20 October 2008

Insurance Does Not Get You Medical Coverage

I am giving up on the active search for a doctor to refer to me to a surgeon who will eventually remove my gallbladder. I no longer think it's worth it. I've played by the rules. I've sought medical advice. I've taken tests. I've taken Barium and been injected with a clear radioactive substance that induces immediate nausea. I even changed jobs and prevented any lapse in my medical coverage. Or so I thought.

The insurance at the new job started on my first day. I was covered and therefore charged from the get, or "jump street," as my grandma would say. I carefully selected a plan - one that will cover 100% of out patient surgeries and allow me to go to an eye doctor once a year (because not all plans do). I searched my network and found a doctor therein. I made an appointment two weeks in advance, provided my insurance information, and called Las Vegas to have my medical records and test results faxed. I arrived more than an hour for my appointment today, left 90 minutes later, and never got to meet with the doctor.

When I signed up, I was given a temporary insurance card. I had to fill in my employer, the group code, and my doctor's name. I filled it and gave it to the receptionist when prompted. She called the provider to get a number for me - everyone needs a number. Pacificare, my provider, did not have a number for me. The receptionist told me the doctor could not see me, as there was no real proof I had insurance. I called Pacificare. I explained the situation to the guy on the phone and he was perplexed. He said he could see my information, but not all of it. He pulled me up under the employer, but could not access my account to see to which plan I belonged. I asked if there was anything he could fax showing I had coverage. He said there was not, and directed me to my own Human Resources Department. He was pleasant and apologetic. But not helpful.

I called my HR representative. She called whoever she needed to call - but it was 2PM, 5PM on the East Coast. She recommended I go to through with my appointment, pay out of pocket, and get reimbursed.

It costs $244 for an uninsured person to meet with a doctor for a first time.

I agreed to pay it.

The receptionist prepared my chart and led me to a room, where we discussed the surgery I told her I would need. She informed me the doctor could not recommend a surgeon without knowing the name of the group within the network to which I belong. He couldn't even give me names, because I need to have proof of insurance for that. Insurance alone is not enough.

So I called Pacificare again. I explained to the woman that the last guy was very helpful and could see that I at least exist in the system. I asked her if she had any specifics as to the name of the group (as I had the network) and she said 'no.' I started to cry. I thanked her for her time and hung up. The receptionist told me her next opening is in mid-November but that she would squeeze me in as soon as I had a number. I decided right then to skip this business altogether and called my mom to tell her so.

Of course she didn't agree and gave me an optimistic timeline that puts me in surgery in four weeks. But I'm really over it. I have tried really hard to cut out all the foods I'm not supposed to have. I found a doctor as soon as I could. I harassed Bobby in medical records back in Vegas until he sent my test results. I called my provider. I called Human Resources. I laid it all on the line for the receptionist. I have found a lot of people willing to help but who can do no such thing. Instead, they have prompted a bunch of questions.
  • First of all, why am I paying for health insurance? I checked my pay stubs. I surely am paying for it.
  • Why do they give me a temporary card that's useless? I can't get treatment. I can't fill a prescription. I have a card-shaped piece of paper that gets me a lot of time wasted.
  • When can I expect to see a doctor? And when could I get in to a surgeon after that? How long before the actual surgery is even scheduled?
  • How important is this? My Las Vegas doctor thought it was imperative. The Internet backs that. But I think it would be easier to buy a gun, shoot myself in the stomach, and have ER surgeons take it out that way.
I'm ready to quit on my gallbladder. It quit on me first anyway.

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