On the heals heels of Congress' gutting of the public option in favor of a cobbled together piece of legislation that leaves most people like me out of the picture, I have some personal (humiliating) experience with how even those with insurance aren't protected, aren't safe.
For the record, I am government employed (city government) and I have health coverage (ostensibly). I pay my premiums faithfully as they are auto-deducted from my pay, 1/2 on pay period, 1/2 the other. My daughter is also covered under this policy.
It's not grand; I've got a $750 per person deductible, a $20 co pay for office visits, a $20 and up co-pay for meds and specialists are covered 70/30.
Today, I learned that means not a lot, actually.
Some of you that know me know my daughter, poor thing, has two ingrown toenails, one on each of her large toes. She has her father's feet, and her toenails grow out in a spread out way, unlike mine. So, she trims them down, only how she's been doing it led to this problem.
We contacted our GP, he advised soaking her feet in warm, salty water and applying antibiotic ointment, and we'd monitor to see if anything happened. That was fine - there was discomfort, but no pain, no infection.
Then, Saturday morning my daughter woke up in pain, with one of her toes really red and inflamed, and it looked a bit ulcerated. We tried the emergency medical center (doc in the box) that day, but they were very busy and we were told we didn't have an emergency, to come back the next day as Sundays are slower. So, we nursed her through Saturday night with foot soaks and antibiotic ointment, and ibuprofen for pain.
Early Sunday, we got up and were there when they first opened. The ARNP took one look at her foot and say 'podiatrist'. And they gave me a referral. They cleaned it, wrapped it and told us to keep doing what we're doing. They gave us Augmentin and an Rx for a stronger ointment, and instructions on how to clean and dress it. (Wearing shoes is painful and the school will only let them wear close-toed shoes! No exceptions, unless it's an Rx orthopedic boot of some kind. ::sigh::) At this point, I've paid a $20 copay for the emergency care visit and $60 for the co pays on the various meds and antiobiotics. This is out of a thin pocket.
The podiatrist's office called me early Monday morning. The lady was nice, pleasant enough, but very pushy. I explained I would need an appointment close to when I got paid, because I knew from experience that a specialist would require more from me in the way of co-payments. She said, 'But your daughter is suffering, in pain, we think you should come in right away.' I presumed she understood about the insurance and financial situation, because I had just informed her of it, so I booked the appointment for this afternoon.
I left work around 2:30pm, taking leave time from work, and picked up my daughter from school. We traveled across town to the appointment, and I parked and let the receptionist know I was there. She gave me paperwork to fill out, even though we were a referral and she had all of it already, but okay, I did it. My daughter is there, in pain, waiting for treatment.
I give her my ID and insurance card. After 2-3 minutes she calls me up and says 'Do you know you haven't met your deductible for this year yet?' And I said, well I wasn't sure but we've had a few different visits this year to various places, so I am shocked to find NONE of them qualified as 'satisfying the deductible'. So, she says, I will need to pay cash for the visit; $175 per toe, plus the office visit. Over $500 total. Cash, up front. NO PAYMENTS.
I look at her helplessly and say, and this is in the lobby in front of other patients, that I can't possibly pay that today, but I could make payments. She reiterates, NO PAYMENTS. And then she reminds me my daughter is 'in pain' and I should go ahead and pay them the full amount now, and did I have a credit card I could charge it to?
I looked at her and said, 'No. My insurance is perfectly good, and I was advised that this visit would not need to go to the deductible, because it was a referral from emergency care. I am not going to put $500 on my credit card today that will turn into $800 over time because I have to make payments on it." I didn't mention to her I only have one credit card, and the limit on it is not high. For a single parent like me, I got only the amount of credit I could reasonable afford to pay off. Screw me for being responsible, apparently. And also, screw me for being healthy - because if I was sick as hell I would have met that $750 deductible and would be getting care for my kid. And screw me three times for being a person who may not be rich, but who works and pays her bills and sometimes needs a bit of time and understanding.
She said, 'we're not going to file your insurance, because we already know they will just put it to your deductible.' I looked at her, and shocked said, 'then how am I ever supposed to meet my deductible?' She said 'that's our policy.'
I am upset, by this point, and with as much dignity as I can muster, I go out into the parking lot and call her pediatrician's office. I also call the emergency care center nurse who referred us; she was appalled, and shocked. The pediatrician's office is going to make a new referral for us, to another provider who will work with us to make payments and who will file our insurance to at least get it applied to the deductible so we will get credit for it down the line. It represents 2/3 of our deductible, so that will help.
I pay hundreds of dollars a month in premiums. I pay my deductibles, I pay my co payments, for both visits and pharmacy. Why should I have a $750 deductible? Anyone can look and see we're hardly profligate health system abusers. We usually get well care check ups and occasionally have a cold or flu we see the GP for. I guess it's the 'you're just slightly too healthy' health insurance tax.
It's not a fatal situation, but it was a galling and humiliating one. See, I have insurance. It's just shitty insurance through my employer. (We don't get the gold-plated stuff some other government types get) It's supposed to work. And now I have a 12 year old, who is in pain and who should be seen - and should not be barred from it because of the economic circumstances of her parent.
That is why Congress' decision is so demoralising. They are basically saying that in my life, this situation is never going to change. That every year, we must pay $1500 out of pocket, then all the premiums and then all the co pays and then the remaining percentages before they'll even consider paying. And why aren't my office visits crediting to my deductible? I've left a message at BCBS of FL on that one. They aren't protecting me, or considering me, and I use the system very little.
In fact, my insurer sees thousands a year out of my hide while I consume only a few hundred's worth of health care a year.
Hopefully, we'll get this resolved. The pediatrician's office was also appalled at the behavior of the podiatrist, so they're going to do whatever they can to help us out. But why should they have to? Why shouldn't my child, like any child in France or the UK or even Canada, just walk into a clinic and be treated...like a human being?
We're still waiting for change on that score.