Tuesday, April 01, 2008

Guilty until proven innocent

I am among the many lucky souls who have allergic asthma. Thus, when my allergies are sufficiently under control, I don't have asthma attacks. Though I'm never totally symptom-free as far as my allergies are concerned, asthma management has always been fairly easy for me. The only extended period of respiratory problems I've ever really had was the direct result of my severe allergy to California. And, since we left California almost three months ago, I haven't had a single attack. Hm.

In the US, uncontrolled asthma is undoubtedly a major cause of morbidity, mortality, and (of course) health care spending. And it seems that just the word "asthma" is enough to put managed care's panties in a bunch. I've had to fill out a couple of post-enrollment "risk assessment" forms for various insurance plans over the years, and of course they all want to know what chronic conditions I have. Because I am pathologically truthful, I always check off the little box for asthma.

I know that this means that I will be contacted by a disease management nurse. And that I will have to work really, really hard to convince him or her that I do not need any assistance managing my asthma, thank you, that my inhalers always expire before I've used them up, and that I have an allergist who actually sees me for appointments, which is far superior on all counts to having someone who's never met me attempting to do disease management by phone.

But as I said, I'm pathologically honest.

About a year ago, I had called our insurance's nurse advice line to ask whether I should use industrial-strength steroid cream or good old hydrocortisone on a rash that had just appeared on my arm. She wasn't much help in my decision-making because she wasn't familiar with the industrial-strength stuff. But then she asked if I have asthma. I said yes. "I'm supposed to refer you to our asthma management program, then, so would you like me to refer you?" she asked. I said no. We hung up, and I went to put some hydrocortisone on my arm. (It worked just fine, by the way.)

A few weeks later, I got a big thick envelope in the mail from our insurance company. "Welcome to the Asthma Management Program!" it proclaimed. "Please call us to complete your initial assessment!" I was not pleased. I called the number and had the following conversation:

me: I just received this packet and I do not want to be enrolled in the program.
asthma management program person: Who referred you?
me: One of the nurses on the nurse line. I'd called her about something completely unrelated. She offered to refer me and I said I didn't want to be referred, but it looks like she did it anyway.
AMPP: Do you have asthma?
me: Yes.
AMPP: Well, maybe this program would be helpful for you. How often do you use your rescue inhaler?
me: Fewer than five times a year. The last time was almost four months ago. I don't want to be in this program. I have an allergist. She's in-network. Please disenroll me. I never wanted to be enrolled in the first place.
AMPP: Oh, okay, it sounds like you can manage things yourself. I will disenroll you. You won't receive anything else from us.
me: Thank you.

A few weeks later, I got another big, thick envelope from our insurance company. "Thank you for enrolling in the Asthma Management Program!" it said. "Please call us to complete your follow-up assessement!"

Oh, boy, was I ever steamed.

me: I am not enrolled in this program. Why do you keep sending me letters that ask me to call?
asthma management program person: Who referred you?
me: A nurse from the nurse line. I told her I did not want to be referred. She referred me anyway. I called earlier this month when I received a welcome packet and asked to be disenrolled. I was told I wouldn't be getting any more materials. This obviously is not the case.
AMPP: Maybe our program could be helpful for you--
me: As I explained when I called the last time, I use my inhaler fewer than five times a year, I have an in-network allergist whom I see regularly, and I never consented to being enrolled in this program.
me: I'd like to file a complaint about this, actually, because I consider this all to be an invasion of my privacy. Maybe the nurse was required to refer me, but if that's the case, it should have been a lot clearer that I didn't have a choice. As it was, she asked for my consent, I withheld it, and this is the second phone call I've had to make to try to get myself disenrolled from a program I'm not interested in.
AMPP: Oh, I'm very sorry. We do take your concerns seriously. I'm going to pass this along to our medical director. You won't be receiving anything more from us.

Convincing my insurance company that I don't need extra help with asthma management shouldn't be like convincing my credit card company that I don't need to sign up for a great balance transfer rate. Although the credit company doesn't necessarily know that I have no debt to transfer, the insurance company should be able to tell from my claims history that I don't show up in the ER with asthma.


Heather said...

Too funny... you seem to get into a lot of these snares!

By the way, I think that you need to post daily until the Gerb makes his/her debut. Because otherwise? I think that it's happened already, and you and Mrs. G are oohing and aahing while the REST OF US ARE IN THE DARK.

Lavender said...

I must concur with Heather... every day there is no update, I do find myself thinking "I wonder if they failed to update because the lil' gerb is here?!"

Gerbil said...

Don't worry, gerb news will come as soon as it can!