There are lots of things I want to write about – Pride, 4th July, more camping, weird questions about polygamy – but today I feel as though I have to write about my first encounter with the US healthcare system. (NB: this is a bit of a rant, and there’s a TL;DR at the end)
Well, not quite my first encounter. When we first moved here, we had to choose which health insurance plan we wanted. This took me several days. No exaggeration. Comparing deductibles, co-pays, out-of-pocket maximums, out-of-network providers, PCPs, Health Savings Accounts. . . this was completely overwhelming for a child of the NHS. So after narrowing down the options, I called the helpline to try and figure out what we needed. As (thankfully) neither of us have any major health issues, I just wanted to know roughly what we could expect to pay for a routine GP visit. Nothing fancy, just a prescription renewal, or something for a chest infection. The usual, everyday stuff.
However, the helpline staff – despite being cheerful – could not help me. The conversation went something like this “So, I want to know how much a routine GP visit will cost me, so I can work out whether I want a fixed/percentage co-pay” “well, it depends” “Depends on what?” “On what’s wrong with you,” “I don’t understand” “well, if you go to your doctor with a chest infection, it won’t cost the same as if you go to get a blood test” “Right. Well, for arguments’ sake, how much would a chest infection cost?” “well, that depends” . . . .
After about 20mins of going round in circles, I just made the decision myself – a fixed copay – at least, this way I would always know what we were going to pay before going to the doctor, regardless of what was actually wrong.
And so the health insurance cards arrived, and sat in our wallets for a few months. Until I needed to get test to prove I didn’t have TB for work (apparently, no BCG over here). So, somewhat trepidatiously, I made an appointment at the nearest in-network doctor (incidentally, this is not the nearest doctor to us. But that is another rant.) I was pleased to get an appointment for the same day, and was told to bring photo ID as well as my health insurance details. All good.
As I expected, there was a bunch of forms to fill out on arrival. So many forms, in fact, that my appointment was actually scheduled for half an hour LATER than the time I had been told to show up. An abrupt nurse showed up and told me to follow her. As I explained (repeatedly) that as I was vaccinated I’d need a blood test rather than the usual skin test, she just nodded and took my weight, body temp, BP, etc – all without informing me of what she was doing or why. After typing a while she said “Wait, you’re vaccinated?! You’ll need a chest x-ray then. Shouldn’t have bothered coming into us at all. Well, you’ve already paid – is there anything else you want to see the doctor about?” Somewhat pissed off, I told her I could get a refill on a repeat prescription. She huffed off, and was replaced by a doctor. He refilled my prescription, and agreed that I didn’t need a chest x-ray, and a blood test would suffice. He then left to find out what medication I needed exactly, and was replaced by abrupt nurse.
This time, she was much nicer – rather apologetic for suggesting the x-ray, and seemed to be attempting to charm me. “Now, we like you to have one physician that you always see. If you like Dr. X, he can be your doctor from now on.” (Long pause…..) “Well, I only saw him for a minute. He seems fine, but I’d prefer a female doctor for the likes of smears etc.” (Disapproving face from abrupt nurse) “Well, he’s an excellent doctor. You should choose him”. After awkward pointed looks, I just asked her for my prescription and for the blood test. She told me she’d just fax my prescription to my pharmacy. Apparently I should have chosen a pharmacy. After tutting at my lack of preparedness, she sent me round the corner to wait for another set of nurses/phlebotomists for my blood test. I waited again. Eventually, I was called in – one girl took my bloods, another filled in the chart and so on. I was dismissed, about 2 hours later than I’d arrived.
This post ended up being much longer than intended, and a bit of a rant. So, for those of you with better things to do, here is the TL;DR: it took two receptionists and four healthcare professionals two hours to take a blood sample to prove I didn’t have a disease I am vaccinated against.
The whole process just seemed cumbersome and unwieldy. Having done a wee bit of research, it seems as though this lack of efficiency is a significant part of what makes healthcare in the US so expensive. In Ireland or the UK, I would have seen one nurse to get this test done, and (reception waiting times notwithstanding) probably have been out in half the time, if not significantly less.
Adding insult to injury – this isn’t even fully covered by my insurance, because we haven’t met our deductible yet. So, despite paying monthly for health insurance, I still have to cover these costs. *sigh*