Health care
This is going to be a rant-y post. If you have strong opinions about
health care, opinions that cause you to talk about "socialists" and
"nazis", you may want to stop reading now, since this will probably
offend you.
What ails me
With that out of the way, let me give some background. Almost 2
weeks ago, I broke my elbow while cycling. A friend of a friend who
was cycling with me clipped my rear wheel, and I fell off my bike. I
wasn't going fast at all. I didn't even hit the elbow in question on
the pavement -- I just twisted it badly.
I knew something was wrong when I got to work and went to take
a shower, and my elbow hurt a lot in the process of removing my
clothes. So, I decided something more serious than scrapes and road
rash is going on, and I better get it checked out. This is going
to be my first experience with the health care system in the United
States. I've lived here for several years, but never needed to see a
doctor or go to the hospital. I have health insurance. Not knowing
better, I have the default one my employer (Google) signed me up for:
Blue Shield HMO.
Ignorance
My super-nice friend at work offers to drive me to the hospital. But
she recommends an urgent care centre rather than the emergency room.
Lines will be shorter, she says. Ok, fine, I've never done this before
so I take her advice.
We show up. I register. They're not sure my insurance will cover it,
since I'm out of network. I call the insurance company. They tell me
that since I'm > 30 miles from my "primary care area" or something
like that, emergency care (which is what I want -- broken elbow here!)
is covered out of network. Great. To make sure it's covered, I have
to call my primary care physician and get them to "note the referral
on my file" or something like that.
I call them up. They say they can't do that. At this point, I have a
broken elbow and don't feel like trying to make my insurance company
and my doctor fight it out with me as the intermediary. I get in a
cab and go to the emergency room.
Okayish
The emergency room is basically fine. There was no huge waiting line,
and they were pretty efficient getting me in. However, once they got
all my information they left me in a (pretty comfortable) room for
about 2 hours before actually doing stuff. They took some X-rays, and
gave me a splint, and let me go. I needed an orthopedist appointment
within a week, they said.
So far, up to this point, we're not doing so badly. I had some
insurance BS at the urgent care place, but that was sort of due to
my ignorance about everything. I should have just gone straight to
the emergency room.
Frustration
Here's where the real frustration sets in. To get an orthopedist
appointment, I need a referral from my PCP (that's primary care
physician, for those of you not paying attention). I call them up.
I tell them just that "I need a referral for an orthopedist". They
say, "ok fine, here's the number, call and make an appointment".
Wow, that was easy, I thought.
Now I call the orthopedist. They don't ever answer the phone; you
have to leave a message. I do so. They call back, but I'm
in the shower. Repeat again the next day. Turns out I shower and
they check their messages at the same time every day. After this,
they just stopped returning my calls altogether.
At this point, it's already a week after I broke my elbow. 1-day
round trip time combined with hefty packet loss is a bitch.
Finally, I decide to get 21st century on their asses. Maybe they
have a website! They do! I fill in their ghetto "contact us" form
on the website, and they actually email me back! I have an appointment!
The appointment is scheduled for a Wednesday, 13 days after I broke
my eblow.
Except. They need a written referral from my doctor. I can't
get that without actually going to see her. So now I need another
appointment, with my PCP, I guess so that she can look at my splint,
say "um, yeah, I guess you really do need to see an orthopedist",
and write a referral.
And guess what? My doctor's out of town. I can't see her until
after my orthopedist appointment. So I have to cancel that
one, and start again. Who knows how long it will take to get the
next appointment.
Meanwhile, my fiancée, whose mum is a nurse, is telling me
scary stories about how they might have to re-break my elbow because
it won't be set correctly, etc. Great.
Lingo
The main thing that led to this complete fail is my lack of
familiarity with this whole system. I failed to understand the
lingo of what exactly "referral" meant. When the doctor's office
gave me the number of the orthopedist and told me to make an
appointment, I thought that was the referral.
Lessons
The main lesson I learned: HMOs suck, and I now understand why.
Having to get your doctor to sign off on everything really slows
things down. As soon as I can, I'll switch my insurance to a PPO.
On "freedom"
Opponents of health care reform in the United States often cite
curtailment of individual liberties as one of the primary reasons
against reform. I don't really understand what about the existing
is so "liberating". Let's summarize what happened to me:
- I couldn't go to the urgent care center I wanted
- I can't go to an orthopedist until my doctor approves
What kind of "freedom" is this, exactly? Of course, the above
statements are slight lies. I can go anywhere I want, as long as I
am happy to pay for it out of pocket. However, if I want it to be
covered by my insurance, I can only go to specific places only after
my doctor approves it.
I'm also free to choose my insurance. That's true, but I think this
blog post demonstrates that I'm way too ignorant to make an
informed decision myself. I would rather just have somebody else make
a good decision for me. Now that I've been through this, I at least
know to switch to a PPO, but learning the hard way sucks.
Money talks
I got the bill from the hospital for my emergency room care the
other day. It's not actually a bill, just a notice saying that they
billed my insurance company and will only ask me to pay in case my
insurance company won't pay. Still, I got to see how much it cost. 2
X-rays and a splint runs $2500, apparently.
Based on that, who knows what my appointment at the orthopedist will
cost? They're going to do more X-rays and may give me a cast. It
will probably be at least another few thousand dollars. I'm fairly
wealthy compared to the average American, but even for me, at a
few thousand bucks a pop I could deplete my savings fairly quickly.
I now understand why so many Americans go bankrupt due to health
care bills. If my insurance company decides not to cover these expenses,
I'll be able to pay it myself but it won't exactly be chump change, and
I can only imagine how much things cost when you need surgery or more
complicated treatments.
