What Good Is Affordable Health Insurance If It’s Impossible to Use?

insuranceI have three boys who think they’re invincible. They jump off bunk beds, rappel down the side of the house, flip themselves over their bicycles, and fly down the stairs on their skateboards. Because of my miniature dare devils, we’ve had more visits to our local emergency room for broken bones, lacerations, and internal injuries than I can count. And any time I’ve been sitting with my child (who thought he was Tony Hawk) while waiting for X-rays, I’ve noticed those people in the ER, waiting to be seen for a stuffy nose. It always made me so mad. I thought to myself, what are they doing here? Why don’t they just see their doctor? A stuffy nose is not an emergency and their selfishness and stupidity is creating a longer wait for me and others who actually do have an emergency.

I have since been schooled. Now I know why some people go to the emergency room for a stuffy nose. I have had the privilege (and yes, I really do consider it a privilege) to see how “the other half” lives. I went from being a married mom who lived in a nice upper-middle class neighborhood to a divorced mom, living paycheck to paycheck, unable to make ends meet, relying on assistance to feed my kids. Recently my kids and I qualified for Medicaid. I actually didn’t even request Medicaid as we have insurance through my job. Unfortunately, while asking for other assistance, we were automatically signed up for it. One would think I would be happy for the oversight. One would think it would help with my medical expenses. One would think. But let me tell you how it really works.

My son broke his arm on a Saturday. I took him to the emergency room. They X-rayed his arm, diagnosed him with a fractured ulna and radius, put his arm in a plaster splint, and instructed us to follow up with an orthopedic doctor in order to get a cast. Medicaid covered the emergency room visit.

On Monday, I searched directories to find an orthopedic doctor who accepted Medicaid. It took several calls to find one who took both Medicaid and the Cigna I have through my employer. I found one after being on hold for 15 minutes. The receptionist informed me that she’d be happy to make an appointment for my son, but I needed to get a referral first. Going to the ER and getting a diagnosis of a broken arm wasn’t good enough. I needed to take time off work, get in to the doctor, and come up with a copay just to be told we need to see an orthopedic doctor. I personally think that’s a ludicrous waste of time and money. But I can’t change those rules so I called the doctor assigned to us by Cigna.

After going around in circles, I was told that they would not see us because we have Medicaid. Great. So I called the doctor assigned to us by Medicaid. They won’t see us because we have Cigna. It seems that Cigna claims Medicaid is our primary insurance. And Medicaid claims that Cigna is our primary insurance.

Getting through to the Department of Children and Family Services is next to impossible and apparently (if you’re lucky enough to get through after literally trying to call in the morning, on your lunch break, and after work every day for an entire week) no one there knows how to cancel your Medicaid services and assures you there should be no problem seeing a doctor anyway. Very helpful. Not. Canceling your insurance through your employer would be a poor choice because the insurance is paid for a month in advance and by canceling it now, you would still have to wait a month for it to be ineffective. That’s not a good solution when your kid needs to be seen today.

So here I am, unable to do anything. He needs a cast on his arm, but we can’t see the orthopedist without a referral. We can’t get a referral because no primary care doctor will see us. The only place we can go for care is an emergency room or immediate care center. And that is why some people use the ER as a primary care doctor: they have no other choice.

In talking to other people I have found that I’m not alone. I think most of us would agree that we still have insurance problems in this country. I don’t know how to fix them, but when a person can’t get a cast on their kid’s broken arm despite having insurance, there’s a big problem.

Image courtesy of ThinkStock

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