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Today I spoke with a former nurse who worked for years in Texas and California because she genuinely wanted to help people. What she found instead was an insurance bureaucracy dedicated to extracting wealth from the bodies of the injured and the sick and even more exasperating for her doctors who were willing to manipulate that system to enrich themselves. Finally a couple of years ago after working for a particularly malicious orthopedic surgeon she decided she could no longer in good conscience be a part of that system.

Here she explains why.

What prompted you to send me your story?

I had read something you posted about healthcare, the story of a man and his son, and all the paperwork they had to do to get him covered by insurance. I read that and I was thinking, oh my gosh, I can relate to that, how you’re trying to constantly figure out, I wouldn’t say loopholes, but how insurance companies are constantly trying to prevent you from getting what you need. I’m dealing with it right now with my daughter and her braces, and the way they constantly trying to stonewall you is outrageous. 

You were a nurse in Texas for eight years?

I was in Texas and California. My late husband worked in the solar industry and we travelled a lot for his work. We stayed a lot on the west coast, but my family is here in Texas so we were always coming back and forth for long periods of time. My dad was sick, so if I knew we were gonna be here a while helping him I would get a job here. 

When did you quit the field?

I left in late 2017 after my husband was killed in a car accident. Really put things in perspective I guess? I did some insurance policy stuff in 2018, mostly to help patients, as any extra income messes with my survivors benefits, while going to electrical school. It was all doom and gloom. Texas has the worst, and I do mean the absolute worst, coverage when it comes to Medicaid and benefits and coverage I've ever seen. The healthcare industry is diseased.

But you liked the actual caring for people part right?

Nurses are truly nurturers. I don't think we would be nurses if we weren't, but the healthcare industry does something to you. It's become a black void of greed and corporate shills who have no regards for the sanctity of life. I could no longer do a job I loved because I believe in compassion, selflessness, and solidarity with my fellow humans, you know? So after some major life changes of my own, I decided to become an electrician and use my electrical powers for good. 

What type of nurse were you?

I was a Licensed Practical Nurse, then I went back to school online for healthcare administration to start transitioning to the business side of healthcare. I really did enjoy being a nurse. I'm a compassionate person by nature so it was a good fit. The healthcare industry is not. During my time as a nurse I definitely became an expert at handling insurance companies and billing practices, what we'd refer to as the business side. I used to want to transform the healthcare industry. I've personally radicalized hundreds of patients by informing them of the sneaky practices the companies were doing behind their backs! But alas, I gave up before it could suck my soul dry. 

So the business side is where your frustration comes from? How long did it take to get disillusioned?

I would say almost immediately. Even working as a nurse, when I would work with patients, I still picked up on things. They keep things separate, so you have the nurses, then the business aspect. Nurses don’t always know what’s going on, what the insurance plans will accept. If the nurse is like ok this is what we need to do, the nurses don’t know if it’s going to be covered. We have to check with the patients’ plan first to see if the insurance is going to cover it. Then we go to the other side, where it’s up to that person running the business aspect to say we’re going to look at the plan to see if it’s permissible. That separation is really frustrating. 

It really is. I go to my doctor or nurse sometimes and ask do you know if this is going to be covered by my insurance or how much it might be if it’s not and they can’t tell you.

Doctors are in the same position. Say you have a person who comes in with a sprained ankle. The first thought is we need to do x-rays. They’re not thinking about if the x-ray is going to be covered, or if it’s going to go toward a deductible they patient will have to pay out of pocket. They’re not aware of that aspect of what’s going on, they just know that people need to be treated. 

I guess there’s some good to that, because you don’t want the doctor thinking about money considerations upfront before treatment. 

Right, you need to treat, not worry about those things. But a lot of the time doctors and physicians, they do a lot of, I’m not sure if it’s over-testing, I get that they want to be cautious but...sometimes they do things because they know the insurance is most likely going to cover it and that the doctors will be paid for it. But if your insurance doesn’t actually pay for it, then you’re out of pocket. 

You had a really bad experience with one doctor which I want to talk about, but were there others you found to be cynically manipulating billing insurance?

Almost every private practice doctor I’ve worked for is all the same. I believe there’s a huge difference between doctors who work in emergency rooms and hospitals and private practice doctors. 

What is the difference?

I’m not saying private practice doctors don’t care, but they’re working for themselves. 

So it’s easy to manipulate the billing like this?

Yes.

Something you saw first hand doing the paperwork for doctors? 

Yes. When the ACA came into effect you'd have thought they were the ones in need of medical attention. Their first thought was money. They were going to lose money. In the next few years they would find ways around it by simply refusing to see patients with Medicaid. Not being contracted with Medicaid meant their new scapegoat was to say “We're not in network.” It was awful.

I've told a patient who had just been diagnosed with terminal lung cancer that their insurance company would not pay for treatment because they themselves were not deemed viable. I've told women with breast cancer their insurance has denied a second mammogram for being medically unnecessary. I've told parents who were barely hanging on to hope that their insurance was not in network so we would be sending their child six hours away to another, less qualified facility. But I guess it was after I saw a little girl with the same name and age of my daughter that I'd finally had enough. 

That girl was the final straw for you leaving the industry.

The catalyst for leaving was when I was working for an orthopedic surgeon. There were a few orthos in the area but none had a contract with Medicaid. We were the only ones, which I later found out was only to receive a tax credit. Even though this doctor did accept Medicaid, there were stipulations the office manager had put in place. You see, doctors who have their own private practice don't like to see Medicaid patients, because Medicaid doesn't pay as much as say, Blue Cross Blue Shield or Aetna. Those are the gold stars, the money-makers to doctors. If a patient came in with a broken leg, the doctor already has a pre-negotiated price with the insurance providers for how much they can charge and how much the insurance company is willing to pay out once it’s deemed medically necessary. So a person with Medicaid vs. a person with Aetna is a drastic price drop. Hence why doctors have extreme bias against patients with Medicaid. 

So this particular doctor, the only ortho in a rural area who accepts Medicaid, has decided he will allow low income patients for a tax credit, but it was determined they would only allow one Medicaid patient per month. Me, being the person I am, would schedule numerous a week because I found the doctor and his wife to be greedy bitches. I got yelled at plenty. 

So back to the catalyst. I had just received a call from the hospital in town who had a four year old girl in desperate need of an ortho. She had fallen at school and broken her arm. It didn't require surgery but she would need a cast, continuous care and lots of follow up visits. I didn't hesitate. “Absolutely! Bring her now!” 

The little girl arrives with her mom and they're both freaking out, which I would expect no less. When I was questioned about who the new patient was, I explained the situation, and all was well, until the doctor found out she had Medicaid. He and his office manager, his bitch wife, were livid. I'd never seen such contempt for a small defenseless child in my life. 

I was immediately told to send them packing. “And where should I tell them to go?” I remember yelling. To the next city over, an hour away, they told me. I couldn't believe it. I went into the bathroom and cried. Cried for this little girl being treated this way because I had a little girl at daycare her same age who was also on Medicaid. I quit the next day. There were several other instances that had made me want to quit but that was the last one. The way they looked at it was I was costing them money by scheduling these patients. Well you're in the healthcare industry. You’re a doctor. You’ve taken the hippocratic oath. Come on.

The girl did end up being seen. It came down to if you want her to leave you need to go tell her and their mom. I said I’m not doing that. I guess they didn’t have the cojones to do it either. It upset me so much.  I was thinking about how my daughter is on Medicaid. It’s because they lost their dad and we lost his health insurance. Things happen. I would be horrified if someone treated my daughter this way. I have one the same age. I said, you know what, life is too short to live this way.

And that sort of thing was common among doctors you worked with?

The price gouging was terrible. Especially to the elderly who don't check their policies on what the doctor should and should not be charging for procedures or even minimal care. All doctors have solidarity. They put what they deem “higher class” patients ahead of anyone else in exchange for golf trips, free Lasik, 30% off a new Lexus (really happened). It was a disgusting power exchange. The hospitals are just as bad, but the staff are usually powerless. They're held hostage by administrators, CEOs, funding. Lots of red tape and politics that I wasn't usually privy to being a nurse. The doctors there are usually oblivious and exhausted. I worked for a few private practice doctors and they were all the same.

And quitting was hard to do because you needed the job I imagine.

I did. But at the same time it was like, ok we have these survivor benefits from my husband to lean back on. So I was financially able to do that. Had I not had the survivors benefits I would have had to suck it up.

After I’d loss my husband, when you're facing something like that, you kind of come into perspective about matters in life. When my husband was alive he made really good money and we had health insurance. Blue Cross, $1200 a month for a family of five, with a $5,000 deductible. So after my husband passed away and I wasn’t working, I put my children on Medicaid. 

We came down here after my husband passed away to be with family. My parents had lost everything in hurricane Harvey. When we came back to Texas everyone was doing really bad. So I went back to work for a while to try and keep things afloat. 

What were the circumstance of your husband’s death?

He was killed in a car accident on his way home from work. For reasons beyond me he did not stop and get gas and so the car ran out of gas. We’d just been transferred to Texas, so he missed an exit on the way home. I’m assuming because we were in a new area, you miss the exit, and you’re just kind of in a desolate area of no man’s land. He got out and started walking home. We were texting and talking on the phone. I was like where are you it’s late. He was walking down the side of the road wearing all dark clothing and he was struck by an 18-wheeler. It was pretty devastating. 

My god I’m so sorry. I assume you think there’s a better way we need to do health insurance? Do you think Medicare for All would be a better system?

Yes of course. The current system we have is not working. My sister is an EMT in Houston, and she works with high risk babies, babies born almost not viable. And for her health insurance she pays like $800 and she can’t even use it because her deductible is so high. And she’s out here working with babies who are striving to live! You’re an EMT and you can't even afford your own healthcare. It’s a tragedy. It really is. 

When I was in California I was able to get counseling for PTSD and bereavement care after my husband. I had to be hospitalized once or twice. Everything was taken care of until we came back to Texas. I just applied for adult Medicaid. I’m only bringing in maybe $2,100 a month for me and my two daughters. And I was denied Medicaid because I make too much money! I asked them, so it’s not enough to be poor, you want me to be destitute? They said in order to qualify for adult Medicaid in Texas your monthly income has to be $280. Who in the world can survive off $280 a month? 

It’s another example of when you’re not doing well, there are all these artificial barriers set up to prevent you from getting help you sorely need. 

Right. You’re poor, but not poor enough. 

And who has the time to figure all this shit out?

Yes. It used to be, and I say this because I helped many people do this, for Medicaid and benefits, you used to be able to lie. And it was easier to get coverage or get benefits, because you could say I’m paying this much in rent, these expenses, and they would check, but it was a lot easier to work around the system. Now they’ve closed those loopholes. 

I think that a conservative person reading this, or a bad person in general would hear that and say that these people are trying to get one over. But compared to the amount of theft and lying insurance companies do routinely, it’s nothing.

Exactly, and it’s the exact way I looked at it. We had a woman come into the emergency room. She was diagnosed with Crohn’s, but she had to have half of her small intestines removed. This was a few years after the ACA. It was like ok, she’s in the emergency room, she doesn’t have insurance, she’s about to have this major surgery. I sat with her, and I said we need to go over your finances. This is what we need to make happen to get you on emergency Medicaid so you’re not going to have to pay for this huge surgery. The way I looked at it, I told her family, this needs to be done. Not only is she not going to be able to afford this surgery, but as much as her and her husband put into taxes for other things in the government, she should be able to have this surgery. 

They never ask how we’re going to pay for the bombs, always the healthcare.

And that’s the way I always looked at it. When I went into the administrative side I helped many people get on Medicaid or try to find loopholes for services they need. You’re working, you’re putting in your dues, the least they can do is help you out when you're sick. 

My oldest daughter is ten. She needs braces. It’s been deemed medically necessary because of the way her jaw is. The way they get around that is by all the paperwork. The orthodontist keeps submitting paperwork, then they say we need this picture, that picture. I drive her over there and they take it. Then the insurance says they never received it. It goes back and forth like that. They pussyfooted around so long that I finally said we’re just going to pay for it out of pocket. That’s the way they do it. They bury you in paperwork, and make these arbitrary deadlines, and that’s how they roll. 

Thank you so much for sharing your story. 

Thank you for caring Luke. You’re a real one.