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August 7th, 2008

Why Insurance in the US Sucks

We don’t use our health insurance very often. Just for routine visits, really. In fact, when I called my doctor’s office a couple of months ago, we found out I hadn’t updated my insurance information with them since my work had changed carriers two years earlier. Most of our insurance goes to cover our daughter’s pediatrician visits.

In the last two months, though, any faith I had in our insurance system pretty much disappeared.

In late June, I was feeling absolutely terrible. I came home from work, tried to sleep it off, and woke up feeling worse. I won’t bother sharing the gory details of the other symptoms, but let’s just say I wasn’t exactly a pleasure to be around. I called my doctor’s office at 4:30 to see if they could sneak me in. They said they couldn’t, but that I could go to their associated Urgent Care center 20 miles away.

I was feeling badly enough that I instead went to the Urgent Care center a 1/2 mile away. They said they accepted my insurance (but later said, “But you’re on an HMO. That changes things.”) I was treated, went home, and started recovering.

When I submitted the paperwork, my insurance denied me coverage because it wasn’t a “medical emergency” and should have been handled by my primary care doctor. You know, the one that was closed. Quite honestly, if I hadn’t gone to the urgent care center, I suspect I would have been in the emergency room later that night being treated for dehydration.

My doctor’s office said “there’s nothing we can do at this point” and so I’m stuck in the middle of appeals hell at the moment.

Secondly, we found out with a mere month’s notice that our daughter’s pediatrician was going off of the plan. So, now we have to scramble and get her a new pediatrician, which isn’t as easy as it sounds since we have some unique requirements.

Insurance shouldn’t be difficult. They shouldn’t work against you and your health. They shouldn’t make it difficult to get taken care of when you’re feeling miserable and can barely move. Why do we, as a country, get it so, so wrong, especially when so many other countries get it so right? (I know the answer, I just wanted to ask it aloud.)

Posted in Politics

COD August 7, 2008, 4:27 pm

It sounds like you have an HMO. HMO’s are evil. Do you have options at work? A PPO plan will be a little more expensive, but you’ll be able to go to any doctor in the network without referrals. Also, PPO’s usually cover out of network visits at about 70%, so if a doctor you really like drops the plan, you have the option of still seeing them by paying more out of pocket.

Ryan August 7, 2008, 7:32 pm

I do indeed have an HMO. It’s a “referral-less” HMO, though, if I’m not mistaken (if I need to go to a specialist). Work does offer a PPO but I’ve always avoided it because up to this point, we haven’t had a problem with our doctors not being covered or with getting care.

May need to rethink that strategy.

Paul August 7, 2008, 7:56 pm

“Why Insurance in the US Sucks”

…I don’t think there are enough bytes on the interweb to fully articulate this.

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