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.