The revolution will not be televised

23 Aug

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…

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26 Responses to “The revolution will not be televised”

  1. Angie James August 23, 2013 at 10:19 pm #

    I will help with the Grassroots movement! Something has got to change, every month I have to call and argue with the insurance company to get my sons medications approved.He takes meds for Seizures and Several other disorders, According to them I should be thankful to have them! ha! They are nothing but an annoyance but unfortunately one that I have to have. There always seems to be such a battle with getting anything approved anymore. It only took them 4 months to get my surgery approved(hysterectomy), I really wonder if the healthcare system will ever get any better???

  2. Renee Anne August 23, 2013 at 10:30 pm #

    ME! We got the paperwork from Little Man’s latest visit to the cardiologist. To see the cardiologist, have an echocardiogram, an EKG, and the 24-hour monitor (which all had to be read, too) – the insurance company was charged almost $7000 and they covered 75% of it…leaving us with a bill for about $1800. The really disgusting part is that go see his metabolic geneticist, it’s nowhere near as much and we see the geneticist, the metabolic dietician, usually a Fellow, and the genetic counselor. Both are in network, too. And then we have to meet our deductible before certain things are covered outright.

    I *HATE* dealing with insurance companies.

  3. Joy M. Newcom August 23, 2013 at 11:06 pm #

    I’m with you. Please start by calling your county social services. They know ALL the offices and programs. That is their job. You will find an advocate somewhere there, typically a social worker or case worker, to help you. Best of all, if they can’t help you, they usually know who you should call next.

    Hang in there!

  4. Judy Raney August 23, 2013 at 11:28 pm #

    I am with you, I am forced to buy insurance. If I get it through my husbands work, it is more than $1800 a month, so I found private for hubby and the 2 kids (not me) almost $500 a month, and because Texas doesn’t require Insurance companies to “cover” Mental Health, I have to pay for my sons ADHD meds out of pocket, and the $600+ visit twice a year for “med monitoring”. If I could put that $500 a month into my own account and pay “cash” prices at the doctors I would be much better off.
    I feel your pain, good luck with the system…we applied for Medicaid, but my DH makes too much (lol).

  5. Jessica August 24, 2013 at 4:49 am #

    I don’t live in the US, but I do travel rather extensively to and from the US. My medications for a very rare metabolic and neurological syndrome is covered under national health insurance where I do live. The system here also involves waiting. It involves referrals. There are staff shortages, referrals get lost. In some regions in the country you will get the Very Expensive and cutting-edge medicine, in others it’s considered too expensive.If you pay to go to a private hospital for planned surgery etc., you are in and out in a week or so. But you do pay the full cost.

    I’m relying on a cocktail of medications just to stay alive. A months worth is 8 000 dollars. The system here, with all its weaknesses and strengths, offers everyone generous subsidies. And I do mean generous compared to many other places. No one pays more than (approximately) 250 dollars a year for prescription medications, 125 for doctor’s visits, PT-visits, etc. I KNOW and truly appreciate these subsidies. The taxation to keep this going is heavy, I can live with that.

    My fiancé is a generously paid research fellow in the USA at the moment. Me moving along would have been preferable but then there was the insurance. He has an excellent plan via his employer. Only, I can’t get on it. Or I could but none of those medications I need to survive would be covered, nor would doctor appointsment, specialist visits etc. It goes under “pre-existing condition” and then its excluded. Welcome to the catch 22-layout of the land. Also, the employer has been really helpful is trying to find us a plan where they could cover at least part of the cost of medication. Alas, that won’t happen. I’m lucky in that I have a way to solve this, I collect the ratio alloted of subsidised medicine, go to visit the fiancé for as long as my ratio of medicines allow, then return home for a bit. If I could solve this, even if its under using novel (and legal) ideas. There are some other hurdles that I really can’t get around, legally, and for different (yet partly related to social and health insurance) reasons, I can’t spend more than six months abroad per year. I can live with that as well.

    Paying out of pocket is always a possibility, but even with a beneficial income, it would be torture. As it stands now, I travel back and forth when my health is stabile enough and when I have energy for it, bringing the ratio of medicine with me, staying for a bit and then returning home for a while. I’ve spoken to god knows how many insurance companies here on whether they would reimburse costs incurred in the US. Well, maybe, but no one is exactly sure. They would pay for emergencies, they won’t cover anything “recurring”, that I know in advance I’ll need, such as medications, Maybe that’s fair. I can’t get any kind of extra insurance, either. There’s the pre-existing stuff again so it’s really not just in the US it happens, but I always have access to health care. The payment is dependant on which country I’m in. I did go for blood tests at a walk-in-clinic. It was really nice, experienced staff, absolutely stellar equipment. it was done in a jiffy (ten minutes). The cost, 1 020 dollars.

    Again, I’m lucky. I shuttle between two systems. I pay the taxes that keeps the system going. Even when I should need any emergency intervention, it would be re-imbursed. There are people in the US struggling between horrible choices of seeking qualified, high-level health care or whether to pay for groceries. Even the most basic medical care, can be out of reach. Medic-aid or not. Requiring emergency surgery could push one into bankruptcy.

    At one time, when my condition was running truly amok and no one seemed to know what to do, I was sent to an american hospital. It was efficient, high quality and I did come away healthier, with a solution that has been working until now.
    The health insurance picked up the tab under a waiver which allows for care abroad when no one know that the f**k to do. I wouldn’t qualify for such a waiver at this time.

  6. sleepymotherof4 August 24, 2013 at 8:25 am #

    I’m Canadian – if Canadians go to the US for health care it’s only because they are wealthy and don’t want to wait. Canada has the best system – where ever I go, I just have to show my health card, issued at birth, for free, and I get the help I need for free. No filling out any paper work. We only pay for non-essentials, like boob jobs and tummy tucks. Prescriptions are not covered but usually your job offers coverage – my husbands pays for 80% of prescriptions and dental. The draw backs are wait times – we had to wait for a year to get in to see a specialist who could diagnose our daughter with autism. But, I would gladly take that than all of what you just described! Like you need all that added stress! Crazy! Wishing you all the best as you deal with your insurance company!

  7. Sherty August 24, 2013 at 9:00 am #

    I’m not a fan of dealing with insurance companies either, but I was glad to have even the piss-poor coverage we do when I had to have my gall bladder out. I was at the hospital at 6:00am and home by 2:00pm the same day. The charge for just the OR room, doctor not included, was $10,000. In my opinion, that’s one of the reasons insurance is so expensive and doesn’t cover much.

    • Jessica August 24, 2013 at 1:19 pm #

      I read an article in some online paper where they had conducted a price comparison. A CT could be well in the excess of 5 000 dollars, at another hospital less than 1 000 dollars, i.e. charges are not only due to insurance costs.

      • phoebz4 August 24, 2013 at 11:15 pm #

        Yeah, Maura once fell and cut her forehead a little. It required 3 little stitches. The ER wasn’t busy, so we were honest to God in and out of there in 30 minutes. Seriously, 30 minutes, 3 stitches…

        They billed us $6000.

        On the flipside, another child required 3 CT scans to make sure she hadn’t injured herself after a bad fall, and that cost us $6000 as well.

        The inconsistency with pricing is ridiculous. Both were major medical centers in cities (Pittsburgh and Chicago – the Pittsburgh one was the $2K per stitch one.)

  8. dickdastardlyfra9156 August 24, 2013 at 10:28 am #

    I hope you are keeping a check on your BP – nothing raises it more than the hoops we have to jump through for our children, just to get what they are entitled to in the first place.
    Rather than making more phone calls = would you consider writing directly to the CEO of the insurance company?

    Give him (a very limited) time to respond, then write to him again (even if he hasn’t responded) then keep writing every couple of days. –
    If he is any good he will have a PR dept. or the like reply or pass it off to a junior vp to deal with. I
    f you keep writing to the CEO (this is an essential part of the strategy)…. he just instructs others to ‘deal with it’ – eventually (how long is a pice of string?) it dawns on one of them …. “it might just be easier (for them) just to pay!

    It’s an extraordinary eureka moment for them – they even feel good doing so!!!

  9. Angel Brookins August 24, 2013 at 10:32 am #

    Living down here in the dirt next to the roots of the grass, I would love improvement to our healthcare in America. I celebrated the day that Obama’s health care reform bill passed, and have waited with bated breath for it to take effect.
    ‘Why?’ some might ask.
    Well, because it’s horrible that I can’t afford to pay $300.00 a month for Cymbalta which actually works on my nerve pain, and be stuck with Effexor because the insurance will cover it, even though it does not work half as well. I also take Mobic instead of Celebrex for my RA for the same reason.
    The people who write my insurance (who are NOT medical professionals) decide which medications that they will cover, and what ‘preferred formularies’ or replacement drugs they will push instead of the ones that work.
    If it is possible for us to get anything done, I’d like to help do it!

  10. Stigma Hurts Everyone August 24, 2013 at 3:44 pm #

    WoW! That really sucks all the trouble you are having moving back to the US. I complain about our high income tax here in Canada and it’s higher in Quebec but we have free medical and $7 a day daycares. We wait a long time for care but I can read or write while I wait.

    • phoebz4 August 24, 2013 at 11:12 pm #

      we get all this and a long wait time as well. When Maura was seeing one specialist in Michigan, I actually started packing snacks and toys and things for me to do. I’d show up with a backpack of supplies because if I didn’t, we’d be there at least an hour waiting. I once had a 9 am appointment there, with a 1 pm appointment at another doctor’s…that I had to push back b/c we were still fiddling around the first place (The Great and Powerful U of M – lol!)

      People used to ask me where I found time to knit…

      • Stigma Hurts Everyone August 24, 2013 at 11:17 pm #

        Ah the memories of my backpack filled with entertainment for minimum 4 hours and that was way before technology today…my kids are now 32 and 34. The waiting has increased by 9am if you arrive at a clinic it is filled already for the day, I have to drive and find another one. I feel for young families with young children…I worked 10 yrs in a clinc but since 97 it has changed. Good luck, I will pray, think and hope things will get sorted out for you and lovely Maura. Blessings

  11. phxross August 24, 2013 at 4:28 pm #

    I’m wondering if your medical plan has a deductible you have to meet first. If you have the plan document is be happy to look it over for you at any time. When I was still working i was in insurance. Health, Life, Disability, etc, first in claims & then account management (servicing employers who purchase the coverage). As of 2009 I can no longer work due to extensive joint problems from a lifetime of lax ligaments (leading to severe systemic arthritis).

    So I’m now a volunteer on a few online health communities helping people understand their plans, etc. The sites include SpineHealth (I’ve had 5 spine surgeries in the last few years), HealthBoards, Breast Health Online, & What Next (cancet related site).

    Just let me know, I can help you anytime.

    Karin

    • phoebz4 August 24, 2013 at 6:35 pm #

      It is a deductible we have to meet – and then after we meet the first one, they’ll things at 70-90%. Then when we meet that number, then we’ll be able to get things covered 100%. Including the meds, or so I’ve been told.

      We just have to meet the deductibles. I didn’t realize that things like Maura’s meds weren’t going to be covered, or that each specialist appointment would have to be paid out of pocket 100%. Or that for whatever reason, we’re being billed for teen boy check ups, when we should be.

      And my next question for them is, if I’m paying out of pocket for all of this, how do they know when the deductible’s been met? Do I have to keep receipts? Do they know by osmosis?

      I should have taken bookkeeping courses so I can keep up with this stuff.

      • Jessica August 25, 2013 at 6:53 am #

        That’s when you call your own gp for a prescription of anti-anxiety meds ;). Alternatively, I’ll recommend wine. Or champagne to go with the quote “Time to dance on the table and drink champagne”. If nothing else, you’ll have some fun for a bit.

        Sorry it’s such a pain in the rear, at least I don’t have to deal with any actual insurance company by travelling back and forth. Although I’d have to deal with my own one should an emergency happen. So far (knock on wood, hell, knock on everything really), I’ve been spared emergencies.

      • phoebz4 August 25, 2013 at 11:11 pm #

        Anxiety meds are not covered either – LOL! But when I get an ulcer from it all, I’m set 😉

      • Jessica August 26, 2013 at 4:23 am #

        In the general mess of it all, that would make kinda sense. Somehow. Why cover stuff that prevents people from having general break-downs. What remains is alcohol. For medicinal purposes. Wine, cognac, brandy, a shot of rum. Or champagne, any kind of bubbly will do, and have a dance of the table

      • phxross (Karin) August 26, 2013 at 6:51 am #

        Everything you buy a prescription and present your insurance card, and the transaction goes through, then that purchase is “recorded”. If, for for example, you have a $600 prescription deductible the Rx insurance keeps track of what you spend out of pocket and when you reach $600 then Rx insurance kicks in. If Costco was $180 for the a Rx without insurance coverage, and Walgreens is $240 with a Rx coverage, and you buy from Costco but didn’t present your Rx insurance card – then the Rx insurance company doesn’t know you spent the $240.

        Also check to see if your deductibles (Rx or health insurance) are per covered person and/or per family. For example, your Rx insurance deductible could be $600 deductible per covered person BUT a maximum of or perhaps a max deductible of no more than $1200 in any covered family. So having 6 of you covered may not mean 6 X $600 = $3600 deductible, it’s more likely (given the sample numbers) $1200 per year per family. And that may be met by just Maura’s medications, or if the boys get any Rx they’ll also “contribute” to the deductible.

        Check out http://www.medicaid.gov and http://www.ssa.gov to see if Maura nay qualify for one or both.

      • phxross August 26, 2013 at 6:53 am #

        I just posted a reply, let me know if it doesn’t show up.

  12. itsybitsymom August 25, 2013 at 6:59 am #

    I so completely feel your pain! In PA any kid with an IEP is covered by MA thanks to a “loophole” regardless of income. As other MOMS to see if there is anything similar in WA. Back in the thick of it all I remember thinking I needed a full time secretary to keep up with the paperwork. Thankfully it is all running smoothly here now. I hope you get to that point too!

  13. denverlori August 25, 2013 at 12:05 pm #

    Oh how I feel your pain. My 2e guy does very well on the medication Abilify. It is a non-formulary not due to go generic until 2015. After reading your blog I wonder if that is even a good thing. The poor Target pharmacist always looks at me in a sad way when I pay for his monthly prescriptions. The Abilify alone is close to $600 a month for a relatively small dose. We have insurance from a major carrier that makes us pay monthly premiums AND hit a crazy high $4,000 deductible for in network providers. Out of network providers have their own $4,000 deductible. Once we hit the deductible, usually in June, then we pay $25 per refill. I literally cried the first time we hit the deductible. The pharmacist thought for a moment the meds were actually for me!?!? Abilify does provide a customer card for those who cannot afford their product. If you are a first time user you get your first month free and then $100 off on every refill after. So, if I didn’t have the card I would be charged closer to $700 A MONTH for one med! Big pharm is definitely one powerful, mother f@cking group!

  14. Joan T Warren August 25, 2013 at 7:28 pm #

    Just a quick note to say I’ve got a Blog Award for you, if you’d like it. See http://joantwarren.com/2013/08/25/bouquet-of-three/ ‎to snag it for your own! Great work you’re doing here.

  15. Laura September 2, 2013 at 11:52 pm #

    Great health care doesn’t count for squat if you can’t afford it. Like you, we’re lucky. We can pay for our daughter’s health care, but we will do without in other places. Our health care system is anything but user-friendly.

    We spent one month without basic coverage (though we had catastrophic coverage) when my husband switched jobs. That was the month my daughter needed to see the endocrinologist. (congenital hypothyroidism) I called Children’s Hospital to ask how much that visit would cost. The endocrinology clinic couldn’t tell me. So I called billing. They couldn’t tell me. So I called patient affairs. They couldn’t tell me, but gave me the number of a woman who could. I called, and left a message. 2 days later, I called and left another message. And again, and again, and again. She never called back.

    Finally I gave up and just went to the appointment, which lasted all of 10 minutes. They weighed her, measured her height, marked her heart rate. Looked at her, asked a few questions. A quick blood draw and we were out the door. That cost nearly $400. But until we got the bill, we had no idea how much it would cost.

    Yes, our healthcare access is broken.

  16. Tara October 3, 2013 at 10:06 pm #

    The main issues that I have run into are with therapy– speech, feeding, physical therapy and occupational therapy. Who’s the genius who decided to limit how many therapy sessions someone can have in a year? I have argued with my insurance company and made several appeals, and the best answer I can get is “well, your employer decided on this plan, it only allows for 20 PT & OT visits combined for the year.” Seriously? Why should you, as the insurance company, even put limitations on services such as those in the first place? The thing that gripes me the most is the fact that if my child were on Medicaid, every visit would be 100% paid for, with no limitations on how many visits she could have throughout the year. But because my husband and I work, we don’t qualify for Medicaid, so my child is the one who suffers. The system is definitely broken. Sorry, rant over. =)

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