Let’s begin proactively — I don’t actually go looking for this kind of trouble. Okay? It finds me. I admit that with my attitude I make myself an easy target, and I also admit that if I altered my attitude the world wouldn’t change discernibly. But that’s not the point, innit?
Setting: out of the blue my physician decides I should have a chest X-Ray. Possibly my first one ever, although I have a vague recollection of having one of these in junior high school. Is that possible? I mean the X-Ray, not my recollection.
He gives me the name and contact data for a clinic that performs these things, which naturally I ignore, but then the clinic calls me and we make an appointment.
I arrive early and the nice receptionist hands me a packet of paperwork, of course, which I dutifully complete although if they want accurate information, they should send me this set of interrogatories shit before I arrive. How the fuck do I remember every surgery and the year and what it’s for? Since the turn of the century I know of 5 procedures on my eyes, and do we count the wisdom teeth (where while under total sedation I attacked the surgeon) and last year’s brutal extraction? Fine. I add question marks after the years. They can’t read my handwriting anyway, because I sure can’t.
Then we get to what is called The Stark Form, which references the Stark Law:
The Stark law is a limitation on certain physician referrals. It prohibits physician referrals of designated health services (“DHS”) for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity. 42 U.S.C. 1395nn. A financial relationship includes ownership, investment interest, and compensation arrangements. 42 U.S.C. 1395nn(h)(5). —Wikipedia
The form asks me to confirm that Dr. Globulous, who owns this X-Ray operation, has no financial relationship with Dr. Prahdem, my primary. I don’t sign it. How the hell do I know what kind of arrangement, if any, exists between these two? Maybe for every patient Prahdem sends over to Globulous he gets $100 or a lap dance or a big bag of sample meds. Maybe they have some weird reciprocal deal at their golf club, and the one who comes out ahead each month gets to start at the ladies’ tees next time, or buys the beer and fruity little drinks at the 19th Hole. Who am I to verify that there’s no relationship – I don’t even know Dr. Globulous.
The nice receptionist isn’t happy when I tell her this, and proceeds to mansplain the meaning and purpose of the form. I patiently (pun) reply that I understand perfectly the meaning and purpose of the form which is why I can’t sign it – it’s asking me to confirm knowledge of an alleged fact I don’t know.
“Look,” says Nice Receptionist. “Didn’t Dr. Prahdem make this referral?”
“Well, that’s all this form is asking you to confirm – that it wasn’t Dr. Globulous.”
But how do I know that there’s no arrangement between those two doctors? Maybe that’s why Dr. Prahdem sends me here. I’m not saying that is or isn’t the case — I simply don’t know, and this form asks me to take a position that I do know.
At which point a somewhat older woman appears behind the counter and says, “Look, I’m Dr. Globulous’s wife, and I manage his practice, and I’m telling you for certain that he and Dr. Prahdem don’t have any kind of partnership or arrangement whatsoever.”
Great! Then YOU sign the form.
“I can’t sign the form — I’m not having the procedure!”
Well, I can’t sign the form either– I’m not privy to the parties’ business. You’re in a better position than I am. I may be the patient, but I’m a stranger here, myself.
This goes on for a while. Mrs. Dr. Globulous (who manages his practice), obviously accustomed to having things her way, is all for sending me out to the street, but Nice Receptionist says she’ll just write “patient refuses to sign” and that will suffice. Which brings up a question – if that’s an option, what’s the point of the goddam form to begin with?
In fact, what possible value does this form have if I DO sign it? The issue isn’t what the patient actually knows or doesn’t know about a possible inappropriate relationship, it’s whether or not in reality such an arrangement between referral and referred exists. The only valuable testimony would be from parties with genuine information. I mean, there’s water at the bottom of the ocean whether I know it or not, right? So don’t ask me to confirm, ask David Byrne. He knows.
What kills me is the way over and over they repeat the same explanation, totally incapable of responding to my specific argument. E.g., at one point Mrs. Dr. Globulous (who manages his practice) asks, “Do you know Dr. Globulous?” Not that I’m aware, I tell her. “There! So how could he have referred you?” she asks triumphantly.
So again I wearily reiterate: I’m not saying he has or hasn’t any financial relationship to Dr. Prahdem. I’m saying I don’t know. I. Don’t. Know. And precisely because I Don’t Know I don’t want to put my signature on a document that suggests otherwise. Let the two doctors fucking sign a document attesting to their honesty and compliance. Leave me the hell out of it. Cover your own goddam asses.
At this, Mrs. Dr. Globulous (who manages his practice) tosses her head with a dismissive hiss and stalks off, while Nice Receptionist staples the paperwork and invites me to have a seat in the refrigerated waiting room and wait until I’m called — which happens immediately as thanks to this Great Debate I successfully make use of all down time, and the technician is standing there tapping his feet, waiting. I’m in and out in 10 minutes.
Useless insurance bureaucracy. File it under bung hole, counselors. My lungs are clear, as is my conscience.