It’s pouring outside, rain gurgling merrily in the air shaft, a perfect day to do a little writing.  I’m working on a book about my father I’ve been neglecting recently and I thought of a great little chapter about his generosity.  I am also working on a book proposal for a much easier to complete book that I have more than half-written.    I’m also working on a letter to the New York State Attorney General, to convince him to propose legislation to regulate the out-of-control fraud of unregulated health insurance companies who do their lucrative business, sometimes enhanced by sharp practices they are not accountable for, in our state.  

But first, I needed to make two key medical appointments.  These having been hanging over me for months; in the case of the dermatologist, for three or four years.  The new kidney doctor (the excellent one I saw a few months ago is not on any QHP I could find) needs to tell me if my membranous nephropathy has yielded to my low-sodium diet and ban on non-steroidal anti-inflammatory drugs (ibuprofen) or if I need to go on an auto-immune drug regimen to avoid the worst case scenarios of dialysis or a kidney transplant.   The skin doctor needs to look at a variety of odd things growing on my skin and tell me which, if any, I have to worry about.  

A nurse friend found me a nephrologist the other day and in a relatively short time today I was able to make an appointment.  I’ll see the new doctor in a few weeks.  Thank God for friends in the field.  

I have the number of a young dermatologist I’ve been trying to make an appointment with the last few days.  I was referred to her by my current insurance company.  I am paying literally ten times what I was last year, for a “higher” level of medical insurance and better care than I was able to get last year.   This doctor’s name came up, and as I found nothing bad about her on-line, I’ve been calling her office to make an appointment.   Although she’s listed as in-network on the “provider” list for my specific silver-level QH fucking P, her office doesn’t think she’s in-network.  They were going to get back to me, but you know how that goes.  When I called yesterday Melanie had no update for me, so today I asked Norma, an extremely nice woman at Healthfirst, to make the appointment for me.  

Norma laughed when I asked if she could put me on hold without the Dr. Mengele String Quartet, and she was able to do so.  I heard only a few notes of their infernal nerve-jangling sawing.  We soon had another receptionist at the dermatologist’s office on the line.   We learned, about 40 seconds in, that the dermatologist was not able to see new patients because she didn’t have an NPI number yet.

If you live in the cocksucking United States of America, and do not have insurance through work, or enough money to buy an expensive but good private plan, and sign up for the PPACA’s mandated product, you quickly learn about things like NPI numbers, which are site specific (the doctor with multiple offices apparently has multiple NPI numbers, or maybe not) and CPT codes, which, if not perfectly transcribed, prevent treatment.  Wrong NPI number?  You pay.   Incorrect CPT code?  No service.  

You want to call someone to fix this?  Call your insurance company, baby, they work for you.   New York State, is there any state agency I can call to get this straightened out?   Uh, no, first work this out with your insurance company, everything’s going to be fine.  Or call this 800 number for the New York State Department of Financial Services which puts you into a cul du sac from the hell our smiling former commander-in-chief, and our glowering present one, for that matter, ought to be frying in.

“Norma, I’m sorry to be venting like this to you…” but Norma was fine, so many customers are experiencing similar horrors.   She worries for her kids, living in an out of control plutocracy with two working parents, a country where it’s no national scandal that tens of thousands die every year for lack of decent medical options, while billionaires compare taxation to Auschwitz.  She worries about the increasingly demonstrative boa constrictor that is life for working people in our great nation.  She is fine with my complaints, interested in my analysis.  But it helps neither of us, helps nobody.  

When I venture my opinion on the precedent, created by our recent two-term chief executive, of killing American citizens without trial or charges, passed on to this angry, unstable fellow occupying the oval office now, she becomes quiet.  It is horrible, she agrees.  Then I cross the line, as one ranting and venting while caught in a chafing trap often does.  

“When we droned a sixteen year-old American citizen, not charged with anything, and the press secretary said, in response to a question at a televised news conference,  ‘he should have been more careful about who his father was’, the proper response for the reporter was to break the press secretary’s nose.  To show that unaccountable violence by the State, in our names, is an unacceptable answer– wipe up your blood and try again.  The American people will no longer accept that kind of crap… our government is not a reality TV show where anything flies that makes people tune in and the cash registers cah-ching.”

Now Norma was silent, and I didn’t blame her at all.  A patient and empathetic woman, she’d been wonderful throughout a long, frustrating chat.  This was more than she was being paid for.  I told her as much, thanked her for her kindness.  She told me, gently, that it had been her pleasure, wished me luck and I sat down to type.  I figured that was as good an option as going to fuck myself.  

I’m going to call my nurse friend and ask her to get me a recommendation for a dermatologist.  If I have to travel an hour from my place to get my skin scanned, as I will to see this nephrologist to have my urine and blood re-tested, so be it.  Now just sit back and enjoy the rain, it’s another happy day for motherfuckers.