A PMP, finally

August 5th, 2008  |  Published in Healthy Indiana Plan  |  1 Comment

Working a lot with computers, acronyms have become second nature – lately it’s been SIP and DID and PBX and a slew of other ones.  Somehow though, I’m surprised when I realize that they don’t just exist in the realm of computer technology.  I’m more surprised when, in these other contexts, they no longer seem like par for the course, this arcane language that one can take pride in navigating, but instead a frustrating impediment, a needlessly oblique interface to tasks that should be simple and painless for everyone.

Getting healthcare for the first time on my own and not through school or family health insurance and getting it through the state subsidized Healthy Indiana Plan has introduced me to an entirely new set of acronyms.  A primary medical provider, that is a family doctor, is a PMP, and your recipient ID number is a RID.  And while cold, technical terms for the participants in a network are fine when we’re talking about computers, when I think about it, it’s a little uncomfortable being reduced to a “recipient”.  Even without the acronyms, the language to describe getting healthcare quickly becomes unintuitive.

After having to change my doctor, or should I say PMP, twice because both my assigned doctor and one I picked from a list of doctors with an “active” status in the MDWise system were not accepting new patients, I ended up just calling most of the doctors on the list provided by MDWise and asking if they were accepting new patients.  It was hard to figure out what to say.  I tried using the PMP term, since that is what was used on the MDWise website, but it just seemed to confuse the seceretaries.  More confusing was when I asked if any doctors in their office were accepting patients.  Most of the doctors that are available through the HIP, with MDWise, in Bloomington are part of a large organization called Internal Medical Associates (IMA) that seems to have around 5 locations and, at least according to their on-hold message, around 60 physicians.

So, it was difficult to figure out which doctors were connected with which location and which phone number corresponded to the office of which doctor.  When I was told that a particular set of doctors wasn’t accepting patients, I was often transferred to another location without really knowing where my call was going.  One location asked me if I had to see a doctor, or if a nurse practitioner (a nurse with at least a master’s degree in nursing) would be okay.  I said either and was able to schedule an appointment with a nurse practitioner  only to then find out from MDWise that only appointments with doctors are covered.

Eventually, I found a doctor who was accepting patients, though not until September, and was able to schedule a physical.  I called MDWise and switched to this doctor and was told I would receive a new insurance card in the mail.  When I told the person on the phone that I had never received my original card, she said that there had been some delays, but that I should expect my new card shortly.  This whole process made me feel happy that I have a job that is flexible enough that I can take the time to make a bunch of phone calls during business hours.  It also made me hope that I will never have to fully master all the acronyms associated with getting healthcare in the U.S., particularly state provided healthcare.  It seems that those who have finally figured out how to navigate the system, to whom the acronyms are second nature, have done so only after a dire struggle to get themselves or their loved ones the care that they need.  I hope that I can stay healthy enough that the frustrations of figuring out how to get health care are an occasional occurence and not a constant reality.  Still, it is important to remember that people already facing the challenges of a state of health that requires more consistent care shouldn’t have to have the additional burden of wading through a bog of acronyms, redirected phone calls, and confusing or unknown information.  I can better understand why some people work jobs just for healthcare.  The idea of being able to get the care you want, when you need it, and to be treated with respect and dignity as you work through the process of that care now seems so amazing, almost luxurious.

I don’t think quality health care should be a luxury.  Perhaps I am naive enough about the logistics of providing health care to expect that everyone could have personal attention, respect, and advocacy for working out problems or questions, but I feel strongly that this should at least be the goal, the benchmark by which the heated issue of healthcare is measured.  I don’t think this is the case right now.  A friend recently made the observation, correctly I think, that the Healthy Indiana Plan is, in fact, a rather conservative proposal.  It seems designed, with it’s coverage of preventative medicine, to reduce the costs of the state from uninsured people using the emergency room and not being able to pay for it.  While it’s certainly true that using the emergency room as one’s primary medical care is not in the best interest of the patient either, my experience with the Healthy Indiana Plan suggests an ultimate goal of cost reduction and not of a positive and healthy experience for the patient.

I’ll continue to write here about my experience with healthcare, with the hope that others in Indiana can share their experiences and together we can identify problems and propose solutions to the state’s healthcare approach. Perhaps we can help share ways that we’ve been able to better navigate the system.  Finally, I want to express the way in which the idea of healthcare has become real for me and not just a topic of presidential debates or news stories.

  • Nitpick: a nurse practitioner is a bit more than a nurse with a master’s degree. NP’s are trained in diagnoses and can write prescriptions among other things.