Archive for November, 2016

It’s Not Obamacare…it’s the Entire Health Care Industry.

November 11, 2016

This may seem amusing to those who have health insurance that somebody else pays for…but it’s not so funny.

This started in April 2016.

I was having  pain in my hip that I thought might be arthritis (it turned out to be sciatica), and also …a rash—like heat rash, that I could not get rid of.  I also had ‘trigger finger.’

I made an appointment with a doctor in my health plan…but not only did it turn out that she was no longer at the clinic, they called me two days before to cancel the appointment because my insurance would not cover it.  Never mind that I planned to pay for it out of my Health Savings Account.

So, I called the insurance company, and thy told me I was entitled to a Women’s Wellness Exam. This would cover  a PAP smear, a full body skin cancer check, and a scheduling  for a mammogram. The insurance would pay. So, I made another appointment with a  clinic picked  gynecologist.

She was an hour late, so she didn’t do the skin cancer check (so would not look at the rash), and could not address the pain in my hip, but she did take a PAP smear & scheduled me for the mammogram. I specifically asked her if I needed any paperwork.  She told me, “No, just go to Mount Sinai Hospital. You are in the system.”

This turned out to not  be true. I was in the system, but they still wanted paperwork, Thankfully, I had the clinic card in my wallet , and called them to FAX the paperwork.

Now, although I was in the system scheduled for the mammogram, I then had to go to Mount Sinai intake and have my contact info entered  again. Even though the  clerk had all my info in front of her, she managed to spell both my first & last names WRONG:  Robin Micheals—but I did not  see this until I was actually in the x-ray room.

It took over a month to get the mammogram, so I had to schedule a different visit at a different clinic with a general practitioner to look at my rash &  address the pain in my hip….and my finger.  I don’t doubt the doctor is a decent doctor, but the pills he prescribed  for the sciatica did not help at all, and the ointment he prescribed (yes—at $26 a tube) me  did not work, either.  He did tell me that if the problems did not go away in 2 weeks, to call him.  He referred me to another doctor  for the ‘trigger finger’, who gave me a shot, and told me it would only last 3—6 months.

Well, due to his being on vacation and  my taking a different job, a month went by.  I decided to see a chiropractor who was highly recommended by  neighbors who had had sciatica treated.  She really is good….but her treatments didn’t hold.

I did called the general practitioner about the rash, but could not talk to him directly. The clinic insisted I make an appointment to see him to get a referral to a dermatologist.  I haven’t been billed yet, but I went in, and he told me to wait and left the room.  About 1/2 hour later, he came back & told me that the clinic had to find a doctor who would accept my insurance plan.  I laughed.  I said, “This is ridiculous.  I have a $6000 deductible, I’ll pay for it out of  my Health Savings Account.”  He rolled his eyes and wrote down the name of a dermatologist.  A few days later, I got a letter with the name of a dermatologist in my plan.  I called, and could not get an appointment for 8 weeks!  Not until after….Thanksgiving!

I mentioned this to a friend, and she said, “I had that—just get some Desitin.” Which I did. It took about two weeks to work.  I will cancel the dermatology appointment.

Meanwhile…I got a letter from Mount Sinai.  My mammogram was inconclusive. They tell me to call my doctor and have her reschedule another mammogram.  You see, I can’t do this myself, for some reason. So, I call that clinic…& they want me to schedule an appointment (and pay for it—or charge health insurance) just for her to make another appointment!

But wait—there’s more!  So the chiropractor suggests I  get an MRI to find out why the adjustments she’s making are not holding.  She tells me  that the cash rate will be $350—400.  That is no problem…but when I call  and ask if I can submit it  to insurance—they may pay (and—how can you reach your deductible if you don’t submit)…ah, no.  Because…they may charge the insurance company $1500, and if THEY DON’T PAY, I have to. That is the difference.

Now, why would an insurance company be charged  double or triple?  Well, that’s how it works.  When you add a step, you add ‘overhead’—and people on a payroll pushing papers, and filing, and a guy at the top who makes $28,000,000 a year.  This is how we create jobs.  They all have a vested interest, which is why they continue to pay our politicians to not have single payer, and allow this  waste.

As I write this, Trump has won the presidency.  He may replace the Affordable Care Act, but the health insurance industry has too much invested in Congress to  allow any changes. We are not going to get anything like single payer  for at least  four years.

I was telling a colleague about this, and she said, “It doesn’t seem like this should be legal.”  Well, anything that is not specifically illegal is legal.  It’s what makes America great.