Living in Madison, we were part of some of the best HMO's and insurance programs in the country. We never worried about care--they told us where to go, who to see (and allowed us to change easily if we didn't click with our doc, or to choose a doc we liked), what to do, and we never paid out of pocket for anything except prescription copays, which were never more than 15$ (even for pricey migraine meds). We had it good.
Then came Pennsylvania.
After the third bill came in saying the insurance wouldn't cover it, we were really starting to get ticked off. Dr. B is under enough stress being a first year professor. He doesn't need to add this crap. He put the bills in his briefcase, and set up a meeting with the insurance people on campus.
Then he started having chest pains. I wanted to take him to the ER, but he refused. After arguing with him for a while, I knew the only way to get him in was to manipulate the entire situation. I didn't like doing it, but you gotta do what you gotta do.
After calling our insurance company and getting the OK, and trying to set up an appointment for him and getting told to take him to the ER right away (I set one up just in case he was really stubborn), I called.
"What time are you done with work? I'll come pick you up."
I neglected to tell him where we were going. He figured it out en route, but couldn't argue any more.
And after six hours waiting, pacing the halls with the baby and eating horrid vending machine food, he got the diagnosis.
"We don't know."
Great.
They did an EKG, blood tests and an Xray, as well as a bunch of other stuff, and nothing was apparent. He's stressed*. He's pretty sure that's the reason, but the doctor at the ER wouldn't tell him much of anything.
Today, I got a call from the business office of our health care provider. She wasn't happy about resubmitting a bill to insurance with a changed code, but she was doing it. (Well, I wasn't happy about getting a 200$ bill for some tests I didn't ask for, that they say I did. Who would ask for a comprehensive screening panel when you've got chapped lips? I didn't even know the words "comprehensive screening panel". Give me a break.) I'll still have to pay for part of it, but hopefully they'll get it changed and resubmitted so I don't have to fork over the entire bill.
And now I have a new mantra when I go to the doctor.
"But, will my insurance cover it?"
The things you learn when you leave Wisconsin...
*He promised to take a nap today, and I'll nag him more about taking bike rides, meditating and doing yoga. Asking him to stop obsessing and worrying about stuff is like telling the grass not to grow, but I'll do my best to counteract what I can.
Showing posts with label HMO. Show all posts
Showing posts with label HMO. Show all posts
Wednesday, April 23, 2008
Monday, March 10, 2008
Culture Shock at the Doc
This is a rant. Officially. I am frustrated. Stop reading now if you're not in the mood--I won't be offended.
Today I took Rowan in for her 9 month appointment, and then saw a PA at my doctor's office (whom I love, so was disappointed that she didn't have an opening). The PA asked if we liked living here. I said yes, but it was a bit of a culture shock. She seemed a little offended. But you know, this is not the midwest. I am reminded of that regularly. It's just not the same. There are things, little things. They probably are no big deal, but we miss them. People in the midwest are really friendly and very relaxed. They have incredible work ethics. They always strive to make you feel comfortable. They have high standards, and those standards apply to everyone. And when it comes to health care, these are things I notice.
Yes, I'm living in Appalachia. But come on. This is a college town. A major university. We should have top-notch health care, right?
And I suppose it's probably fine. We're not dying or anything. But comparing it to the great care we received in Madison, and the wonderful doctors I saw in Paris, I just feel that something is lacking. Stupid, little things. The nurses never introduce themselves. I don't get asked the laundry list of questions every time just to make sure nothing important has changed. When phoning in with symptoms, they say, "well, if you think you should come in, you can."
I shouldn't have to think. They should tell me. THEY'RE THE EXPERTS. And when a baby has had a fever for 5 days, it's worth checking out! What if she had an infection? What if there was a major problem? How long am I supposed to wait--how serious does it have to get before they say, "you should really come in!"????
Then, we get notices from our insurance saying they won't cover trips to the ER, even though no other doctors were available at the time. Because it turned out to only be strep throat and wasn't serious enough. Which we would know... how? Except by going in, and when the pain has markedly increased and is nearly unbearable, well, yes it is an emergency! And it WAS strep throat!
In Madison, we were members of 2 different HMO's, both rated in the top in the country. They told you who to see and when and how often. They told you where to go based on the possible seriousness of your condition. More often than not, you had to go in. And they knew what they were doing. They were efficient, friendly, thorough, professional and they always introduced themselves. They made us feel like they really, really knew what they were doing and we would be well taken care of. And we were.
Here? I call at 2 in the morning because my baby is screaming and running a fever of 104, and they act as if it's no big deal, but don't take the time to reassure me of that fact. They don't tell me what temperature I should be worried at--just that "it should break in the next 24 hours". I go in for painful, itchy, scaly lips that haven't improved in 6 weeks despite throwing every possible thing I can think of at them, and I get asked if I've tried anything organic or Carmex and if I'm taking vitamins. You know, because a little fancy twigs-and-bark lip balm is going to solve a problem medical-grade lanolin and pure olive oil can't. And get told to come back in a week if Carmex doesn't work, and they'll refer me to a dermatologist. (At least she did take blood work for a thyroid test when I asked for it, since there's a family history.)
So here I sit. Itchy lips, a baby who still is fussy and won't sleep, and I don't even remember the names of the two nurses I saw today.
I want my HMO back.
Today I took Rowan in for her 9 month appointment, and then saw a PA at my doctor's office (whom I love, so was disappointed that she didn't have an opening). The PA asked if we liked living here. I said yes, but it was a bit of a culture shock. She seemed a little offended. But you know, this is not the midwest. I am reminded of that regularly. It's just not the same. There are things, little things. They probably are no big deal, but we miss them. People in the midwest are really friendly and very relaxed. They have incredible work ethics. They always strive to make you feel comfortable. They have high standards, and those standards apply to everyone. And when it comes to health care, these are things I notice.
Yes, I'm living in Appalachia. But come on. This is a college town. A major university. We should have top-notch health care, right?
And I suppose it's probably fine. We're not dying or anything. But comparing it to the great care we received in Madison, and the wonderful doctors I saw in Paris, I just feel that something is lacking. Stupid, little things. The nurses never introduce themselves. I don't get asked the laundry list of questions every time just to make sure nothing important has changed. When phoning in with symptoms, they say, "well, if you think you should come in, you can."
I shouldn't have to think. They should tell me. THEY'RE THE EXPERTS. And when a baby has had a fever for 5 days, it's worth checking out! What if she had an infection? What if there was a major problem? How long am I supposed to wait--how serious does it have to get before they say, "you should really come in!"????
Then, we get notices from our insurance saying they won't cover trips to the ER, even though no other doctors were available at the time. Because it turned out to only be strep throat and wasn't serious enough. Which we would know... how? Except by going in, and when the pain has markedly increased and is nearly unbearable, well, yes it is an emergency! And it WAS strep throat!
In Madison, we were members of 2 different HMO's, both rated in the top in the country. They told you who to see and when and how often. They told you where to go based on the possible seriousness of your condition. More often than not, you had to go in. And they knew what they were doing. They were efficient, friendly, thorough, professional and they always introduced themselves. They made us feel like they really, really knew what they were doing and we would be well taken care of. And we were.
Here? I call at 2 in the morning because my baby is screaming and running a fever of 104, and they act as if it's no big deal, but don't take the time to reassure me of that fact. They don't tell me what temperature I should be worried at--just that "it should break in the next 24 hours". I go in for painful, itchy, scaly lips that haven't improved in 6 weeks despite throwing every possible thing I can think of at them, and I get asked if I've tried anything organic or Carmex and if I'm taking vitamins. You know, because a little fancy twigs-and-bark lip balm is going to solve a problem medical-grade lanolin and pure olive oil can't. And get told to come back in a week if Carmex doesn't work, and they'll refer me to a dermatologist. (At least she did take blood work for a thyroid test when I asked for it, since there's a family history.)
So here I sit. Itchy lips, a baby who still is fussy and won't sleep, and I don't even remember the names of the two nurses I saw today.
I want my HMO back.
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