John R. Fischer

More often than not, we stand alone when it comes to any challenge, including with our own healthcare. Whether it’s a medical emergency or the common cold, doctors and nurses are caring for multiple patients and will not stop everything to tend to your needs when it suits you best. Regardless of how severe your condition may be, someone else always is ahead of you on physician lists.

Because of this, it falls upon us to be our biggest and most of the time, only advocate for securing the care we need. This past week taught me a number of lessons on this subject, and in the process, gave me a better understanding of how much I value myself and what I am willing to do to have my care needs met as soon as possible.

A little over a week and a half ago, I began to feel pain in my neck. I immediately knew what it was a pinched nerve. Having had this condition a few months back, where it went away after a week, I did not think much of it and assumed this would be gone within seven days as well. But fast forward a few days to last Monday, I realized this was not the same when I awoke around 6 AM to the most excrutiating agonynI have ever felt in my life. The acute, sharp pain was shot down the lower right side of my neck like a bullet train traveling at 100 miles per hour to my shoulder and down through my entire arm.

Unable to lie down, I paced around my apartment, hoping that moving around would stop the pain but it only intensified, and after an hour, I realized I needed medical attention. Because it was Martin Luther King Jr. Day, I knew there was no chance of finding a primary care doctor in my area who was open, and was forced to wait another hour for the earliest urgent care to open. When I finally was able to go to it, I was told there was little they could do, and that my best bet was to head to an ER if the pain was that bad. I ordered an uber and headed to the nearest one I could find at NewYork Presbyterian Methodist Hospital two miles away.

On average, patients spend 25 to 50 minutes waiting to be admitted to the ER, according to a Business Insider story that was medically reviewed by a doctor, and Mondays are notorious for being the busiest. When I arrived, a triage nurse recorded my symptoms and told me I would need to wait a while in the waiting room. By this point, the pain had taken such a toll on my body that I began to feel hot and nauesous. My vision became blurry, and the voices of the people around me were muddled and growing fainter. Feeling like I was about to collapse, I told the front desk that I needed medical attention immediately or I would pass out. Within two minutes, the nurse arrived with a wheelchair to take me inside.

Had I not said anything, I probably would have passed out and fell on the floor, potentially making my condition worse. Lesson number 1 of self-advocacy: Don’t stay silent, speak out. No one else will for you, and if you don’t say anything, no one will do anything to help you.

Once inside, I removed my coat and fleece, which helped me feel less hot and my vision and hearing began to return. I think the anxiety of waiting combined with the hours of pain I had already endured were what made me feel like I was going to collapse. I tried to lie down on the bed, but the pain would not let me relax. Instead, I sat there, taking deep breaths to try and relax myself in between pangs of pain. The doctor arrived, and I told her my symptoms. She said she would put in an order for some pain relievers and left me alone in the room. Half an hour later, I still had not received my meds.

I don’t blame the ER for this, as I know the doctors and nurses there are dealing with 40 to 100 patients or even more at times. But not being able to endure the pain any longer, I knew I needed to do something. So I slowly walked over to the nurse’s station and tried in the most polite way to ask when I could expect to receive my meds. The nurse I spoke to gave me a curt, “When we have them.” Instead of arguing, I said okay, thanked him, and walked away. No sooner had returned to my room when five minutes later, the same nurse appeared in the doorway of my room with a cortisone shot, a valium, and some tylenol.

Lesson number 2: It never hurts to ask. Not only does it not hurt to ask, but if you do so in a polite way, people are more likely to give you what you need. Advocating for oneself is an art form that requires balancing assertiveness with patience and respect. Even though the nurse was curt with me, I can’t help but feel that my demeanor and choice not to argue with him made him more a little more compelled to get me my meds. By saying something, I made him aware of my needs, and by thanking him, I silently indicated that I understood his frustration and was not trying to make his job more challenging or give him a hard time. I can only imagine how many people have screamed in his face, asking why they haven’t yet been seen or received their meds. It just goes to show, a little kindness and patience can go a long way.

An hour after taking my meds, the pain remained unchanged, and I knew I needed something else. I again headed over to the nursing station and politely asked another nurse to page the doctor, saying that the meds I took weren’t working and I needed another solution. Within ten minutes, the doctor showed up and said she would get me another round of meds. A few minutes later, the first nurse who delivered my meds appeared again with a steroid and some morphine tablets.

I still could not sleep on the bed, so I asked the nursing station for a chair, only to be told to sit on the bed. I understand why. They probably were dealing with a lot of patients, as it was mid-morning and didn’t have time to go looking for a chair. But I knew I needed a hard surface to rest my back against, so I found the doctor and asked for a chair. She obliged and got me one. Lesson number 3: Don’t take no for an answer. If you need something and someone tells you no, ask someone else. Remember, people may be too busy to accomodate you, so try and find someone who may not be so stretched for time. While doctors are just as busy as nurses, they do not have as many physical demands and may feel more relaxed and therefore, more willing to accomodate you, as mine seemed to be.

It took an hour and a half, but the meds eventually kicked in, and I started to feel better. After a radiology scan to rule out any broken bones, I finally was able to fall asleep with the help of the morphine, and when I awoke, left the ER with a prescription for some pain meds.

Two days later, the pain was better but still hurt. Feeling that the meds I was prescribed were not strong enough, I headed to an urgent care where I got a prescription for some more powerful pain relievers and lidocaine patches, which are medicinal strips you place on areas of your body to relieve nerve pain.

At the pharmacy, I was provided with my pain medication but told that the lidocaine patches required prior authorization and that the urgent care needed to make a request to my insurance company. When I phoned the urgent care to tell the doctor, I was told the pharmacy had to submit a CoverMyMeds request to the urgent care before it could get the ball rolling.

This is where delays in care always occur, because no matter whom you talk to as a patient, no one ever gives you the full details of what you need to know. And often times, different parties will tell you completely different things, creating more confusion and extending delays. In my situation, I called the pharmacy to ask it to submit a CoverMyMeds request, only the pharmacist to say that my insurance does not require this and that the urgent care has to call the insurance company to start the process.

After a day and a half of playing telephone tag and being the messenger between the urgent care and pharmacy, I finally took matters into my own hands and went down to the pharmacy. I had the pharmacist call and explain the issue to the urgent care, while I was there. The urgent care said it would call the insurance company, but a day later I called the insurer myself and was told that no request had been filed. Whether my insurer could not find the request or the urgent care never made it, I am not sure. Luckily, the insurance company told me I could start the process on my end and that it would fax over the request to the urgent care. So, I got the ball rolling myself and then called the urgent care to confirm it received the fax. The receptionist had the doctor fill out the fax form, marked it as urgent, and sent it back. A few hours later, I got a message that my insurer gave me the green light to get my patches.

Lesson number 4 (I know, finally): Don’t wait for others, act yourself. If I had waited for either the pharmacy or the provider to figure out who had to start the process, I probably would not have gotten my patches at all. The same is true if I had waited for the insurance company to make the request. Call the insurance company yourself and see if you can do this. If not, go down to your provider in person and ask to see the doctor to make sure this happens.

The thing to understand here is unlike a primary care doctor, who sees patients regularly and has a relationships with them, an urgent care doctor is never sure if they will see a patient more than once and as a result, is less likely to be motivated to engage with the insurance company as fast to secure prior approval requests. Most of the time, they have already shifted their focus on their next patient.

Additionally, the problem also lies with the insurance companies and their lack of transparency. Almost each one has their own prior authorization process that lack any uniform paperwork or guidelines, making it harder for any provider that takes multiple forms of insurance to start and complete the process, which is a big reason why patients can run into barriers that prevent them from getting access to necessary medications when needed.

The process is meant to prevent patients from spending money on unnecessary services, but in many instances, does the just the opposite by keeping them from accessing the care they need in a timely manner. According to the American Medical Association, 30% of physicians also say that prior authorization criteria is rarely or never evidence-based, meaning that insurance companies do not explain why they approve or reject PA requests, forcing providers to figure out on their own why a request may not have been approved to begin with, further delaying access to treatment for patients as well as contributing to headaches and even burnout among providers.

By starting the process myself, I was able to get my patches within a few hours. When I arrived at the pharmacy, I was told there were 30 patches and that together they would cost me $100. I knew I did not need that much and asked if the pharmacy could cut it down. They were able to, and I ended up only spending $33 for 10 patches, with the rest still available should I need refills. While still a lot for patches, I feel, just that one question saved me almost $70. Again, lesson number 2, it never hurts to ask.

No matter what, people have their own priorities, and there time is just as valuable as yours. But if you want your needs to be met, you need to be your own advocate and speak up. At the same time, you don’t want to come off as aggressive or unappreciative, as this will make people less inclined to help you out. You must be courteous and respectful when asserting your care needs. None of us want to annoy or take time away from others, but sometimes you have to to get what you need. Always be polite, but do not wait around, because then you may not get the care you need at all.

Self-advocacy is an art form that requires tact and the right approach. Like anything in life, it’s not easy but is achievable and can be learned by practicing it as well as by taking constructive feedback from others. Most of all, the best way to learn is through failure, as is the way to learn most things in life, so do not beat yourself up if your advocacy hits a roadblock or you make a mistake. Instead, pay attention to Lesson number 5: Learn from your failures. It takes time to learn how to advocate for yourself, and trying and failing is the best way to improve this skill. Failure helps you grow more than your achievements and to learn more about yourself. Additionally, it can teach you to love and value yourself more by giving you a better understanding of your self-worth, which is the ultimate key to successfully advocating on your own behalf for anything, including your healthcare needs.