and the doctor themselves be late or not show up, you can reschedule free of charge, as your time isn't worth anything.

But now you've finally synced-up your schedules and you and your new doctor meet. Upon meeting you, the doctor can: a) decide they don't want you as a patient and welcome you to leave, b) decide they don't want you as a patient but continue seeing you in a half-hearted way to keep getting the money from your insurance company, or c) decide they don't mind having you as a patient and will accept the money from your insurance company in return for not addressing your health issues in a half-hearted way... when they are in the mood.

From this point forward, you have been embraced by the American Medical System and will have consistent medical care as long as nothing changes, such as your health or the doctor's address. Should your doctor leave, then you have the option of returning to the phone book or insurance listings and pick another name at random, or the doctor's office refers you to a new doctor who keeps losing patients and needs some more. To formalize this transfer, your old doctor will send a copy of his anecdotal office notes of you to your new doctor for his or her entertainment. If you are luck, these notes will contain copies of one or more objective test result.

But let's say your doctor stays in business and you see him for a new health issue than the ones he's been treating you for all along. Then he needs to gain a significant understanding of your new health problem to determine: If your insurance will cover it*, If your insurance will cover him or her treating it themselves*, Or does your insurance company have a list of acceptable doctors who can treat that condition*, If so does the doctor chosen from that list still accept your insurance coverage*, and if 'Yes' is that doctor accepting new patients*. If he is accepting new patients, then he has probably lost some and needs some more.

When seeing this new doctor, whom we'll call 'A Specialist', when you arrive at his office he or she can: a) decide they don't want you as a patient and welcome you to leave, b) decide they don't want you as a patient but continue seeing you in a half-hearted way to keep getting the money from your insurance company, or c) decide they don't mind having you as a patient and will accept the money from your insurance company in return for not addressing your health issues in a half-hearted way... when they are in the mood.

Now that seeing a doctor is clearly defined for you, let's talk about diagnostic tests. Should your condition need to be explored through diagnostic testing, then the doctor can first see if the insurance allows diagnostic testing for the condition he or she believes you might have. If the insurance company doesn't allow such testing, then the doctor can try to argue your cause at their own expense, or agree with the insurance company that your condition shouldn't be addressed... by them.

But let's say you actually have a condition that the insurance company will cover and the doctor orders tests for. Now the doctor will give you an 'order slip' to request a test that you need. You then either have to pick a testing facility from the phone directory, from your heath insurance list, or conveniently it's a test your doctor's office can do themselves. Insurance companies rarely cover the latter as they've found those doctors tend to order the tests they can do in their office rather than the tests you, yourself, need. To assure a problem like this doesn't occur, the doctor's office will often bill performing the test in their office under a different company name so the insurance company won't know.

Once you've had the test done (assuming that the testing facility agreed to perform the test on you*) you then either return to the doctor's office at a predetermined time to discover what the test results were (if the doctor wants to share them with you) or the doctor's office will phone you and tell you the results (if the doctor doesn't want to watch you breakdown when it's bad news). Many times the test results will be lost by the testing facility or not provided to the doctor's office. On these occasions you may be lucky enough to arrive at the doctor's office, pay for the appointment, and then be told that the test will have to be redone...

With luck, the test results come back and reveal that you don't have the condition the doctor suspected you might, thus you get a firm pat on the back and sent home despite the fact that you are still having the same symptoms. Rarely will a doctor test for something else to explain your symptoms as doing so would be admitting that their first guess was wrong. But let's say that the test results have come back and show the problem the doctor suspected was, in fact, there. If this occurs, then the doctor checks with the insurance company to see if it is a condition that your insurance will cover*, and if so decides (based on what the insurance company will allow) what course of treatment you shall have for it. If the course of treatment the insurance company covers isn't one that's known to be effective then you may be lucky enough to have a doctor who will tell you that; though this would often mean they will soon no longer be accepted by the insurance company and you'll have to see someone else instead, likely someone accepting new patients because they've recently lost some.

Finally, if for some reason you have an urgent issue that can't wait until the next free spot in the doctor's appointment book, we do have urgent care facilities and emergency rooms. Urgent care facilities are places, often privately owned, that you can go to without an appointment and wait until you can be seen by a doctor who either can't have a private practice, or has chosen not to have a private practice as he or she doesn't want to see patients on a recurring basis. At these urgent care facilities they can address and handle any condition that really isn't urgent, but that you simply couldn't have made a doctor's appointment for in a timely fashion. For truly urgent conditions you would go to the emergency room, which is typically part of a hospital, so they can quickly review your condition and address it promptly... Once you're done waiting in the waiting room and one of the emergency room doctors is eventually free and doesn't have a more exciting case to distract his or her attention. Once the emergency room doctor has addressed your condition enough that you will survive until you can make it to a regular doctor's appointment opening, they will then give you a list of doctors affiliated with the hospital from which you can pick at random to seek follow-up care.

After visiting the emergency room or urgent care facility, your insurance company will review the resulting records and decided for themselves if you really couldn't have waited until the next available doctor's appointment. Realizing that they'll have to pay if they conclude it was a valid visit, they will often conclude it wasn't and the hospital will send you a bill that you'll have to pay along with your monthly insurance coverage premium, and the portion of regular doctor's bills also not covered by your insurance.

In this way, the system assures the best outcome... for themselves.

(* If not, best of luck to you...)