Wednesday, 27 April 2011

Survival of the Fittest

Let's talk private health insurance. For those of you who don't live in the UK and are used to having fights with tight-fisted insurance companies who are happy to take your money but then quibble over costs when you're actually ill, look away now. And apologies if this all sounds too much like Groundhog day.

For us residents of the British Isles, until fairly recently private health care was for those fortunate few who were probably too well-fed and too well-bred to ever need to use it. For most of us, we had no choice but to rely on the NHS - a national institution that is still perceived by the general public as a free service, even though it's exclusively funded using taxpayers' money. The NHS boasts world-renowned doctors and often attracts nurses and health professionals from around the world who come to work in its hospitals. It's a well-respected institution and has been around since 1948. But these days, due to mainly the actions of a Thatcherite government, it's under-resourced, underfunded and too bureaucratic. For the patient this has meant long waiting lists, overstretched and stressed out doctors and less than adequate standards of patient care. The media love to report stories about women who end up having to give birth in hospital toilets after being told there's no space on the labour ward and will tell of misdiagnosed cancer patients who spent months complaining about a headache, only to be sent home with a packet of paracetamol.  It's little wonder then to discover that more and more patients are opting to go private.

But this in itself has its own problems. Take a few weeks ago. My kind-hearted oncologist who could see that every so often, at the thought of not being around to take care of my virtually newborn babe, I would dissolve into a flood of tears, decided that I might benefit from the services of a psychologist. At this stage of the game, I am open to all suggestions. So far, I've dabbled in acupuncture, chinese medicine, hypnotherapy, reflexology, support groups, visualisation methods, meditation, massage, journaling and vitamin supplements and the list goes on. I figure that when the grim reaper finally rears his ugly head, at the very least I'll be able to say that I tried everything that was available on the market. So I agreed to see the psychologist, but unfortunately the experience was not a happy one - see In Defence of Denial post).

I put it down to an un-meeting of minds and thought no more about it. But a few weeks later, I receive an invoice from the psychologist in the post. I had worried whether my insurers would pay for the service since they had in no certain terms told me that I would only be receiving herceptin until the end of the year, but the psychologist thought that they probably would. In any case, I had to sign a letter to confirm that I would pay her in the event that they didn't. Which I did, as I felt too embarrassed not to sign. 

So when I received her invoice, naturally I assumed that the insurers had refused to pay and when I contacted them, they confirmed this. Even though they were very sympathetic about my current diagnosis (there's nothing like the mention of the C word to get the tone of people's voices to lower and act as if you already have a few weeks left to live), apparently if I'd read the terms and conditions I would have noticed that I should've been referred to a psychiatrist before seeing a psychologist. 

er, why ?

Those are the rules, apparently. Perhaps I have a too simplistic view of mental health. I always thought that psychiatrist = severe mental health disorders, that possibly need to be controlled by medication, psychologist = less severe emotional problems and a more touchy-feely approach all round. But I could be wrong. But still, it all seemed wrong. Here I was, struggling like any sane person would be, with an enormously devastating diagnosis and I couldn't even talk to a shrink about it without being fleeced for a £150 fee. So in typical fashion, and in light of my view that the pen is mightier than the sword, I wrote them a letter of complaint. In fact, I wrote three. I sent two to the most senior people who had decided that I should pay. I asked them how they would feel if they'd just been diagnosed with secondary breast cancer with a 15 month old baby to look after. I told them that on the NHS, I would never be asked to pay for the services of a psychologist, especially after a diagnosis of cancer. I then contacted my company's HR unit and wrote to them too. I sent my oncologist a text and asked if she could write a letter in my support and then I e-mailed the psychologist and asked if she'd ever heard of such a silly rule. 


After all of that, I felt written out. I didn't expect to win and began to make plans as to how I was going to pay for the fee. £150 was three pairs of summer sandals that I surely wouldn't be buying this summer.

But, surprise, surprise, win I did. I even received a personal phone-call from one of the insurer's staff who told me how very sorry she was to hear about my situation. As a gesture of goodwill, they would pay for the fee, but not for future sessions. It was a great result and I thanked them. But I somehow didn't feel elated. What if I hadn't bothered to write in ? I would've been £150 poorer at a time when I really can't afford to be. What if there's someone else out there who has been similarly asked to pay £150 but who is so busy struggling with a cancer diagnosis that they're unable to respond in a rational and assertive way ? It seems that even in the private world of healthcare (which should be all about customer care and compassion) only the fittest survive. I should campaign for a change in their policy, but to honest, I'm too busy dealing with my own day-to-day life to do so. And so, the nonsensical rule will stay and be enforced until another David turns up and decides to take on the mighty Goliath. But until then, I'll be steering well clear of psychologists for the time being.

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