As with many St. Helenans of a certain age, I’m on a regimen of maintenance drugs for a couple of chronic conditions. And, along with my friends and neighbors, I’m corralled by my insurance company into getting a three-month supply of these drugs by mail order. Mine come through an entity with the faintly Orwellian name of OptumRx.

There’s one pill I take three at a time, That’s 270 pills over 90 days. OptumRx used to send me three bottles of 90 pills; that’s easy to store and keep track of. But just recently they started mailing me five bottles of 54 each (a new bottle every 15 days). That was annoying and inconvenient. So I asked them for the old three-bottle package. That’s when confusion, misdirection and fiction entered the conversation.

I was told they couldn’t provide “custom” packaging. I wasn’t requesting that; I was simply asking for the previous bottles. Then I was told they had to send me what the drug manufacturer provided. But that’s not what they gave me: the five mini-bottles were their own; it was the previous larger bottles that came directly from the drug company. In the end, of course, I was stuck with the five mini-bottles.

In sum, I was never given a clear answer why the bottles changed and why my packaging request couldn’t be accommodated. A small matter, but a straightforward example of no customer service.

Three years ago, this column reported on the Sisyphean quest of a St. Helena father to have our hospital explain its emergency room bill for his son’s soccer practice injury. After months of effort, his attempts were unsuccessful. He did, however, uncover several absurdities. One of which was that an x-ray was priced differently whether it was ordered by the ER or the orthopedic department. For the most part he was tossed back and forth between the hospital billing office and his insurance company without gaining substantive answers from either.

Most of us, I’m sure, both appreciate having a 24/7 ER 10 minutes away and also understand that hospital finances are complex. But that doesn’t explain why cost information is almost impossible to obtain.

When I recently went up the hill to the ER I found no cost info available. Intriguingly, the ER receptionist said the total absence of info was deliberate; the hospital, she said, doesn’t want an ER patient wasting any time thinking about cost – which might cause them to delay treatment. That response was a little too cute and a lot too paternalistic. If I wanted some financial info, I was told to go see the hospital’s “financial counselor.”

I did indeed find that person. However, she said her role was to explain the inter-play for the patient between their insurance company and the hospital’s billing. That connection is based on the contract between the hospital and the insurance company (which varies for each patient). She said she was unable to provide info on the hospital’s basic pricing for services.

I was, however, told that for ER patients without insurance their bills are discounted by a whopping 85 percent. I remarked that this discount could be more favorable than the insurance price. But then I was told we had no choice: if the hospital has our insurance policy info on file it was contractually obliged to bill through the insurance company.

So here’s where the customer is stuck: not only is cost information unavailable, but we also have no choice on whether or not to use our insurance. A double whammy. Perhaps what we should do is to instruct our local hospitals to erase whatever they have on file on us and tell them we would provide updated insurance data when we next used hospital services. But as we’ve learned from Facebook and Google, have you ever tried erasing anything?

One lesson here is that if we have to depend totally on medical institutions for care we then become a captive audience and will receive very little customer assistance. We need to try to obtain services directly. That’s not as impossible or impractical as it used to be.

The Silicon Valley medical information company 23andMe is now providing to customers personal data previously the province of health care institutions. Its founder, Anna Wojcicki, recently told CNBC that “Since our earliest days we wanted to pioneer a path where people can get their genetic information directly and do not have to go through a physician or genetic counselor for access or interpretation.”

Her company worked with the FDA for five years to get the go-ahead.

That’s one small step in the direction of controlling our medical services and what they cost. But it doesn’t help me decide where to store all these little pill bottles.

The Star asked hospital spokesperson Jill Kinney about the issues raised in Epstein’s column. Her response is as follows:

“Adventist Health St. Helena always wants to make sure our patients are taken care of and have access to answers for questions about their care and finances. A patient can ask for assistance by speaking with a Patient Advocate or a Financial Advisor. The Patient Advocate or Financial Advisor can help them identify the costs or even provide access to a Charge Master or a list of prices by procedure once they have access to that patient’s doctor’s orders. If a patient has access to the physician’s orders (which typically are entered within three to five days after the care is provided), our Patient Advocate can look up the prices for each of the doctor’s orders. Should the patient have questions or require financial assistance, they are always welcome to speak to a Financial Advisor or a Patient Advocate.

“If a patient enters our Emergency Room, we are required to follow EMTALA, a federal law that requires hospital emergency departments to medically screen every patient who seeks emergency care and to stabilize or transfer those with medical emergencies first, regardless of health insurance status or ability to pay.

“Lastly, we do offer private pay discounts for those that are uninsured. Those discounts vary by service but can go as high as 85 percent.”

(Mark G. Epstein moved to St. Helena from the East Coast early this century after a career in international business.)

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