Saturday, October 27, 2007

Health care frustration

Facts:

(a) On Wednesday night, Lucas puked all over me, but otherwise was running around and seeming to feel fine.

(b) On Thursday, we kept Lucas home from daycare because he still couldn't keep food down. Between pukings, he was in good spirits.

(c) On Friday, Lucas returned to daycare. As far as we know, he didn't throw up at daycare. Although he's usually a good eater, he only ate the fruit in his lunch. Of course, by the time we found this out, the doctor's office was closed.

(d) On Friday night, Lucas didn't want to eat much. I got him to eat about half a pear. An hour after eating it, he threw it up. But otherwise he seemed in good spirits. I hoped he would be able to eat on Saturday morning.

(e) It's now Saturday morning and Lucas is showing NO interest in eating. This means he's now gone 2.5 days eating hardly anything. And of course it's Saturday, so the doctor's office is closed.

I went online to my health insurer--Blue Cross of California--to try to find an urgent care clinic nearby that's covered by Blue Cross. I'm not sure he's at the ER stage, since he seems to be doing fine otherwise, wanting to play and appearing otherwise to be in good health.

But:

(1) When I went to look for an urgent care center, the Blue Cross site didn't have my plan listed under its many health plan options in its drop-down menu. When I chose what I thought would be the closest type of plan, no urgent care center showed up as available.

(2) So I tried to register on the site. It asked for my 9-digit ID number. Next to "Member ID" on my card, there is a 12-digit ID number, 4 letters and 8 numbers. No reasonable combination of those numbers allows me to register on the site. It said I could use my Social Security number, so I entered that instead, and repeatedly encountered an "internal error" message.

(3) So I went back into the drop-down list of health plans and selected another random one. And what do you know? I was prompted to download a list of Urgent Care clinics. And guess what? There isn't one in my county covered by my insurer. Yes, I live in a state of 40 million or so people, and my insurer, I imagine, covers many thousands (if not tens of thousands) of people from my university, and yet it offers no urgent care clinics in this county. The nearest one is about 45 minutes away. Nice, eh?

(4) So I did a Google search for urgent care centers in my county, and one came up at the local hospital where Lucas was birthed (and where we are, alas, very familiar with the ER because of Luke's propensity for spiking very high fevers very quickly). "Great," I thought. "I'll call over there and see if they happen to accept my specific insurance plan." So I called the number listed on the website, and a very nice advice nurse explained that she can't give me advice because Lucas's doctor is in the university health care system, not the hospital's health care system. She told me to call our doctor's office.

(5) I call Dr. Wonderful's office. The answering service takes my info and says they'll have the doctor on call give us a call. I'm not holding my breath. Dr. Wonderful is indeed a wonderful doctor, but the health care bureaucracy working in my favor on a weekend? Highly unlikely.

So it looks like we'll be taking Lucas to the ER for a visit that, unless he ends up having some kind of digestive blockage, will place us in a group that everyone complains about: people who use the ER for non-emergency services because their health plans don't cover regular care. But you know what? My health plan is supposed to be a GOOD one--I pay extra for it, and we do have some choice of providers and care.

I'm pissed. I've tried to do what I can to lobby for health care for the poor and working class in this state, and to ensure coverage for all children. But here I am, fully insured, and I can't even get my sick child to see a friggin' doctor because the extent of his illness didn't present itself until Friday night/Saturday morning.

Good fucking job, America.

UPDATE: Just a moment ago an honest-to-goodness doctor did call and said there's a Saturday urgent care clinic closer than any of those listed by my insurer--but still not in this county. He's going to call and get an appointment for Lucas. Yay for doctors who are available to return calls at 7 in the morning!

I'm still pissed, however, at the system.

3 comments:

Seeking Solace said...

Health care does suck, but thank god for a good and kind-heated doctor.

Hope your little guy feels better soon.

Susan M said...

I had Blue Cross too at UCLA. Over the Xmas break I got a sinus infection and had to go to a doctor in LB instead of at the student health center, which was closed. My plan requires that all care begin at the student health center or be referred to another provider by them, I called BC to see if I could just head to teh local doctor. They said I wouldn't need a referral, since the referring center was closed for Xmas. Of course, months later they had still refused to pay the doctor's claim. I had to file a complaint and get BC to listen to my recorded phone call with them in order to avoid having the bill sent to a collection agency.

I hate fuckin' Blue Cross. These are the same people who have been repeatedly hauled into court in the last few years because they try to kick cardiac patients, etc. off their rolls after 10 years of coverage because of bogus "errors" on their applications--discovered mysteriously after the patient becomes really ill.

At least with Kaiser, my previous insurer, they were complete idiots, but once they'd really fucked you up, you got decent care from this non-profit HMO instead of 10 years of retro-active medical bills.

Laura said...

There are no urgent care clinics here. If I get sick after hours, I have to go to the ER--seems really inefficient. And expensive.