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Life Health > Long-Term Care Planning

On the Third Hand: Provider Directories

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My husband and I recently had a terrible idea: To take my daughter’s 6-year-old friend and the friend’s mother out for a nice afternoon of 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. Badly. In many complicated, difficult to re-assemble pieces.

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. In theory, given that we had Web-friendly cell phones and an insurer with a Web-based provider directory, 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, to make sure that would know where to go in what a consumer would think of as being an emergency.

Parents 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, 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.

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 at Giant Health Insurer Inc. were available to answer questions.

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, not exactly an emergency.

Certainly, on the one hand, we literate, cell-phone owning adults had a responsibility to be good health care consumers and do our best to use in-network providers.

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

On the third hand: Many Web startups are trying to show that they do something of genuine value.

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 billing hassles.

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.


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