Wednesday, May 23, 2007

When Health Care and Marketing Collide

I received a lovely invitation in my mail the other day. It was from my insurance company, inviting me to join some sort of wellness program. I was recommended for this program because my insurance claims apparently tripped off some sort of alert. Well, that's very nice! So it had a quiz, to assess my risk for heart disease - if I scored above a certain level I should enroll in this wellness program. That's nice too! So I took the quiz, honestly, even fudging on the side of caution (my father's heart disease wasn't diagnosed until he was 60, and I've been advised by the cardiologist that this doesn't count as a "family history," but his mother died of a heart attack in her 50s, so to be cautious I said I had a family history of heart disease - even though she smoked like a chimney and never exercised.) Despite this meticulous honesty, I still scored as at low risk for heart disease. That's nice! Then I read the personalized letter included in the packet. It seems they want to help me, because it appears that I'm at risk for heart disease, due to my overweight and diabetes. Basically, the wellness program is a sort of telephone support for diet and exercise, with nurse support.

Except I'm not really overweight and I don't have diabetes. I was not advised to lose weight by any doctor. I voluteered that I wanted to lose weight, and was advised to exercise, and also meditate and eat a healthy diet and take my vitamins and get some sleep, all of which I'm doing, but this was a weight and diabetes management program for someone with a heart condition. So now I was curious enough to call the number to tell them that I think their screening mechanism has a few bugs. I got a very nice nurse, and told her that I'd received this letter, and that I suspected that it was due to my recent medical claims. When you have a cerebral aneurysm it can mess up your heart, so I was put through a full battery of heart monitoring and testing while in the ICU.

She confirmed that my hospitalization triggered alarms, and they got my referral with the diagnosis that I was suffering from heart failure. Heart failure?? I told her about the cerebral aneurysm, and that I suspected that this is why I hit their list. She agreed, said it was wonderful that I had recovered so well, and they'd make a note that I was not obese, diabetic, and suffering from heart failure. Because I really don't want some computerized marketing program to start writing notes about me in my insurer's files, God knows how that could come back to haunt me. We live in a weird, weird world.

It's been a busy week, but I'm at 91.85 Runagogo miles, and I should hit a hundred this weekend. Girlchild already hit 100, and is now thinking she'll hit 200 by July 4. I think that's probably a bit overly ambitious for moi, but I will move the goal line to 150, and see how far past 150 I can get by July 4.


sallyjo said...

I had a stress test, and I have no heart disease! but that isn't where I was really going.
I'm at 4 - count them - 4 miles! in the go-go thing.
I wish my life would get out of the way sometimes.

Catherine said...

I'm sure it wasn't the stress test that triggered it. While I was in the ICU I was wired to all sorts of devices and they were keeping a close eye on my heart, because a ruptured brain aneurysm can cause cardiac arrest. I had more machines beeping behind me when I woke up, and I couldn't even turn around to admire them because I had some sort of wire down into my neck as well as the little sticky things all over my body - I'm not sure what the neck wire was doing, I think it was part of the monitor. Apparently it was the combination of "ICU" and "wired to devices that look for heart things" that got their attention. The nurse said the record she had didn't even mention the SAH, which is of course what put me there, and why they were monitoring my heart. It's just a sign of how the system works - some insurance bean counter reviewed my bill and saw all the heart stuff and put me on the marketing list for this wellness program, which, if had been told I needed by an actual doctor, I certainly would do. They said it would be a good thing to exercise to reduce my stress, but I wasn't told to lose any weight. I'm already doing it anyway. I didn't need the wellness program, but I didn't want to be on their record as a "non-response" lest they hold it against me later. And I'm glad they called, since they had the wrong damn diagnosis.

As far as the exercise goes, you have to shove your life out of the way. I didn't do that for a long time. Now that I am back at work I am as busy now as I was before this happened, and the gym didn't happen tonight because groceries were needed and I left the office a bit late as usual, and by the time I tended to groceries the critters and I were hungry, so I blew it off, but tomorrow night I'll be there. I can't let myself get out of the habit, it's too important. I knew when I went back to work that I'd be lucky to do 4x a week. 5 would be better, but 4 is better than zero.

KatyaR said...

After reading this article today, I'm worried for you:

I hope this wasn't a ruse to get information to determine your insurance coverage.

I just don't trust the insurance industry anymore--and I work in healthcare!

Catherine said...

Oh, and also, it's good that you don't have heart disease! I should have mentioned that before ranting about the way insurance companies come up with their own conclusions from medical bills. :-)

Catherine said...

I have group coverage and I know about the all-holy Certificate of Continuous Coverage, which is the only reason I have a house now after my husband's coverage expired before he did and I was able to slide him onto mine at the end of his life. I am confident that it came from my insurance company, and they really do offer all of these lovely wellness programs. But they offer them based on reading a bill - I had a lot of heart stuff on the bill, so I must have heart failure, as well as being an obese diabetic! Except that I'm none of the above. That's why I called and talked to them. I've had a cerebral aneurysm, that's a fact, I can't hide it, but I don't want to get tagged with things that weren't diagnosed. But this is why I can't leave the safety of Dilbert World and insurance, I couldn't get an individual policy with my health history. Even though my CT scan indicates that my brain is now perfectly fine, and there's no reason to think it'll happen again.

sallyjo said...

Single payer health coverage is second on my list, after ending this stupid fucking war.
I'm thinking of starting a campaign, writing to your congresspeople and asking them if they know where their balls are.

sue c said...

hi, so i work in a neuro icu and take care of people with brain aneurysms. i have found it heartening to read your blog because so many aneurysm patients don't do nearly so well as you. i think the answer to the heart failure thing is that you very likely had an echocardiogram while you were very ill and the numbers were awful because that happens sometimes with aneurysm patients. however, it is a temporary problem related to the aneurysm and another echo would now show normal numbers. i have had aneurysm patients whose regular docs got worried about heart failure based on the in-hospital echo. you might need to check on this because your records might contain an echo with no longer valid numbers. sue c

Catherine said...

I've had a follow-up echo since then, Sue, and it was still slightly off but my cardiologist wasn't too worked up about it, he thinks my heart is still "getting over" the SAH, and recommended exercise and eating right and getting enough sleep, etc. to help myself heal.

What got me about this, though, is that some clerk (or some computer) referred me for this program without any reference to the SAH that put me in the hospital! So that's why I called and talked to the nurse, and she agreed that I wasn't the kind of patient they were looking for, and made a note of it. It's scary to think how easy it is for erroneous information to get attached to your insurance profile.