Everyone Has A Story: Nolan Kelly

My story isn’t about a large and scary medical episode. It’s not about some big price tag or near-death experience. It’s not overly dramatic. But that’s kind of the point. My story is a right-down-the-middle example of what everyone in this country deals with regularly. And it was really, really frustrating. It put a spotlight for me on some of the systemic, operational issues in healthcare. And it made me think about all the moments anyone could just throw in the towel and say, “Forget it, I’m fine,” without really knowing.

My story began with unexpected appendicitis. I guess that does qualify as an emergency event, and it brought me to the emergency department for an all-too-expected eight-hour carousel of waiting, talking, waiting, testing, and waiting. I was ultimately whisked upstairs for emergency surgery with everything going according to plan. In my post-op discussion with the docs, they reviewed my notes with me, suggested a follow-up colonoscopy to rule out any root-cause risks, and sent me on my way. But this is when the real pain showed up.

Navigating Follow-Up Care

Let’s start with trying to schedule a colonoscopy if you’re under the recommended age of 45 and don’t have a documented family history of colorectal cancer. No one will schedule you until it’s confirmed that insurance will cover the procedure. Not an unreasonable ask; they have a business to run, but in my instance, that should’ve already happened.

Insurance Logistics

So let’s move to insurance. They just paid $41,000 to my local hospital for my surgery. Surely they know from the hospital how it went, what the doctors reported, and the clinically recommended next steps, right? I guess not. They had no access to any of that information from the hospital. Nice of the insurer to pay $41,000 without seeing the clinical record for what they’re paying. So I had to start the process of taking screenshots of my clinical notes detailing why a colonoscopy was the recommended follow-up care.

Inefficiencies In The System

I think my point is this. I just bought a pair of pants online on Black Friday. Shopped from my phone. All my info was known and pre-populated, shipped right to my house with a data handshake between the retailer and UPS. I tracked the whole thing and got a text with a picture when it was delivered. Pants don’t fit right. So I clicked one link from my email inbox, printed a return label, and brought the bag to a UPS dropoff location. Done and done.

Juxtapose that with having to make phone calls to PCP asking them to fax my records to the surgery center. That turned into printing out an info release form, filling it out in pen, taking a picture of it, and emailing it to the PCP before they could fax my info out. Not too dissimilar to the other work I had to do of taking screenshots of my hospital’s online portal and emailing them over. And the engagement with my insurer to get this approved and tied together. It’s just not how the world works anymore. My expectations as a consumer are different and the market hasn’t moved fast enough. There were lots of opportunities for me to bail, but with a lot of eye-rolling and some personal frustration, I waded through the inefficiencies of this system, just like everyone else. But this has to change.