I really love Mondays and I really love when Monday's happen to be on the first of the month.

The first of the month is always a dreaded day for me but its repute holds much more than paying the rent; insurances change on the first. I make my disdain pretty widely known in the office, because on that day I have to come in and verify that the patient’s are eligible. One probably thinks to their selves, what’s the big deal? Well here it is: Even if a patient understands you do not take an insurance, they will still try to weasel their way in for an office visit and hope that your adeptness to the understanding of insurances fall short. In part I hope they do these acts intentionally because I believe it is almost impossible that at least 90% of the people whose insurance changed that fall between the ages of 20 and 55 do not understand how it happened. I also like to think their stages of handling the situation is likewise for other doctors and other institutions that have the pleasure of gracing even the slightest time of these people. That's just wishful thinking.

There is a pattern to the response of these people. I usually prepare myself on the phone; give some alternative even before they get a word in. Usually that works in pain management, give the most ethical, kind response you can think before anyone can speak. I usually insist they change their insurance, here’s a list that we do accept! I do this in hopes of ending the phone call shortly so I can inform the next 10 people of their dismay. Nobody wants to hear that his or her pain management doctor cannot see them for their office visit. They’ve probably been out of pain medicine for weeks. Usually this approach works for the first phone call but they will call back.

After I give them my oration they get extremely angry. (Most of the time this is a matter with Medicaid. You would think having government funded insurance that you had to pay no more than 2 dollars as a copay – no premiums, no deductible – that you would keep up with it right?) They tell me they have regular Medicaid. They deny they have an HMO, although I am looking at their DCF profile online. They go on to say Medicaid MUST pay for my office visit. Politely, and with all my gathered patience for this day I state to them their insurance changed to an HMO, we do not accept it and go on to give them alternatives.

Afterwards they thwart their attention to the DCF/Medicaid office. I love this part because I can only imagine the things they say to the representatives there. How they’re entitled to pay everything, how could you change my insurance, blah blah blah. I’m not off the hook yet and now I have involved everyone in the office and they do not even know it yet. Soon enough the girls up front and even in the back will be inundated with phone calls, from the same 5-10 people I called this morning, trying to repeat the conversation but in much different tones. Most will call back, screaming, yelling, tells us the manager of Medicaid said that we must see them. Some call back and try to guilt us, they cry, they mope on the phone; none of them take No for an answer. Eventually they will call and then proceed to hang up on us. We cannot do anything, unfortunately.

So today I came in bright and early. A couple of patients have been nagging me the month before to check their insurances although the insurance does not change until the next month with medicaid. I decided to check one patient first because him and his girlfriend call about once a day to swear up and down Medicaid has changed his insurance. Then he tells me I need to check the insurance by 8:00 because of his appointment time. Apparently I have a new boss, and he isn’t paying me anything… Well his insurance was compatible with our office so I called him. It went straight to voicemail. An image of him ran across my mind, him lying around, probably not even up yet.

Anyway, I call my first insurance changed patient. At first she is pleasant, but eventually she followed through with every phase I have mentioned above. She put a twist on it though. She said that we hated her, that we were racist and this is why we would not see her. No matter what we said, we were racist and then she would hang up. The last time she called she even stated her disdain for her previous office visit, how the doctor wouldn’t give her what she wanted and how long the wait was etc. etc. You know what would have put the icing on the cake? If she would have said she was going to report us to Medicaid for not giving her the blue pills she wanted, I’ve heard that a couple times. Instead she just called us a couple more times and by 10 AM she was done. I mean that’s a lot of work to persistently harass a group of girls for more close to two hours.

I unjustly did not mention the 10% of the patients who’s insurance changed and they graciously fixed the situation without yelling at my first. I applaud them for taking the time and responsibility to understand their insurance, regardless of what kind of insurance it is. You go glen coco.