I learn something new about healthcare every day

I want to move on from this topic, but pain currently has a starring role in my life, and issues I didn’t run into when I had adequate health insurance keep surprising me.

For instance, the reason people without health insurance use the ER as a primary care facility became clear to me last week when I finally caved in and sent detailed notes about my chronic pain, and some rather grotesque pictures, to my primary care physician.  She referred me to a specialist, but due to the exclusion rider on my pre-existing condition that basically states that nothing having to do with my chronic pain will be covered, I would be considered a self-paying patient, and the doctor she referred me to doesn’t take any self-pay patients.

“So that’s why people go to the hospital when they don’t have health insurance,” I said to myself.  A hospital has to treat everyone.  A private doctor does not.

When I explained the situation to another specialist’s office, its billing department said to come in anyway and that I would be billed after the doctor decided what he wanted to do.  Perhaps self-paying patients get second-class treatment in his office; for some reason, he saw me for less than five minutes even though I was at the office for an hour and a half.  In that five minutes, he wrote a prescription and ordered another diagnostic test.  A representative from the billing department later called me about the appointment I had set for the test.  The rep told me that my insurance company said that “no diagnostic tests relating to (my pre-existing condition) are allowed until the year 2011.”  This really means they’re allowed, but I would be paying for the $1800 test out of pocket.

If she had said those words to me face to face, I think I would have punched her.  That’s not true; I just would have been embarrassed because she would have seen the rage heating my face and the tears forming in my eyes.  I smiled through the droplets and in my most chipper phone voice, I said, “Cancel all my appointments.  If I have an emergency, I’ll just go to the hospital.”

Would a visit to the ER cost twice as much as the diagnostic test in a private office?  Probably. Would I get the treatment that I need?  Definitely. Would I end up paying the bill? Maybe. But there’s also the chance that the hospital would just pass the cost along to all of you lucky, fully insured people who are afraid of losing health insurance that you don’t even realize sucks.  And you don’t even realize that one of the reasons it sucks is because you’re covering what the very company you pay won’t cover.

Wake up!


1 Comment

Filed under Health, Health Insurance

One response to “I learn something new about healthcare every day

  1. Dani

    I have so much I want to say, as someone who has seen all sides of the healthcare industrial complex -as an under-insured and chronically ill child, as an uninsured and chronically and randomly ill adult, and now as an insured-through-the-military adult whose chronic conditions have lessened. But it would take forever. So I will just say a few things.

    I had to go to the ER in Louisville a few times, and once I had to be hospitalized. There was an agency that contacted me after I went home b/c I was uninsured and had a $5,000+ bill…They have you fill out a ton of forms to show you can’t afford to pay, then most of the bill is waved and the rest is put on a payment plan. I don’t know if it still exists in these trying times, and I can’t remember the name of it (for what it’s worth, I remember it was off of Hurstbourne in the office complex near the ice skating rink), but it’s worth looking into.

    Also, getting good treatment is sometimes just as hard for me now with insurance as it was when I was uninsured for 7 years. There’s still the referral loop and doctors who barely look at you and trips to the ER b/c of being misdiagnosed or not getting enough care from my doctor in the first place. One night I went to the ER even though I had seen my (uninterested, uncaring, unfit) doctor that very day and been sent home with a referral. If I have a cold or flu, that’s easy. But anything requiring a specialist just puts us on what I call the “never-ending hamster wheel”. It’s so frustrating! You feel like you can breathe easy b/c you’ve got the all-mighty insurance, and then you still find yourself fighting to get decent care.

    And I can’t even relate to you just how PUTRID the hospitals in New York were. Going to the ER there was frightening for both of us – cots in the hallway, dirty floors, doctors that diagnose you after talking to you for a minute and not even examining you, and waiting 6+ hours to be seen when I had kidney stones. kidney stones!! At Baptist East I went to the top of the heap when I had kidney stones b/c of how painful they are! So at least now I know that Louisville really does have some of the best hospitals.

    And I know I’m still lucky. yet isn’t that sad, that dealing with totally impossible systems and money-grubbing practices as opposed to not having insurance at all is supposed to be some kind of luxury? It’s a sad state of affairs, but I know I’m preaching to the choir!

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