Cynicism or a Healthcare System That Needs Help

This story is about a patient with no real experience in the healthcare system.

A patient was having some sinus issues in December of 2012. Basically, mucus had settled into his sinus cavities. It was like talking in a tunnel and difficult for him to hear.

To get relief, he started with his family doctor in December. The family doctor prescribed some antibiotics-a fast, powerful dose. After a month, experiencing no relief, he went back. The doctor prescribed more medication. No relief. He sent the patient to an Ear, Nose and Throat (ENT) specialist.

The ENT prescribed steroids. He claimed that cured 80% of the individuals with this problem. The patient had high hopes but the steroids did not work, either.

The ENT recommended a CT scan at the hospital. After much searching and aggravation, the patient found out it would be about $2,500 (Note: the patient did have insurance but had a $2,500 deductible and 20% co-insurance). He shopped around (an arduous process) for a clinic to get a price. He found one that would do the sinus CT scan for $400.

The CT scan confirmed everything. The sinuses should have been black (denoting air) but they were gray (denoting mucus).

The doctor recommended a sinusplasty. This is a procedure where the sinus passageways are stretched to allow for draining. A balloon is inflated to allow this to happen. The mucus present would be sucked out through a kind of straw. It was an outpatient surgery, taking about 1.5 hours. It was scheduled for May 31st. The patient said ok.

Of course, prior to the surgery tests had to be done (really?). A blood test, chest x-ray and an EKG. The EKG was because the procedure included a general anesthetic.

The nurse called him two days prior to surgery. The tests were fine. But the EKG indicated a Myocardial infarction (MI)-age undetermined. That meant the patient had experienced a heart attack sometime in his past.

What???

The patient was stunned. Other than being overweight, he had no health issues. If he had a heart attack, he was not aware of it. It didn’t matter. The surgery was cancelled until the patient could obtain cardiac clearance. He had to see a cardiologist to get that.

After an exam, the doctor told the patient, he probably didn’t have a heart attack. The EKG was faulty. The machines were sensitive and could give a false reading pretty easily (the patient was of course, still charged for it).

After another EKG and a heart echo sound, the doctor confirmed there was no attack and that, in fact, the patient’s heart was hale and hearty.

Cardiac clearance was received and the surgery rescheduled for July.

While everyone seemed to mean well, was all of this really necessary? Are all of these doctor’s visits, tests and medications normal? The patient is not cynical by nature but…

Sue (Sunni) Patterson, CMBA, Co-Founder
As an accomplished marketing professional, entrepreneur and lifelong learner, Sunni constantly seeks out dynamic business opportunities. Sunni started in the healthcare industry as a senior medical claims processor with a major insurance payer and since then has partnered with RMK123.com, a top medical billing and revenue management firm. Sunni leveraged this to create Medical Bill & Claim Resolution (MBCR), a medical bill patient advocate firm assisting individuals with interpreting their medical and hospital bills, disputing erroneous charges and resolving/understanding insurance claim decisions. Sunni holds the specialist Certified Medical Billing Advocate (CMBA) designation, which is issued through the Medical Billing Advocates of America upon successful completion of their exam.