2009/10/05

But I don't think so

It might be possible for me to be more angry at and frustrated with the "health" care system in this country right now, but I don't think so.

We do not have a system that cares for health. We have a system that cares for bottom lines, bureaucratic form-filling, and number crunching. The right hand not only doesn't know what the left hand is doing, it has more arms than anyone knows and they're all oblivious of the others.

We have a system that makes me afraid to go to the doctor when I have either broken or sprained my ankle - I don't know which I've done, because I have yet to get an appointment with a doctor. I now have an appointment for Friday, which is one week after the injury. I did not go to the emergency room because I was not dying, and I did not (and do not) think the thing's broken, but I have no way of knowing that until it's been x-rayed. And so why don't I just go get it x-rayed? Or, there are a lot of reasons for that. Here's a partial list.

1. Emergency room visits are expensive. The co-pay is $125, which I happened not to have in my pocket last Friday.

2. Emergency room visits for non-life-threatening injuries are time consuming in the extreme (not that this is much different from any other form of waiting room in any other form of medical office functioning within the AMA)

3. I was not home when it happened - making a logistics problem as well as an insurance tangle.

4. You can't just go get it x-rayed unless a doctor writes orders for it. So, the choice is wait for an appointment and get orders, or go to the emergency room. I chose to wait.

5. There is no way to know how much out of pocket money I might spend on this project, and we are already paying hundreds and hundreds of dollars in unanticipated medical expenses for a test the doctor ordered and the "insurance" approved - but no one could tell us how much that would cost either.

Yes, yes, we asked. Insurance has to approve. Great. So ... did they? No one bothered to call to let us know that either. Yes. They approved. Great. So I had the test. And? And I got a bill from the other side of the country, from a doctor I'd never heard of. I thought it was a scam! But no, that's where the guy who reads the test has his billing done. And that was a separate bill. The hospital got a chunk as well. The doctor doesn't make the appointment, the doctor's receptionist doesn't "even know how much they charge over there," and the people at the hospital will do whatever the doctor ordered, and the insurance doesn't know how much the hospital, doctor, or test reader will charge ... but whatever it ends up being, I have to pay the bill.

No other industry does business this way -- or, not legally, at least. Just imagine taking your car to the shop. "It doesn't work right," you say. "Okay," the guy says. "I'll do whatever I think needs to be done, and you'll pay 30% of that. That be okay with you?" Oh, sure. You'd agree to that, right? He has no way to tell you what the bill might be. But you have to agree to pay a third of it.

I've just spent the morning on the phone, trying to figure out how to handle the fact that my ankle was injured in a fall. As usual,

1. I have to be approved for the expense for the insurance to pay anything.
2. I called the insurance people. How much do I have to pay?
3. It depends on what the doctor orders. You pay a third of whatever the doctor orders. How much might that be? There's no way of knowing that.

If my ankle weren't the reason my right foot is currently the size of a joke foot, I would now take a very brisk walk to work off some of this steam. I hate dealing with medical people and insurance people - especially when all they can tell me is that they don't know anything at all about what someone else might decide or what those decisions might cost me.

The "system" (which is really just a wadded-up and for-profit mess made of every system there is, including the one where people go without care - you know... like in Bangladesh or the wilds of Africa?) is a system that does not work for me. We are employed. We have insurance. And I'm scared to go to the doctor. So - our system? Maybe it could be more broken - but I don't think so.

4 comments:

Dogwood Diarist said...

So, let me get this straight: we're talking Canada here? I lived there for 19 years, and never experienced such a thing. I never dealt with an insurance company under OHIP. Have things changed? Does every province have a different system? Are some known for better ones? Whenever I speak to Canadians, they are always very happy with their healthcare.

Deanna said...

Most of what we are hearing is about the uninsured but the insured are often not a lot better off. And there are those who don't believe we have a health care crisis???

Stephanie said...

I live in Washington state, right on the river that borders WA and OR. Our health care insurer is a big one here - Providence. And I'm going to Providence doctors, and (hopefully never again) to Providence hospitals. My care from the nurses at the hospital for my surgery last summer was incredible, healthy, amazing, and comforting -- I need to say that too. They were great.

But this business I'm dealing with now is frustrating in the extreme - as you see. I'm not dying. I'm PROBABLY not broken. But I should see a doctor, and I'm waiting until Friday to do it because I want to see an orthopedist. Next available appt. is Friday.

It's crawling around the house, homeopathy, and sympathy until then.

Carol Whipps said...

I sympathize with you! (but not like the insurance gal who said she understands your frustration).