HARVARD SQUARE COMMENTARY

November 12, 2007
From Regent Street

The State of My Healthcare

Neil Turner


Considering the lack of healthcare for the poor and working class of this nation, I know I have no right to complain, but I'm going to anyway.

One of the benefits of being a teacher in Anne Arundel County, Maryland was the excellent healthcare benefits. My coverage with Blue Cross/Blue Shield basically paid for every expense related to health. I'm been extremely lucky to have had good health so far and the expenses of my healthcare thus far has been for some sinus infections, a ruptured disc in my neck, torn cartilage in my knee, and chronic back problems. My health insurance basically paid for all of that except a $250 anesthesiologist bill for my neck surgery and some prescriptions at six dollars a pop.

The only problem that has plagued me throughout most of my adult life has been my back. After years and years of trying to have to problem solved by various sports medicine doctors, I finally went to a chiropractor who performed a miracle. I had always considered chiropractors as sort of quacks, but I was certainly wrong. Dr. Ricci - whom I've nicknamed "The Wonderful Dr. Ricci" - has taken me from a state that, at times, I couldn't stand up straight or get out of bed to long-term back health with just a few minor setbacks along the way. I have been graced by this state of back health now for almost fifteen years.

So, being one of those people who doesn't believe in going to a doctor unless there is something wrong, I've breezed through life so far being very, very lucky.

There was a little bump in the road when I retired. I had a choice of retaining the full coverage I had had all along or moving to a preferred provider network. Because the full coverage was considerably more expensive, and considering that The Wonderful was in the network, I chose the preferred provider option. This meant that I would have to pay fifteen dollars every six weeks when I went in for a back check-up. All went well for years until a little over a year ago, I received a letter from the healthcare people at the school board.

The letter told me that I was invited to a meeting in which I was to be educated upon a change in my healthcare that was going to "lower my expenses while providing better care." I knew right away that this was not going to be good. Anytime a bureaucracy has to hold meeting to explain how it has benefited you, you're out to be screwed, and that is certainly what has happened. Under the new and improved system, I was to have a primary care physician. In the great world of healthcare, primary care physician is code for an establishment designed to prevent you from getting the care you are seeking. My reward for finding this angelic sentinel of my well-being was that I was now only going to have to pay ten dollars a visit. Of course they didn't address the fact that now I was going to have to pay a stranger ten dollars to give me permission to go to a doctor I already knew and then give that doctor another ten dollars.

Consider my situation. The only doctor I had gone to in, at least, ten years was The Wonderful. I now had to go out and find a doctor I didn't know and who didn't know me to get permission to go to a doctor who had been giving me care for over a decade. Now that makes great sense.

My other glorious choice was to continue in the preferred provider network and incur the added expense of "$200 a year deductible with a maximum of $500 of out of pocket expenses." Now does that make any sense? If your deductible is $200 per year how can you encounter $500 of out of pocket expenses? I have written letters trying to get them to explain exactly what the phrase means but no one has given me an answer.

Being told that I was required to choose a primary care physician and being basically sheep-like, I put down the name of a doctor near me who had taken over the practice of a doctor I went to about twelve years ago for a sinus infection. I went there, waited over an hour to be seen, and was treated rudely by the staff until I finally go to see the doctor. Now I thought I was set to be able to go to the doctor I had already been going to for years having been given permission by a stranger. Silly me! The glorious referral is for three months or three visits. I go to The Wonderful every six weeks so the referral is only good for two visits. A few weeks ago it was time for another visit, and I called a rude member of the staff of my glorious primary care physician for yet another referral. I was told that I had to make another appointment, wait again for over an hour, be rudely treated by the staff, and then be seen by a doctor who didn't know me to be able to go to the doctor I had been seeing for years. At that point, I said, "To hell with it!"

I called The Wonderful's office where everyone is friendly and courteous and was told to just come in for my visit after which they would submit the paperwork, and we would see what would happen.

What should have happened was that The Wonderful's bill of $50 was to reduced by $28.25 leaving me to pay the preferred provider $15 co-pay and, I suppose, be charged the additional $7.75 as part of my $200 a year deductible.

What did happen is that the $50 was reduced by $28.25, The Wonderful was sent $11.75 by the insurance company, and I am expected to pay a $10 co-pay. This is without a referral. The insurance company doesn’t know what it is doing.

I have decided to blunder blindly ahead and just see what happens. The whole system is so screwed up that nobody knows what is going on. I'm just grateful that there is nothing seriously wrong with me.

Post Script I - I once asked The Wonderful why he just didn't bill me $22.75 for a regular check-up as that is what he is finally paid. He told me that the insurance company requires that he bill the higher amount. If he billed the amount he was actually paid, they wouldn't pay him at all. Figure that out!

Post Script II - In three years, I will be sixty-five and Medicare will be paying a large part of whatever medical expenses I encounter. When that happens, my monthly healthcare insurance charge will go up almost a hundred dollars. I'll have to pay more for my insurance when Big Brother is paying most of the bill. Now explain that!


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