Friday, June 11, 2010

But We're Some of the Lucky Ones!

I've been blogging all week about my poor, sick daughter. She was put on antibiotics yesterday, so I'm hoping this will help! I also blogged on Tuesday about how we went to a pediatric after-hours clinic on Monday night after my daughter's nose gushed out blood for what seemed like an eternity. At this clinic, they declined to take our insurance insisting we pay $300 for the doctor to just look at our daughter to let us know how we should proceed. This incident brings me to today's topic on health care reform.

A lot of people I know are definitely for heath care reform. However, a lot of people I know are also against reform. I honestly don't know why anyone would be against reform. The current system is so badly broken. The reform measures will help a little. People who have not been able to get insurance will be able to get coverage, for example. But I don't think the reforms have gone nearly far enough.

My husband's health insurance coverage is pretty amazing. We don't even pay a monthly premium. Just a few years ago, it was considered primo coverage. When I had to take my daughter to get physical therapy because she was a late walker, we were told by the firm that provided the therapy that our insurance was amazing--the best there is.

I don't know what happened over the past few years, but less and less is covered. I know that's pretty typical. However, we're having a harder and harder time getting covered items reimbursed. The insurance company will claim we didn't get pre-approval for things, when we did. They lose paperwork we send (every time). They have high staff turnover, so you're never dealing with the same person when you're trying to get issues straightened out. It also sounds like they have minimal staff to handle many people, so it's no wonder why things are lost and forgotten. When we finally do get reimbursed for things, it can be a year later or more--no exaggeration.

The clinic we went to said they no longer take our insurance because the insurance company hasn't been reimbursing them either over the last few months. I wonder if this will eventually spill over with our other medical providers.

This is the system that many people loves so much? I'm at a complete loss why. I, personally, do not think the health care reforms went far enough. Call me a socialist, but I would love to see health care covered by a single provider. Will it be perfect? No. But this current system is ridiculous. It is hard and expensive to get good coverage and even when you're lucky enough to have "good" coverage, it's abysmal. I just don't think a blood-covered, sick six year-old girl--who has PPO insurance--should be turned away from a clinic because of the ineptitude of the insurance company. Did I mention this clinic advertised that they take all PPO plans? Whatever.

I just have to remind myself, as I'm mailing for the third time (certified, return-receipt, of course) yet more documentation to our health insurance company, that we're some of the lucky ones who at least have health insurance.


  1. I am cautious about health care reform, not necessarily because I think the current system is so great. As the parent of a child who wears hearing aids, we currently pay out of pocket for the hearing aids and any specialized hearing tests.

    Of course, I would love to have insurance pay for the hearing aids (approximately several thousand dollars every three years).

    But I worry that insurance companies would dictate which hearing aids to purchase, rather than families or audiologists.

    Currently, we buy the top of the line hearing aids because my son's loss is severe and the quality of the aids affects not only his hearing, but the clarity of his speech (if he can't hear clearly, he won't understand correct pronunciations).

    People don't understand that with excellent hearing aids and intensive early education, hard of hearing children can have language skills on par with hearing children of the same age.

    I'm definitely cautious about health care reform, though I agree that the current system does need to change.

  2. It is awful what your daughter, husband and you went through with the urgent care place. Things will keep getting worse even for people with "good" medical care if something isn't done. All of us with adult children worry when they age out of our insurance. They could be denied due to a pre-existent condition. I personally know someone who had bipolar condition and tried to check herself into a hospital 3 times, but her insurance declined to allow her to be admitted. This ended tragically. The reform didn't go far enough but at least it's a baby step in the right direction.

  3. It just isn't insurance companies, it is also hospitals and doctors. The hospital I had my daughter in is covered by my insurance company. What the hospital fails to tell you is that the staff working in the NICU are not actual employees of the hospital. They are some company based in Texas who run the NICU. Of course, if your baby is sick, you aren't going to care. A hospital needs to be up front about these things. This company also charged my insurance for intubating my daughter. Never once did she have a breathing tube. They tried to charge medicaid first, instead of our primary insurance company. When medicaid denied their claim, they came after us! We had to explain to them 3 different times that they have to charge our primary insurance company first, then our secondary medicaid. See.... they charged medicaid first because medicaid is less likely to fight outrageous charges. Our insurance will fight these charges. I never heard back from these people as to why they charged the insurance company $200 for a procedure that my daughter never had. Curious, isn't it? So it's not just insurance companies, it's everyone. Though I'm not exactly for government run health care, changes do need to be made. How that would happen though, I have no clue.

  4. Amen, Cheryl. Seriously. People are so afraid of change, so afraid of things that aren't even part of the reform. Or they're scared they're going to lose out on something to help the greater good. It's a fear-based society thanks to the previous administration. I would love to see everyone have coverage. Especially children.

  5. Thanks for the comment on my blog!

    Actually health care reform is something close to my heart. I'm originally from the UK and although the system there is FAR from perfect I wouldn't have them change it for the world, simply because it's free. Everyone has the right to healthcare, whether they have money or not.

    Now I'm a military spouse, so I have free healthcare (in the form of Tricare) here too. I'm honestly terrified of what it would mean for us in that respect if my husband were to get out of the military. I don't understand how a healthcare system like the one in the US can still be in place, in my opinion everyone deserves affordable healthcare as a basic human right and everyone under the age of 18 should have free healthcare.

    My son was a preemie, we didn't have to pay a thing for his NICU care because of tricare, but I saw the bill to the insurance and it was over 100,000. We would have never been able to pay that if we were not military. Because I'm now considered high risk for another preemie, we're planning on having any more kids before he gets out of the military, otherwise we would go bankrupt if we had another preemie.

    I also have OCD, we wouldn't have been able to afford my behavioural therapy sessions if we weren't military.

  6. I am sorry you had to deal with that, as if your daughter not feeling well isn't enough - they had to do that!!! What a shame :-(

    Hang in there and I am hoping everything works out well!

  7. Hi Cheryl. Hope your daughter is soon feeling better. Posts like this make me really happy to live in England where we have the NHS. It isn't perfect but it's pretty good. Thanks for stopping by my blog on SITS Pot Luck Friday x

  8. I hope your daughter is feeling better tonight. Thanks for stopping by my blog on Friday. I love meeting new friends and new blogs. I am stopping by to say hi and follow your blog.

  9. I will refrain from getting on my soapbox. I will only say that people don't get what it is like to not be able to have insurance. Hubby was in a terrible car accidents and now can't get insurance at all because of it.

  10. This is a very hot and heated topic for many. I personally believe that everyone should have access to healthcare, regardless of their ability to pay. No one should be suffering from an illness when there is a means to treat it. I can't imagine how anyone could possibly disagree with that.

    By the way, I'm visiting from SITS. Have a wonderful day! :-)

  11. I wonder if we have the same insurance company...