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On the Third Hand: Provider Directories

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A few days ago, my husband and I had a terrible idea: To take my daughter’s 6-year-old friend and the friend’s mother out for a nice afternoon of Mother’s Day ice skating.

Many details here have been changed to protect the identity of my daughter’s friend, but one point that is genuinely true to life is that the child broke a bone.

The mom was there and had great health insurance from Giant Health Insurer Inc., so, no problems there.

The health insurer had a Web-based provider directory, so, in theory, between having the provider directory and Web-enabled cell phones, there should have been no problems there.

In the real world, there were problems.

In a perfect world, Giant Health Insurer Inc. would have charged us $10 each to provide an app that would have pushed updated, personalized, localized kid care provider information into our phones every month, or even more frequently.

Mothers who wonder what they will do if their children get hurt are probably the world’s best customers for apps. Offer us programs that promise to adjust our children’s astrological charts to reduce the influence of Pluto on their injury rates and we’ll buy that one, then ask about apps for adjusting the effects of Mercury retrograde aspects. If we’ll jump to buy that sort of nonsense, then think how much more likely we’d be to pay 10 easy, 1-click dollars for an app that might actually have value.

As it was, we were driving through the wilds of Manhattan with a 6-year-old boy with a broken arm, pleading with the Web to dole out information as we passed in and out of cell phone range.

The provider directory said one thing about which doctors were in network; provider review sites seemed to say something else. There was no way to search for in-network doctors who could handle children with broken bones and were actually in the office at that moment.

When we finally got to a hospital — that was, according to the provider directory, in-network — the hospital and doctors were unable or unwilling to say which, if any, of the doctors the child was seeing were actually in network.

Of course, the injury happened on a weekend, so no live humans were available at Giant Health Insurer Inc. to answer questions.

Was the provider directory wrong, or was the provider review site wrong? Probably the latter, but only time will tell.

We live in an age when friends tell their friends whether they’ve checked in to a coffee shop or bookstore, and we work in offices where our e-mail systems tell us whether colleagues are in or out.

Where are the apps that tell health plan members which in-network emergency care and urgent care providers are working at the emergency care and urgent care facilities in a health plan enrollee’s network?

The Patient Protection and Affordable Care Act (PPACA) does require to plans to limit enrollees’ out-of-network emergency care costs to the in-network cost-sharing level.

I don’t know if that provision will apply in this case. Taking a 6-year-old boy with an arm that might be broken to the hospital certainly feels like an emergency to the adults involved, but maybe that was just a very urgent care matter.

And, really, all of the adults involved wanted to be good health care consumers. None of us were trying to run up Giant Health Insurer Inc.’s costs. We would have very gladly have taken the boy to certified in-network doctors if there was a practical way for us to do that.

And, certainly, on the one hand, we literate, cell-phone owning adults had a responsibility to be good health care consumers.

But, on the other hand, it would have been much easier to use a cell phone to find good pizza delivery options near in-network hospitals than to find and get in-network near-emergency urgent care.

On the third hand: Facebook is about to launch an initial public offering and is trying to show that it does something of genuine value.

Groupon is trying to show that there’s value in sending hordes of customers to advertisers who will offer special one-time deals.

Other services show users where their friends are.

Why not talk one of these companies into developing an app that can display a map showing the current locations of in-network emergency care and urgent care providers who are actually in the office? Charge patients an extra amount to see those doctors, and, in return, find some way to protect patients who see those providers against balance billing.

I think that, if nothing else, a private-sector initiative to create that kind of app would ease a lot of the balance-billing grief that turns health policy wonks with what on paper appear to be platinum-level health benefits into bitter, bitter people. There’s nothing like paying $2,000 in out-of-network bills for emergency X-rays to turn a diehard free-market health insurance system advocate into someone who thinks The Government Should DO Something About That, Goshdurnit!!!!! 

On the fourth hand: All of the commotion about PPACA, Greece and rising health care costs may swamp any efforts to improve the commercial health coverage market. Maybe the best we can really expect out of our health care system over the next few years is a choice between aspirin and a leather thong we can chew on if the pain gets too intense. But a mom can dream …


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