Why Health Insurance Is Killing Me

This blog post could also be titled:

"Health Insurance: America's #1 Shell Game"
"Health Insurance: The House Always Wins"
"Health Insurance: Your Kid Is Sick, That Must Be Terrible, Blah, Blah, Blah..."

At around 2:00 p.m. today, I got off the phone with a customer service agent at our health care insurance provider who chided me (multiple times!) for being rude. I can certainly guess that my voice was not ringing with sunshine tones, as I had a small child screaming about how much her ear hurt while I was sitting there on the phone with the FIFTH person in two hours, all to get a simple urgent-care visit. That was it. Once again, we were put through a ridiculous ringer of health care coverage madness while our sick kid suffered, and no, I'm not feeling particularly polite about it.

Here was today's scenario:

1) Wee hours of the morning: EJ wakes up with a terrible, hacking cough. She is sobbing. I take her into the bathroom and run the shower until the steam helps her to relax. I give her the tiniest bit of Benadryl. She goes back to sleep.

2) Morning: We wake up and ask EJ how she is feeling. She says she's great, she wants to go to school, etc. Unfortunately, her loud, dry, scary-sounded cough is in full force. No fever, energy up, but our guts say keep her home. We do.

3) Mid-morning: Mike stays home so I can go to a doctor's appointment I've had on the books for awhile. We ask ourselves, "Why does our kid always get sick on the only days that we have plans?" EJ keeps Mike more than occupied, as she is squirrelly and full of energy, but coughing in full force. We start to regret our morning choice.

4) Noon: All regrets are set aside as EJ becomes very cranky, then starts screaming every time she swallows or coughs. "MY EAR HURTS!" Time to call the doctor.

5) 12:30 p.m.: We call our doctor of 5 years. While on hold, they play a message that states that they no longer accept our insurance. We received no notice of this. Once we talk to an agent, they let us know that it is likely we would need to pay out of pocket, so they will not give us an appointment. It becomes clear that they are worried we won't pay what, at minimum, will be a $300-400 bill. They ask us to call our insurer for names of new doctors. They also suggest we just "take [our] daughter to the ER, because they have to see her." Fun!

6) 12:45 p.m.: Insurance call #1. The very kind lady explains to us that, although she can find our provider on her list of preferred, in-network providers, it appears that in all of our claims from the last year, she has used a different tax ID than our insurer has on file for her. Because of this, we have been billed out-of-network. I tell her that I have repeatedly contested those bills, and she states that they have all be individually reviewed, and if the doctor "chooses to use the wrong ID," they have no choice but to bill me out-of-network. She also has the incorrect address for our doctor---it is the address for the main hospital, not the clinic---which explains what our insurance told us last year (during a dispute): if the doctor is covered, but the clinic in which she works is not, you will receive no in-network coverage. EJ is still screaming loudly, so we give her Tylenol and a heating pad. The representative gives me the name of a family practice (and three docs) who should be able to see our child.

7) Moments before 1:00 p.m.: I comfort EJ and field a work call that I had been expecting ("Can we postpone? Thank you, so much!") while Mike now calls the practice. He gets transferred once, twice, three times before getting through to someone. They can't see us anytime soon, nor do they like to see patients for urgent care first. No kidding---wouldn't be our ideal scenario, either. Mike is transferred to pediatrics, which we hope has a doc that would cover us, but all he can do is leave a message for the nurse to see if anyone will see us. He is then transferred to internal medicine---if you are following this, our child's care has now been transferred from family medicine to peds to internal medicine---and we get a hesitant, "Yes, I think we take that PPO" response, and an appointment for tomorrow morning with a resident.

8) 1:45 p.m. (notice how long the previous call took): I call the insurer back for call #2. I want to confirm that this resident will, in fact, be in-network. I also want to find out if the attending physician, who we have never heard of before, is covered. During this call, several things happen:

--I am told that I am rude for interrupting (when she begins talking to me about past bill disputes, not addressing the question that I put forth at the beginning of my call), and if I would just listen I could understand what is going on.
--I am told that it is the consumer (i.e., me) who must confirm that the tax ID number that the physician uses to bill service is the same one that they have provided to the health insurance---when I ask how many consumers think about tax ID numbers when they are sick and going to the doctor, I am "ma'amed" and called rude again
--I am told that checking the website or calling the insurer to find a covered doctor is futile, because, and I quote, "That information can change daily. It isn't up-to-date." I ask if she has an up-to-date list, and am told that they see the same information I do. So, to review: the website that lists in-network providers is out-of-date, and when you call an agent, they use the website to help you.
--I am never asked how my kid is feeling, but I am told, "I understand that you are frustrated." Sadly, this is not said in an empathetic way, but rather, in a "sorry you can't make my day easier, crazy rude lady" way.

So, at the end of the day, here is what we have:

1) A child in pain---not enough pain or problem to go to the ER, but enough to be completely miserable
2) No pediatrician, and no real hope that we can find one in network
3) An appointment tomorrow with a doc who may or may not be covered, and who may or may not regularly see kids
4) Another missed day of school for this kiddo, or at least a missed morning
5) More missed work for Mike, who will have to take EJ to the doc because the only appointment we can get is while I am teaching
6) The knowledge that the sheer frustration of the health care situation has probably taken a few hours off of my life and my husband's---thank you stress, raised blood pressure, etc.

Is this the precious system we don't want to lose? Honestly? Because if it is, it sure isn't doing right by my kid, and I have no problem letting it go.