Thursday, February 28, 2008

Jumping Through Hoops Sucks

"OK, fine, I'll have my baby at Big, Urban, Major University-Affiliated Hospital, rather than Closer-to-Home Extension Hospital within the same system. But only if I won't have medical students or residents poking at me."

"Oh, you won't be a teaching case. You have good insurance."

This is a representation of an actual exchange I had with my doctor while I was pregnant with Ellie. Because of her known and unknown medical conditions, the doctor wanted me to deliver in a hospital that had more support for higher-risk births. It was the right decision and I had a good experience with the hospital, although I did choose to have Ada at Closer-to-Home Extension Hospital, where I also had a good experience.

I've never had a problem getting the health care I need - with the singular exception of the short period between when I expired from my parents' insurance and the corporate coverage from my first job kicked in, during which time a UTI became a kidney infection. Nonetheless, one of the issues I've been watching this election year is health care. I think it's horrifying that so many Americans do not have sufficient health insurance, and I think it's exciting that there's a real possibility of addressing that issue in the near future.

Today, however, I had an experience that shook my faith in the prospect of the single-payer system, just a little bit. The story surrounding this experience is not mine to tell, so I will be a little vague.

A good friend of mine is a little bit pregnant. Today, she started cramping and bleeding, and she just knew that she was miscarrying. She was understandably distraught. Not knowing what else to do, but unable to sit around doing nothing but freaking out, she hurried over to her doctor's office.

Where we waited, and waited, and waited. The clinical medical assistants and nurses were wonderful, offering hugs and support but no false comfort. Eventually, an administrative medical assistant with, er, somewhat less bedside manner came in to explain that with my friend's government-sponsored health insurance - a plan she had no role in choosing as her government employer chose for her - she couldn't be seen as an obstetrical patient, let alone given an ultrasound or exam, without a referral from her primary care doctor. It's worth noting that she sees her OB/GYN at least annually for an exam and other gynecological care, but hadn't seen her primary care doctor in quite some time.

I called and pestered and cajoled, to little avail. Despite the insurance company's assurances to the contrary, and the primary care doctor's immediate action to call in a referral to the insurance company, no referral had been received by the OB's office when we left a couple of hours later.

Fortunately, they were eventually willing to proceed without the formal referral, after receiving a verbal referral from the primary care physician's office. An assistant had been on hold for hours with the insurance company by that point, trying to complete the process.

What if I hadn't been there to be the assertive bully? I have no doubt that my friend's medical office would be eventually taken care of her, but the whole process was horrible and excruciating and unnecessary.

The end result was good. The referral will come through, and my friend's insurance will pay for the medical care she needs. And she did not miscarry today. (I too had threatened miscarriages with both of my pregnancies. They're not uncommon, but that doesn't make them less scary.)

But we need to make sure that we fix a lot of the kinks in the current systems before we adopt them on a larger scale.

7 comments:

Orange said...

I don't think the Dem candidates are talking about moving to a single-payer plan. Obama and Clinton are both proposing universal health care coverage in which everybody has to buy insurance (with subsidized or negotiated premiums, I imagine) from the same damn insurance companies we deal with now.

(P.S. Your posts are a lot easier to read in RSS form, where they're not white text on a black background...)

Brian said...

Not to go off on a tangent or anything, but that's one of the big reasons not to go to your doctor's office for an emergency. Even though they're way friendlier and know more about your medical history, they are Not Fast and they often get hung up on insurance.

Emergency rooms may have their own sets of problems, but lack of speed is seldom one of them. Even when there has been confusion about my insurance, I've never seen an ER delay care while they wait to figure out the money.

(I suppose it helps that insurance companies tend not to argue so much about ER charges...)

ccw said...

The sheer amount of stories like this from people with insurance is frightening. I cannot even begin to imagine the inadequate care and bullshit an uninsured person must go through.

Sarahlynn said...

Orange, you're right about single-payer plans. Both Clinton and Obama would like to create a pool of competing insurance companies as well as an expanded government-sponsored company. And I do think that it's worth a heck of a cost to get everyone covered. But when expanding public plans like Medicaid or Medicare, I think we need to clean up some things. My friend's medical insurance is "good" insurance, and she still has this problem with the one plan offered by her employer.

(FTR, Obama's plan wouldn't require everyone to be insured; Clinton's plan would.)

CCW, yeah. One blog I used to read included a rant about how she should just drop her insurance in order to get the care she needs, since the uninsured have it so good, never having to pay their own medical bills. What planet is she living on?!!

Brian, my experiences are unpleasantly different from yours. Unless you come in unconcious in an ambulance, average national ER wait times are measured in hours. And every time I've had to go to the ER, I've spent a not-insignificant amount of time "registering" and providing my insurance information.

When I had to go to the ER with a staph infection last year, I waited until midnight to go in and chose a quiet hospital out here in the county: no wait! But when I've had to take Ellie down to Childrens? Shudder. Ditto Barnes, etc.

And my ER co-pays are a lot higher than my office visit co-pays, probably to discourage me from getting my primary healthcare through the ER like the they do on TV.

Unfortunately or fortunately, the sort of situation my friend had didn't qualify as a medical "emergency" (though it sure as hell was a personal emergency) and the ER probably would have directed her to her OB/GYN. At least it all worked out!

My new love: Urgent Care. St. Luke's has a new branch near me and I loved it so much I might never get another primary care doctor.

Susan said...

For what it is worth, I have experienced US private insurance--both HMOs and PPOs and nationalized insurance (Norway's) and the latter requires far less hoop jumping, even with a child who requires a cardiac specialist on her healthcare team.

Indeed, unless things change dramatically in that area, I am not sure we will ever move back to the US. In the US, even if you are lucky enough to have "good" insurance, they are always looking for ways to get out of paying.

Sarahlynn said...

You're in Norway! And I'm so out of touch. I'm still feeling really really guilty about not getting back to you about pediatric cardiac issues. Your email is still in my inbox, waiting. At first, my life was falling apart, and then . . . it had been so long, there's a huge hurdle to get over.

I hope that H's doing really well. And you, too!

FTR, we have had no trouble at all with Ellie's cardiology concerns and our insurance company; I think a lot depends on the plan you luck into.

Susan said...

H is doing really well, thanks (as am I). :) Not to worry, I knew you had quite the full plate when I wrote to you.

At her first appointment here, we finally got an explanation for what was going on with her heart murmur. Turns out she was born with a VSD (news to us!) that has long-since self-repaired, but she also has a common a-v valve, so her heart has to work a lot harder (and enlarges) due to the backflow. Fortunately, the primary treatment is an ACE inhibitor twice a day. They don't think at this point that she will require surgery. So, yay!

I enjoy keeping up with you via your blog. I should do better about updating mine. ;)