FIDUCIARY RESPONSIBILITY


Years ago, my wife was on the Blue Cross Advisory Committee advising them whether certain procedures qualified for coverage and payment.  Reduction mammoplasty was discussed one night, where excessive breast tissue, a significant problem for some women, is removed.  A lot of men don’t understand the issue, but large breasts require a woman’s back and neck to compensate for the torque, causing pain. Skin rubbing against skin causes redness and infection.  There are women who benefit greatly from this surgery, and my wife argued that it ought to be covered by insurance.

Others commented that some physicians would use this coverage as a way to do plastic surgery on women who wanted their breasts reshaped, not true reduction mammoplasty.  This is “gaming the system” or “cheating.”  To my wife, the issue was whether Blue Cross would deny the procedure to women who were suffering because of cheaters, or cover it anyway.  Nearly all of us have suffered because of a few bad apples ruining it for everybody, with the flagrant exception of guns, where virtually no restrictions apply.

Reduction mammoplasty was paid for.  It was one of my wife’s quiet triumphs; she doesn’t brag about them.

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We should have walked out of the mall on New Years’ Eve without going by the Sprint counter.  Between that and the endless cold I’ve had with laryngitis, it was another crappy holiday season.

We have two carriers for two phones.  AT&T works well in cities, but it doesn’t work in most wild places.  I accept that.  My wife uses Sprint; her phone works in Arizona but not in the house in Eugene, a reasonable-sized city.  If her phone rings, she makes a beeline to the bathroom, where the reception is best, before the call drops.  She has been to the Sprint counter three times, and got a quote from another carrier that she liked, but she needed the phone “unlocked”.  That will be legal in February, finally, but may be difficult for Sprint phones.

At the counter, we went through the same discussion about her phone with a different person.  Time passed, and we should have just told him we had already discussed this.  Neither my voice nor my mood was improving.  We heard about how bad other companies were; well, Sprint wasn’t working for us.  Finally, we were offered a booster device for free; prior to this, we were told we had to buy it.  We had heard at a computer store if one got insistent with Sprint, one could get the device for free.  I find that dishonest.

We finally saw three employees huddling in a corner near the kiosk, I guess trying to discuss what to do with this old couple who clearly weren’t happy.   Later, one told me that 3 bars was all he got, and the number of bars doesn’t matter.  Actually, it does, and I drew a exponential graph, showing that 1-2 bars is pretty much the same, 3 is a little more, and 4 or 5 are significant.  I may not know much about the various CDMA and GSM technologies, what bands the carriers run on, and the various models of iPhones.  I do know something about dropped calls and people who can’t hear me.

I finally told my wife, “15 more minutes,” because we weren’t making progress, wasting yet more time in my life, in which I have wasted enough.  The second guy was still on the phone with customer support, “because your call is important to us.”  In any case, at this point, a slightly older man, number three, probably the manager, started to talk to us.  He should have been called right away, when it was noted we had been here before, and we had a difficult problem.  That is what managers get called and paid for.

He asked a good question:  “What would make you happy?”  My wife said that a working phone in the house would help.  He then started going through the same fixes we had heard about three times—or was it four?— to the point where I just walked away.  When I returned, he was still going, time was passing, and when he said, “usually” referring to getting a free booster, I walked away for good.

The booster is so simple, we were told it just had to be “plugged in”.  Well, not exactly.  There was a 5+ minute video on YouTube which involved a lot of unplugging and plugging, followed by a cord to run a GPS to a closed window.  That wasn’t going to work for us.

I don’t like the telecommunications industry, and it goes back to the ATT deregulation of 1984.  It ruined phone service.  For years after, I was shouting into most phones, often claiming we had a third world telephone service, well before cell phones.  Don’t laugh.  I’ve texted home from central Kenya better than I could text from my driveway when I lived in Tucson.  The companies now have us hostage to our phones or vice versa.  Take your pick.  Where is fiduciary responsibility in America today?

When I practiced medicine, my job was my patient’s welfare, concomitantly recognizing that resource use affected all patients, and I had to be a steward of society’s resources, too.  I got up in the middle of the night, was yelled at, spat upon, threatened, in order to treat patients, many of whom didn’t pay me ($30,000 worth of unpaid bills every year), could sue me if I were wrong, but had the right to the best care I could give them.  I didn’t do unnecessary tests to pad my wallet.  I did what I thought I needed, charged fair prices, often discounted them if the condition were simple, like a spontaneous facial paralysis (Bell’s Palsy).  This is fiduciary responsibility.  The patient’s needs come first.

I expect my financial advisor to act in MY best interest, not his.  I dropped one because he recommended only his company’s products.  Health insurance companies in my view have a fiduciary responsibility to cover what should be covered and not covering what shouldn’t be. I remember how upset many were when bone marrow transplants for breast cancer were not covered.  They were not proven to work.  Not paying for it is not the same as saying the person can’t have it.  The procedure was eventually abandoned.  Reduction mammoplasties are covered.

I’m a naive, old, retired physician.  I had a fiduciary responsibility for my patients.  It took so much out of me that I eventually quit practice.  Companies have fiduciary responsibility to stockholders and to their customers.  It’s a balance:  do-gooders can go out of business for not collecting money.  Others run highly profitable margins at the expense of their customers.  The rules in medicine were different.  We took care of people first.

I did not have a sign in my office saying, “Payment is expected at the time of service.”  Silly me.

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