Long Waits, Short Appointments, Huge Bills: U.S. Health Care Is Causing Patient Burnout

[Diamond_Dog]

You haven’t been feeling well lately. You’re more tired than usual, a bit sluggish. You wonder if there’s something wrong with your diet. Or maybe you’re anemic? You call your primary-­care doctor’s office to schedule an appointment. They inform you the next available appointment is in three weeks.

So, you wait.

And then you wait some more.

And then, when you arrive on the day of your appointment, you wait even more.

You fill out the mountain of required paperwork, but the doctor still isn’t ready to see you. You flip through a magazine for a while, then scroll through your phone until you’re finally called. You wait a little longer in a scratchy paper gown, then talk to your physician—if you can call it talking, since she’s mostly staring at a computer screen—for all of 10 minutes before you’re back out in the lobby with a lab order to have your blood tested.

Then you call to set up your blood test, and the waiting process starts over.

A few weeks after you get your results, a bill arrives in the mail. You’re charged hundreds of dollars for the blood work. The appointment was over in minutes, but your bank account will feel the effects for a long time.

Going to the doctor may never be a fun experience, but surely it can be better than it is right now. In 2019, even before the COVID-19 pandemic rocked the foundations of health care, an Ipsos survey found that 43% of Americans were unsatisfied with their medical system, far more than the 22% of people in the U.K. and 26% of people in Canada who were unsatisfied with theirs. By 2022, three years into the pandemic, just 12% of U.S. adults said health care was handled “extremely” or “very” well in the U.S., according to a poll from the Associated Press–NORC Center for Public Affairs Research.

More

https://time.com/6257775/patient-burnout-health-care/

[MOMFUDSKI]

1. Nailed It!

I wasted MONTHS being jerked around by the system. All the while I had a pinched nerve caused by a herniated disc. Primary sent me for X-rays. Then I made an appt with a PT. Then they sent the wrong Xray to the PT so she didn't know about the herniated disc. Then I saw a Chiro. Then I had to beg my primary to get an MRI of lumbar region. Then my primary wouldn't authorize me to see an Ortho Surgeon so I had to fire her and get a new primary. Then I had to do the Gabapentin pills and then I had to have the steroid injection into my spine. OF course all of these appointments took a lot of WAITING. Finally the surgeon offered me surgery. It was 10 months of a pinched nerve so I am hoping it will wake up. Doc said it was pinched a long time so wait and see. Wouldn't have been a LONG TIME but for all the fucking waiting. Our health care leaves a lot to be desired.

[CrispyQ]

2. I have a giant Kaiser facility down the road from me.

It takes about three weeks to see my PCP, but if it's more urgent, but not ER urgent, they'll schedule you to see a staff doctor, usually in a couple of days depending on your situation. Also you can call & talk to a nurse before scheduling anything & if your situation is urgent enough they will help get you in to see someone.

The lab is on the first floor of the building. If my doctor orders bloodwork, I stop by the lab on my way out. It's take a number wait your turn & I've never waited more than 15 minutes. You can do it all in the same visit or come back. No need to call, just show up & take a number.

I hate the health insurance industry, & was disappointed to hear Kaiser was a big part of the Medicare fraud case, but I've been happier with Kaiser than any other carrier I've had & I've had a lot of them. Overall though, the US healthcare system sucks.

[IbogaProject]

7. I've always liked clinics or health centers

I go to the Bellvue hospital clinic at the oldest public hospital in the western world a few blocks away here in NYC. Almost everything I need is in that one complex. Even staff doctors report to an attending physician (supervising the same as over resident post study new doctors). But of course NYC and NY State have the best healthcare access in the whole country. Cutting out the whole administrative and billing part would cut costs 30%, only 27% are uninsured. Then the increased preventative care and faster initial symptoms to treatment would both generate savings and improve health outcomes. And everyone would benefit. I pray for the time 2hen our system is so effective ER physicians will have occasional quiet nights playing cards between a few patient checks.

[Ms. Toad]

14. I'm guessing you're in CA.

I like the idea of Kaiser, and my CA friends loved it (last time I checked with them). I've tried two different versions of it in Ohio - the worst of the worst.

The first version (traditional Kaiser) - every singe time I needed to see my primary care physician I had to choose a new one since the one I saw the previous time (less than a year ago) had left the system. Since part of what I loved was the idea of a family physician who knew my family well and coordinated our care, having to pick a new physician for every single visit kinda blew that idea out of the water.

The second one (community based Kaiser, with access to out-of-network providers) - they were the only plan which was willing to cover my same gender partner. It was horrendous (it took 200 hours of my time to clear up a billing dispute). Their crappy system buried their approval for treatment by an out-of-network provider at in-network rates at the bottom of a long (and growing) unsearchable .pdf. Their practice was to have a single claim number for each diagnosis, and to tack each claim/approval document on to the end of the .pdf. The top of the pdf was approval for an out-of-network second opinion, only. So they billed every encounter for treatment by that provider under the out-of-network fee sharing. Three corporations were involved. The corporation making out-of-network payments properly paid the bill . . . except that they shouldn't have had the bill in the first place. The corporation that should have paid the bill didn't have it - so they did nothing wrong. The third corporation sent bills to the paying corporatyion (out-of-network or in-network) and patients were not allowed to speak with anyone in that corporation. So I had to get the first and second corporation (which had each acted properly) to explain to a third corporation that it had made a mistake that it needed to correct. After the first surgery was finally esolved, they billed each subsequent encounter incorrectly. So I had the same battle over and over again.

By the time I had the second surgery for this condition - about 18 months later - I was down to a disputed $100 (the total amount I owed for the surgery - it was my copay, which I had paid, assuming I should pay what I knew I owed while they resolved the rest. I insisted they start a new claim number for the second surgery - even though they insisted that was not the issue. It was - all of the claims under the new claim number were paid correctly the first time. Now I refuse to pay the bills until all the insurance dust has settled.

I hate to think how people fare who don't have the ability to sort out what is going on behind the scenes and advocate for themselves.

Never again.

[Auggie]

3. It's awful. Specialists might be worse.

8 week wait to see an orthopedist. 6 week wait to see otolaryngologist. That was under my old HMO.

[Diamond_Dog]

4. I love my PCP

But his staff is difficult to deal with. 90% of the time when you call them about anything, you have to leave them a message and MAYBE they will call you back the same day. I have waited 2+ days a few times for someone to get back to me. And getting bloodwork results! It would be easier to find where they buried Jimmy Hoffa!

If I need a prescription renewed it’s anyone’s guess if they called it in and when.

Then when I get my bill from the insurance, that always needs a phone call or three to understand or question what they’re billing me for.

[Ms. Toad]

11. I just refuse to be shunted off to the leave-a-message center.

I don't fit into any of the narrow reasons they are willing to allow me to speak to a human being (same day appointment, returning a call from them). But I just ignore the directions. press zero, and wait for someone to pick up.

[Diamond_Dog]

21. That won't happen on my doc's office phone.

A person never answers. If you don’t leave a message it disconnects you.

Honestly I am *that* close to thinking about switching doctors, except I really like this guy, I’ve been going to him for like 20 years, and he knows me. It’s his office staff that makes things so difficult.

[Ms. Toad]

29. See if he's willing to communicate with you directly.

I often have pretty complex questions, which are impossible for office staff to translate to the doctor. I usually give them one chance, and then have a chat with the doctor at the next visit with a concrete example of why going through the office staff doesn't work. I don't think I've ever had a doctor refuse to communicate directly with me (usually by email).

[leftstreet]

5. DURec

[Hortensis]

6. We've both had more healthcare this year than our entire lives,

and we're about as privileged than a large majority of Americans who have some form of insurance.

And we don't see this.

We are treated through ordinary for-profit Medicare-reimbursed providers and my husband VA providers that include various specialties.

Any "burnout" here is from old age, which now it's started just keeps coming. But the care we're getting means there's no actual end in sight. Not yet, of course.

[malaise]

8. Thank Reagan and Thatcher

This is a global problem - deregulate everything - destroy all social good programs including healthcare - market over society and people.
That is all

[slightlv]

9. A month ago I took a bad fall.

Took me over 30 minutes to get from the floor to a prone position on the couch. Couldn't put any weight on my left leg/hip. Everyone was telling me to go to the ER. I HATE the ER. I said if it wasn't better in a few days, I'd go. Well, it didn't get any better, and I was getting around on crutches, so I dragged myself down there for X-rays.

They told me it wasn't broken. When I asked how anything could hurt so bad and couldn't bear any weight being put on it and not be broke, what could it be? The PA softly said "old age and arthritis" and quickly left the room before I could turn around and ask any questions!

My primary care physician asked if I wanted a referral to an osteo doc. I refrained because I had an appt with my rheumatologist coming up. I just had it on Wednesday. He took more x-rays, and then called me at 7:30 Thursday morning to tell me that my hip WAS broke, and he would really like to have a cat scan of it. My primary care doc put in an order, but Radiology hasn't gotten it yet, and says it's probably stuck in the Insurance okay phase (I've got Medicare Advantage). So, who knows if I'll ever get it. Meanwhile, I've progressed from crutches to canes.

But I'm swearing up and down (again) I'll never go to the ER again. Unless you're on death's door, they're just no good... and even then, I'd probably have questions and issues, being female!

[Ms. Toad]

12. One of the main reasons to go with original Medicare.

There is no "insurance okay phase."

MA is run like a typical insurance plan: In order to save money they delay, deny, and hope you don't appeal.

[MOMFUDSKI]

18. You are correct on no pre-auth with standard Medicare

but that doesn't solve the waiting problem that we are all experiencing regardless of what type of insurance we have.

[Ms. Toad]

19. I'm not actually experiencing most of the issues described in the OP.

Nor is anyone in my family.

The issues I'm experiencing are primarily in the ER (which I avoid by going to a free-standing ER), and on certain floors in the hospital.

I spent about 10 hours in the ER for debilitating vertigo (with uncontrollable vomiting anytime I moved at all). I could easily have died without anyone noticing for hours, had it been the stroke or heart attack they suspected. (I arrived ~ 6 PM, they tossed me in a separte, unstaffed, waiting room, with no means to contact anyone if something went wrong, and the last time anyone even checked on me was about 4 hours after I arrived.

So the next time I needed an ER, I went to a free-standing ER associated with the same hospital system. It took no more than 30 minutes before I was taken back to an examining room.

I had a similar disparity in care during those two admissions, with the only difference being the floor I was admitted to. The first admission was the worst experience I had. The second was about average or slightly better (aside from the (in)competence of the doctor).

But I see my doctor within 24 hours whenever I have an urgent need. When I am going for regular, non-urgent, care it takes about 2 weeks for an appointment. The only exception was follow-up from the second hospital visit - and the 3-month delay I was told about turned out to be a function of how the office works. Once I got to his office, rather than the generic scheduling office, I had an appointment within 2 weeks. It happened to be a video appointment. I set aside an hour, since it involved some complex medical detective work. I had sent him all of the info ahead of time - not really expecting him to have read it. He had read it, was familiar enough with it to answer all the questions I had included and be done within 15 minutes. (Because of his advance work, 15 minutes was time enough to address medical issues - AND - discuss what I'm doing now that I'm retired. I.e. it was not a rushed 15 minutes.)

[slightlv]

24. Yippers...

and if you try to switch back, even if you were tricked into the MA, you pay for it for the the rest of your life. I know, I tried. I couldn't afford the (much) higher rates of Supplemental, once I'd been on MA. And I DID get tricked into MA... actually, I was put on it without even knowing it. Came as a complete surprise to me 2 days later when I tried to get some scripts filled. I was livid.

[DET]

27. Some Thoughts

I looked into this extensively when my husband’s retirement package switched from Medicare/Carefirst - which was excellent - to Medicare Advantage under Anthem in 2023. We thought about leaving, but it’s hard to pass up no deductibles, no copays (except for certain meds), no maximums, no limits on out-of-network providers and benefits, and additional services. Of course, that’s what my husband’s former employer negotiated, so most won’t have the same payment structure or benefits. We went with the MA plan and so far they have been fine.

From what I understand, legally you have a window of one year after opting for/being on MA to switch back to Medicare and a supplemental policy without penalty. After that, you are subject to underwriting by the supplemental insurance provider. Since most people over 65 have some kind of medical issues, that means that supplemental insurance providers can charge you pretty much anything they want. I suspect that’s what happened to you.

Can I ask how you were signed up for MA without your knowledge? It might help other people to know what to look out for.

[slightlv]

34. Sure...

I was asked to initial so they could "research what meds I was taking"... in effect, I was lied to. I could have taken all this information and the anger I felt and called Medicare with it and probably have changed things right then and there, but I was under so much other stresses with my Mom's stuff at the time that was more pressing. And she was not being helpful. In fact, I was getting daily updates as to how unhelpful, i.e., how angry and hostile she was at people. I knew I wasn't responsible for her behavior, but when it's your mom, you can't help but feel responsible for getting things worked out as quickly as possible in the best way possible for all parties concerned, including the aides who have to work with her. It was just a horrible time all the way around. Not to mention a very vulnerable time for me, as I was trying to grasp what a diagnoses of lupus and fibromyalgia meant for me, personally.

[DET]

37. Sorry You Had To Deal With That

What a horrible time that must have been. Regarding your mother, been there, done that, and I know how stressful it is. Unless your mother is a naturally difficult person, she may have some degree of dementia, which can make the elderly hard to deal with.

You might try to pursue the insurance issue further once you have some degree of stability in your life, recognizing that this could be a difficult, time consuming process. As Ms. Toad points out later in this thread, each state has a SHIPP office that is dedicated to helping the public deal with Medicare issues. I would probably try that first. Good luck.

[slightlv]

38. Oh, I will readily admit I screwed it all up big time

for myself. Seems I can take care of everybody else but me. (sigh) And yes, Mom has dementia. Changed her personality completely. Went from a wonderful person to a complete harrian. Screaming, cursing, even hitting people. I had her living with me for a couple of years and had planned for her to spend her last years with us until she got to that point. I just couldn't handle it any longer. She was also about 3x larger than I was and when she would fall there was no way I could help her get on her feet. She also got into this phase where she would get on the phone and call EMS. She just wanted the attention she got at the ER, but when she got there she wanted to go "home" and would get belligerent when they wouldn't let her go. It was just awful. But I knew things had to change when she asked me who "that man" was and I saw in her eyes she really didn't know who my husband was any longer. Mouser had put up with so much and supported me in so many ways... but his memory was really shot to hell. Sometimes I felt like I was the only one who had any functioning marbles in the house.

Someone in the thread mentioned how unfair it was to make seniors, especially those in cognitive decline, to deal with all this Medicare stuff, and it really is unfair. It's also unfair to their kids to make them pick up the slack for their aging parents. I'd done it for years for my mom, while at the same time doing it for me and my husband during the open enrollment periods. It just adds a burden of stress we shouldn't have to bear, either for ourselves or as caregivers.

I know when I was desperately looking for someone to help me sort all this out, all I got was come-ons for Medicare Advantage. I didn't get anyone, even from the Council on Aging, to actually help me sort through it all. I'd never felt so alone. I don't know how many times I told that "broker" who came over that I was not ready to go with any plan at the moment, that I still had more research to do, and yet he completely disregarded my words and signed me up for Aetna anyway.

I have to admit, up until this moment, I've not had an issue with them. But then, I've not had anything major happen until recently. A month ago, tho, I took a really bad fall. A week afterwards, after much coaxing and pushing, I went to the ER for X-rays and they told me nothing was broke. When I nearly dropped my teeth, asking how anything could hurt that bad and not allow me to put any weight on the leg and hip, all I got from the PA was "old age and arthritis" and she was gone before I could turn around from getting dressed.

Well, this past Wednesday I saw my rheumatologist and told him what happened. He ordered another round of X-rays, specifically on my hip. He called me at 7:30 Thursday morning to tell me I had, indeed, broken my hip. He also wanted me to have a Cat Scan done of it. I called later that afternoon to make an appt for the scan, but the orders hadn't come thru yet. Hospital said it probably had been held up at insurance level. And this is where I figure I'm going to have problems with Medicare Advantage vs Medicare.

The last time something like this happened, my primary sent me to an osteo doc and they ended up just replacing the right hip. I figure this is where this is going to end up, too. So, I'm still hanging on to my old insurance from work, as well as the MA, just in case. We don't bring in enough from SS to end up with high med bills.

[Ms. Toad]

28. I hate how hard it is to find information -

combined with the hard sell for MA, it's pretty hard to avoid.

There ought to be a clear set of mandatory disclosures that agents selling MA have to make before signing anyone up.

[DET]

30. Absolutely

This should not be so hard. It took me many hours to research Medicare options and I still have questions. For example, it’s my understanding that if my husband’s former employer drops coverage entirely for their retired employees (which they could do), then that is an involuntary change in coverage and we could switch to Medicare and a supplemental policy without penalty. But what happens if they change to a really crappy plan at a later date? Are we stuck with the crappy plan for the rest of our lives?

The standard recommendation is to call your local Office on Aging (assuming you have one) for advice, but they don’t seem to be able to handle anything other than routine questions. I would have gladly paid a knowledgeable professional to sort this out, but I couldn’t find anyone. We’re all kind of flying blind here, which is really unacceptable, especially given the ramifications.

The principal source of disinformation on this subject is probably TV commercials, most of which are incredibly deceptive. Something really needs to be done about this. Older people who may be in cognitive decline or who are just not able to ‘handle one more goddamn thing’ should not have to deal with this.

[Ms. Toad]

35. The office on aging isn't likely to be helpful - BUT - each state has an SHIIP program.

They are generally excellent on addressing Medicare questions. They should be advertised more.

You might even be able to switch to Medicare without it being forced by a change from your employer. I chose to end my employee insurance 3 months and a few days after my 65th birthday. I was retiring April 30, and didn't want to incur two annual out-of-pocket limits by starting the year on the employer plan, then switching to Medicare.

That gave me a qualifying event for a special enrollment period, since I was changing from employer-related insurance to Medicare. The phrasing on the website isn't involuntary - it is "I left coverage from my employer or union." None of the forms require that you be forced out - I answered the questions honestly - I left my employer's coverage on 1/1/2022 (even though I was still eligible for another 4 months).

If you ever feel like changing - I'd suggest calling your state SHIIP office to confirm that you can voluntarily drop employer-related insurance that you are eligible for a special enrollment period.

[DET]

36. Thanks For The Feedback

Actually, where we live the SHIIP program is in the Office on Aging. I called them when I was initially looking at options, but they couldn’t answer the question re voluntary opt out of the employer’s plan. You brought up an interesting point re the phrasing on the website. I’ll have to look into it. Thanks again.

[AverageOldGuy]

17. Medicare Advantage . . .

. . . is a racket. Dump it and get back on regular Medicare with a supplemental policy to cover your deductible.

[slightlv]

25. See above

The cost to do that is absolutely prohibitive. I've already looked into it. It's almost like they "punish" you for going with MA with higher rates for the supplemental once you try to go back to regular Medicare.

I agree it's an absolute racket, and a few more words that I could use that would probably get me kicked off here. It's a particular pet peeve of mine. I've already warned my sister, who's a few years away from retirement, herself. I was trying to get my Mom's health insurance straightened out, while getting her settled in a memory care home, and dealing me and my hubster's retirement stuff. All on my own. I could have used some help, which is what I reached out for. Instead, the guy signed me up for MA. Some help!

[moonscape]

10. I have a number of health issues,

cancer among them, but have the most amazing team of docs and specialists. If I suspect a new issue, I am seen immediately, or referred to someone who sees me right away. Honestly, they are all amazingly top-notch and I feel incredibly blessed. I have Original Medicare with supplement so can see anyone with no co-pay.

For economic reasons, I really need to sell my place and move somewhere cheaper, it’s inevitable, but the thought of starting over with a new medical team is what paralyzes me. My network is so solid here.

[friend of a friend]

13. I am 100% service-connected disabled SMC L so I have VA healthcare,

and my wife has Medicare and CHAMPVA so we get very good healthcare.

[OldBaldy1701E]

15. Well, when you are more interested in protecting your income than treating patients... (n/t)

[AverageOldGuy]

16. Blood tests

We live in a rural VA county with two small, struggling rural general hospitals 25 and 40 miles away. Except for our primary care -- which is a small office with a couple of Physician's Assistants -- all my wife's docs are in Richmond, 2-1/2 hours away.

She needed blood work for two upcoming appointments.

Both docs sent orders to LabCorp -- which, I assume, has the testing lab business sewn up nationwide. We received two emails from LabCorp telling us they had the orders and all we need to do is contact the nearest LabCorp facility, check our website. I found a LabCorp test place 35 miles away. Called them. Left message. Waited 24 hours, no response.

Called them. Left message. Waited 24 hours, no response.

Called them. Left message. Waited 24 hours, no response.

Called them. Left message. Waited 24 hours, no response.

Called them. Left message. Waited 24 hours, no response.

Emails went unanswered.

According to the website, the facility that is 35 miles away was open 1:00 - 4:00 Mon - Fri, so, we drove over Thursday, arrived at 2:00. Closed. No notice on door, no nothing, called, left message. Went back Friday, arrived at 1:30, waited until 2:30. No luck.

I'm an EMT with a local volunteer rescue squad. One of our squad members' wife works at lab at one of the local hospitals. Told him our story, he told her, she has access to LabCorp orders, found my wife's orders, told us to come to the 25-mile distant local hospital Saturday morning, lab was closed but she would be there catching up. We did. Blood work done.

This is NOT the way it's supposed to work in the richest nation on earth.

[Evolve Dammit]

20. It's not just the providers, which is very frustrating, but the pharmacies as well. Extremely poor

for patient/ consumer all the way around. Didn't used to be this way. Huge consolidations in both "health care" networks and pharmacy network corporations. Still #1 cause of bankruptcy in the U.S. (medical debt). We need single-payer insurance (expand Medicare) and we need it yesterday.
Remember when Blue Cross/ Blue Shield was Non- Profit??? No co-pays, no deductibles, and prescriptions were less than 5 bucks. I do.
We have accelerated down a wormhole of predatory "health care".

[area51]

22. We desperately need

universal healthcare in the US.

[DET]

23. It's A Crapshoot

We’ve been pretty fortunate so far. My husband has HUGE cancer bills, but they’ve been approved and mostly paid for 100% by insurance. We’ve even had some treatments approved that doctors said wouldn’t be. My husband is mostly treated at the local hospital, which has an entire new state-of-the-art cancer facility. Most of our labs are done in-house at the doctors facilities with reasonable wait times. We automatically get lab and scan results as soon as they’re done via the patient portal (double edged sword - not how you want to find out you have stage 4 cancer). Most of our providers offer virtual visits since Covid, which is really nice. Nonetheless, we have some complaints, most of which are reflective of healthcare in general…

- PCPs don’t seem to treat virtually anything anymore except the most obvious, simple complaints. So they refer you to a specialist.
- The wait to see a specialist is ridiculously long no matter where you live.
- The amount of paperwork you need to fill out just to get in the door is overwhelming. The same questions over and over again each time you see someone new. You’d think that someone could set up a central database for this kind of thing. And then you’re lucky if the doctor even looks at it.

We’re lucky that we live in an area with a huge number of doctors and hospitals to choose from. I can’t imagine what it would be like to deal with routine, let alone emergency, problems in a rural environment. And if you don’t have insurance, or don’t have good insurance, you’re screwed.

[lostnfound]

26. Desire not to die is barely able to overcome the desire not to seek medical care

[Scrivener7]

31. Oh, wow. I am so lucky with my docs.

[allegorical oracle]

32. So true. A friend of mine recently lost his wife of 35 years. Appointment delays, blood panels that

conflicted each other. He woke up to find his wife had died overnight. He's taking it really hard. Even the autopsy took two months to be completed and mailed to him. His wife was a doctor's delight -- never drank, smoked, had all tests on time, not over or under proper weight. He's searching for answers that I fear he'll never get.

[XanaDUer2]

33. Yet many Americans demand nothing better nt