The revolution will not be televised

I just got a bill from the pediatrician.  $641 for two well checks and two shots.  The shots were the cheap part.  Each well check cost $248.

Can we say “sticker shock”?

Our fantastic pediatrician in Michigan charged $60 for well checks.  A GP visit in Ireland was 60 euro (and if you had to return within 48 hours or so to be checked again, that visit was free.)

Here?  $248 per child.

Which my insurance isn’t covering, despite it stating in the document that routine exams and immunizations are covered 100%.

Maybe I got the guy who’s not in network.  Still, some of it should have been covered.  I don’t know.  I get to call the insurance company yet again.

In the midst of me going “WTF?” the other day over our prescription costs ($220 for a 20 day supply of seizure meds, if you missed that), my brother asked me to be honest – was heath care better in Ireland or here.

I wouldn’t say it was better.  It was different.

You didn’t have as many options when it came to specialists.  Hospitals appeared old, less innovative.  The one time we waited at the ER, it was six hours of waiting about.

In many ways, it was similar to here, where you had private (health insurance) and public (social welfare) options.  All kids were covered under social welfare, no matter the income.  Going the public route meant longer wait times – we were always told to go the private route since we had insurance.

Having insurance still meant we paid out of pocket, and then were reimbursed.  But prices were affordable for us.  60 euros to see the GP.  180 euro to see the neurologist.  We never saw a bill for the EEG or ER visit.  Maura qualified for the Long Term Illness prescription plan, a form of social welfare, so we never had to pay for her seizure medications – but if we did have to, it was only 80 euros ($106 US – compared to the $300 they want to charge me here.)  Antibiotics ran us seven euro.  The pharmacist thought I was mad when I misheard her and thought she said 70 – lord knows I’ve paid more for that in the US for one antibiotic.

Our options were less – if Maura had a crisis, I don’t know if they would have managed.  Temple Street Hospital for Children, last I heard, didn’t have a urologist on staff.  Crumlin Children’s hospital can afford renovation costs and are appealing to the public to do fundraisers for them.

No, it wasn’t better.  Just different.

And while we weren’t going to get cutting edge health care – at least the health care we did get was all friendly and personable and most of all – we could afford it.

But we moved back here so we could have the best health care for Maura.

Now I’m wondering if we can afford it.

What’s the point of being in a country that prides itself on its stellar health care, its innovative medicines, if no one can afford it?

Why am I, a person with what the representative on the phone described as “one of the best insurances out there”, being told I should apply for Medicaid for my child?

As I told a friend yesterday, I have health insurance, I just want them to pay for stuff.

I shouldn’t have to jump hoops and have a degree in Legalese to figure out what my insurance policy covers.  I shouldn’t have to apply for Medicaid for my disabled daughter, while betting I’ll be told that she’s not disabled enough, or we make “too much” to qualify.  I shouldn’t have to listen to an insurance company rep tell me how I can switch meds to save money, he’s not a doctor or nurse.

And color me less than impressed (which is a beige sort of color) but it shouldn’t cost $248 to weigh and measure my obnoxiously healthy teens with no history of medical issues, ask them about sports and classes they like, then spent less than ten minutes doing a routine exam to tell me they’re still obnoxiously healthy.

And for God’s sake – can SOMEONE read all the friggen paperwork they make me fill out?  Seriously, don’t make me spend 15 minutes writing out details of our whole lives and those of our relatives, to walk in and go “So, do you have siblings?  Any health concerns?”  Read the paperwork I *had* to fill out.

RIght now, I’m waiting for the pediatrician to fax notes to the neurology department, so they can read them over and decide how to see Maura.  I’ve been trying to make an appointment all week at neurology.  Part of going to the pediatrician ASAP was to get that referral to the neurologist.  We saw the pediatrician on the 13th.  The referral finally got there on the 20th.  We’re now held up because of records.  At this point, I’m tempted to go to the pediatrician’s, get the dang records myself, and drive them to the children’s hospital here so we can make an appointment.  Because in the meantime, we have the whole medication fiasco happening and I’m hoping a neurologist could help us out.  At this rate, I won’t get in until 2014 (seriously – they’re scheduling out in November as of two days ago…and she said it might be days before they decide what kind of doctor/appointment Maura needs…)

In the meantime, I’m told “Fight it all!  Call a rep!  Get a lawyer! Make a stink! Get on Medicaid!  Get on disability!”

I really shouldn’t have to.

I have insurance, it should pay for stuff.  Right?  I mean, that’s why we get it, so it’ll pay for stuff.  And if I didn’t have insurance, what these people charge for basic things shouldn’t cause me to go broke.  $224 for a twenty day supply of medication to keep my daughter’s brain functioning properly.  $248 for a well check for a healthy teen boy.  All a surprise to me.

In Ireland, you can walk into a clinic or dentist, or check their website and they will have their prices listed.  Right there.  You say “How much is a well child check up?”  The receptionist will tell you, “This amount.”  A filling for Miriam?  75 euro.  Just like it said on the wall chart of prices.  No surprises.

Here, it’s turning into some warped version of an evil Christmas – I keep getting surprised, but it’s nothing I want to see.

Health care in Ireland wasn’t better.  But it was easier.  It was less frustrating.  And you felt like people were trying to work with you.  On every occasion, they would work with us, to find us the best route, the best price, how to get Maura on the right program so we wouldn’t have to pay for something that could be covered by a government program.

Here?  So far, I can’t even get someone to call me back.

What’s the point of having a great health care system if I can’t access or afford it?

I’m far from alone, and no where even close to being a terrible case.  In the comments alone from my last post on this subject, people were sharing things that made my head and heart hurt.  Hell, I went to Trader Joe’s yesterday and the girl asked how my day was.  I made a noise, and she said “Oh, gee, that bad?”  I blurted out about Maura’s medicine costs, and this young woman’s eyes grew wide and horrified as she gave me ALL her sympathy and told me how her boyfriend went through the same thing – he was on one seizure med and they tried to give him the generic, and how he had a horrible time on it so now has to pay through the nose for the name brand.  Even Sean said as we left “Well, she gets it.”

Yes.  She got it.  As does too many others.

You know, we brag about how Canadians come down here for health care, how people fly from around the world for the cutting edge treatments.  Meanwhile, my kids listen to me say many bad words about the insurance coverage and medicine costs and ask “So we can’t afford her medicine?”

We can.  We’re lucky.  But that’s money we won’t be able to use for something else – like a second car, or piano lessons.  We will do what countless other middle class people who make “too much” for their disabled child to qualify for Medicaid will do – we’ll make do.  We’ll do without.  We’ll budget.  We’ll keep making phone calls.  Until maybe, we get lucky, and we find someone who will actually help us.  Meanwhile, others not in this situation will argue for or against the whole Obamacare issue, go off about those lazy jerks on Medicaid who should get jobs and insurance, even some who’ll think “Well, they shouldn’t have had such a child, they’re just a burden…”  We will hope for change, but not expect it.  Because let’s be real – the people making the choices about our health care are either politicians who have really great insurance, or the insurance company CEO’s, who are making so much, they can afford a health crisis.

In the meantime, I will be abusing my cell phone plan’s “unlimited calls” plan as I memorize the insurance company’s phone number and plot a grassroots movement while I spend time on hold.

The revolution starts here.  Who’s with me?


Please post your stories in the comments if you want to share your health care woes…