Thursday, July 16, 2009

Healthcare Reform Pt. 1

I'm not a medical professional, I'm just a mom. A mom who has spent a lot of time trying to navigate through inefficient systems trying to get care for my children. I'm going to give you several posts related to many of the headaches I've had to go through in order to get care for my children.

Let me preface this by saying I have health insurance. In fact, I've had the exact same health insurance for the last 12 years from one of the bigger players in the health insurance game. I work for one of the largest employers in the U.S. and have what most think are the "best" benefits around. After reading through my posts, I wonder if you would say we are getting the "best" medical care available to a working family of 4.

Scenario 1:

My son (now 12) had a seizure when he was 4. I do not have any medical training and had no idea what was going on with him, so I called 911 and asked for an ambulance. As EMS entered my house, my son came around and started vomiting all over them. They did his vitals, a blood glucose test and told me they suspected a seizure. Once they determined my son was stable they suggested I transport him myself to the hospital.

Want to know why? Because my insurance company was most likely not going to pay for the trip to the hospital since it was not "preauthorized".

Had we been on Medicaid, would I have been advised to transport him myself? Or would authorization have been assumed? And more importantly, can someone tell me exactly how to preauthorize a trip to the hospital when my child is unresponsive, unconscious and twitching all over the floor? Should I have asked him to hold please while I call the helpful 800# on my medical card?

* For the record, the EMS guys were awesome with us and I am not bashing them. My mind was on my son and I was freaked out by his seizure. They were level-headed and professional enough to know I would end up with the short end of the stick and didn't seem phased by my son's lunch on their otherwise tidy uniforms. *

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