I have often told people that my job as an elder law lawyer is to maneuver within complex bureaucracies. The complex bureaucracy I deal with most often is the court system. However, I also work with with title companies, life insurance companies, Medicaid, Social Security, Veterans Administration, and stock transfer agents. Each of these worlds has its own rules and traditions.
To my mind, however, the deepest and most impenetrable bureaucracies surround healthcare. The rules and procedures that govern interactions with hospitals and large health care providers are some of the most frustrating of any I have ever encountered. I read complex legal documents for a living. Nevertheless, I am still today incapable of understanding a medical "explanation of benefits." I once got a bill from a dentist that was so cryptic that I had to write the office to ask how much I was supposed to pay. For my elderly clients, I have come to believe that the deep entrenched bureaucracies surrounding health care may have become so impenetrable as to constitute elder abuse.
With this in mind, I reviewed the Oregon elder abuse statutes. There wasn't much help. The statutes didn't clearly apply to abuse by red tape, but even if they did, health care facilities are exempt from Oregon's elder abuse statutes.
I am technologically skilled, educated, and generally considered a high functioning American. Nevertheless, I am regularly stymied when trying to obtain health care.
I will pick on Kaiser Permanente here because that is where I go. Last month I needed a refill for a prescription I have taken for years so I could take the medicine on vacation. I began on Monday with a call the pharmacist. By Friday, many telephone calls later, I had the folks at Kaiser swearing they had delivered the renewal to the pharmacy. The pharmacy swore they had received no such thing. Using the flexible phone system in my office, I called both and patched them together on the same phone call so that they could speak to each other. I was promptly informed that Kaiser could not speak to the pharmacy if the conversation was on the patient's phone.
One of my clients had back pain. She cried hard enough over the phone about the pain that she was allowed an MRI to see what was wrong. She had the MRI and was eagerly awaiting a message from her doctor as to the results. Instead, she got a call from the office of a surgeon attempting to schedule a surgery she knew nothing about.
So what to do? Not much. I do, however, have a couple of suggestions. When a large bureaucracy is giving you problems, it is often useful to change the method of communication of the angle of approach.
If phone calls are not working, try email. Sometimes just a change in the communication channel produces results. It is odd, but it is a true. Write a letter. Some folks will be impressed that you took time to write in this technological age, but it may work. Have an agent, friend or lawyer call on your behalf. You will have to provide a release to allow them access to records, but an assertive friend may have success where you did not.
Try to talk to someone else. My studies in organizational theory suggest that organizations employ gatekeepers to protect the "us" who belong to the organization from the "them," who don't. If you bump into a particularly tough gatekeeper, try to find a different one.
If these don't work, you may need to take a more aggressive stance. Most commonly these approaches will be taking advantage of the fact that the people who work within large bureaucracies are also victims of bureaucratic complexity. There are another set of rules and expected behaviors that vex them, just as much as the ones they enforce vex you. In my next post, I will address some strategies that use this aspect of living and thriving in a highly bureaucratic society.
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