First, it costs me just shy of $200 every two weeks in premiums. That works out to over $400 a month to simply carry insurance. Let’s say one of my kids has to go to the emergency room. That will cost me a $300 copay at the time of the visit and then my coinsurance amount will be billed to me. Of course while I’m sitting in the waiting room because my kid needs stitches, there will be dozens of people, for whom state insurance covers 100% of ER visits, using the ER as a doctor’s office and waiting to be seen because they have the sniffles or a hangnail.
The way doctor visits work is asinine. For example, Savannah pulled her bicep at her water polo game on Wednesday. Her arm hurt, but not terribly. She jumped in the pool Thursday and warmed up with no problems, but the first time she took aim and shot the ball, she cried out in pain, tears streaming down her face. Her coaches had her sit out that game so she’d (hopefully) be healed in time for the district match on Tuesday. Her coach told her she HAD to get in to an orthopedist before Tuesday’s game. However, before I can make an appointment with an orthopedist (or any specialist, for that matter), my insurance dictates that I must obtain a referral from her primary care physician.
So, I called, explained the situation, and asked her doctor to please write me a referral to an orthopedist. They refused to write the referral until they’d seen Savannah. “Why can’t you just write the referral? You can’t treat her for this injury and you’ll just send her to an orthopedist anyway so why do you need to see her first?”
“We have to see her before we can write the referral.”
“She was just in your office for an appointment three weeks ago! You’ve recently seen her. You can’t treat her arm. Please write me a referral for the orthopedic doctor.”
“No. She wasn’t seen for her arm so we can’t write a referral until we see her for her arm complaint.”
(Translation: You need to pay us a $20 copay before we’ll do anything despite the fact that everything you’re saying is simply common sense.)
After I silently swore and called them less-than-flattering names in my head, she offered to see Savannah if I could get there before their office closed at noon. (Down here in Florida, doctors don’t work on weekends and are usually closed Friday afternoons if not the entire Friday. You know, there are only so many hours to play golf . . .) I looked at the clock. 11:28. Half an hour to get someone to cover my class, drive to the high school, park, walk in, sign her out, drive to the doctor’s office. And here in Florida where no one can manage to get up to the speed limit, no less.
I took the chance and floored it. Made it to the office at 11:58. Paid my $20. The doctor examined Savannah’s arm. Told us she’d pulled her bicep (kinda like I said). Wrote us a referral to the orthopedic doctor.
Now, Monday morning, I get to miss more work and pay a $40 copay for the orthopedist to tell us she pulled her muscle and needs to rest it, use compression, elevate it, alternate ice and moist heat, and take ibuprofen for pain and inflammation. And in the long run, after all the running around, money spent, and time lost from work, her muscle won’t heal any faster than if she’d just stayed home and done these things. But then I’d be a bad mom who didn’t care about the health of her daughter and more importantly, the outcome of the district game. Too bad she doesn’t suck at water polo and warm the bench every game. Then no one would’ve insisted I get her to the doctor right away.
And this is why I work at a job I hate when I’d rather be home taking care of my kids and house and working on my next book – my fabulous insurance.
I don’t know what the answer is to the question of how to fix healthcare in America, but in my opinion, this isn’t it.
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