Thursday, July 16, 2009

Healthcare Refort Pt. 2

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 2:

While trying to determine the underlying cause of the seizure (and other symptoms I didn't realize were common with Autism), my son's pediatrician sent him to the local children's hospital for a sleep-deprived EEG. He did a referral for the procedure and we thought it was covered by my insurance.

I got a bill for over $500 for this procedure a few weeks later. Want to know why? Because the neurologist or the pediatrician (both offices finger pointed at the other) didn't provide the correct "diagnostic" code to the evil insurance company. Pediatrician's office said they didn't have a diagnosis so they couldn't have provided it when the test was ordered. Neurologist's office said they only read the test results. They are not responsible for the diagnostic code, it was the pediatrician's responsibility.

I fought that battle for over 6 months and paid out the wahzoo for the EEG - both in time and in cold hard cash. To add insult to injury, because this drug on for so long, I was sent to collections over this bill.
When my daughter's ear drum "busted"/"perforated" (whatever the medical terminology is) months after this issue, I took her to the same children's hospital. Do you know that I got the Stink Eye from the admissions representative because I had a "past due" balance with them? Oh - and they had our insurance information already on file from that old visit because we haven't had any change to our insurance. Hello?! Clearly something went horribly wrong with the referral/diagnostic process, but I'm the bad guy.

Hmmm....and I/my employer pay monthly premiums for this special kind of torture? Oh wait, and I pay taxes so that people who are uninsured can get all types of tests done without any cost to them?

**And yes, they do. My mother in law is on Medicaid and had this exact procedure done to determine what was causing her headaches and balance issues. FYI, an EEG can't diagnose plain ol' crazy. **

1 comment:

  1. Not only have I had the unlucky pleasure of having similar problems I have also had to deal with both of my children being diagnosed incorrectly by 'so called doctors' in the ER at our podunk hospital. I feel your pain it's really sad that in the U.S. we have to pay for healthcare. In Europe and Canada everybody is covered. I wish you peace and with a little luck things will change for all of us.