I promised myself that I would not write anything more on the subject of healthcare here in the US. I have said all I can and I am boring myself with it, and risk boring everyone around me. But last night as I was having my cast removed so that my broken finger could be x-rayed I found myself tumbling headwards into the Kafkaesque black hole of American healthcare. The normally stoic and unflappable J lost his cool and turned to me and said, “This should be on your blog!” This is the man who doesn’t mind spending seven hours on the phone to our insurers and filling out forms for the tenth time only for them to go astray in the labyrinth that is the Montana Health Coop. I lose my cool at the slightest whiff of bureaucracy. Seeing him angry last night actually calmed me down.
This is what happened: After having my cast removed and my finger x-rayed, Doctor S (who is covered by our insurance plan) examined my finger and said I needed a new smaller cast so I could get back to moving my wrist. “We’ll sort you out,” he said and promptly left. At this point, a nurse shot into the room with a page full of options for us and a list of names and places we could call in order to do what the doctor had recommended. I needed a cast and was told that I also had to have physiotherapy twice a week for six weeks. She began circling places on the list and telling us about them.
“Hang on. Physiotherapy?” J and I said in unison. The first thought in our minds was that there is no way this would be covered by our insurance. We let that one go.
“Let’s focus on the cast,” we said to the nice nurse. “We’ll think about the physio later.”
“OK,” she replied. “We’ll get Kay, our cast person, to come and do it.” There was a silence. “She doesn’t actually work here. She’s in another part of the building but she can do it now.”
“So, is this part of the same appointment?” we asked.
“I have no idea. I’m not sure how it works,” the nice nurse said.
“How can we find out?” we asked.
At this point Kay, the woman who makes the casts, came in with the doctor. After bludgeoning them with questions, we learned that she is not part of the doctor’s practice and we would be billed separately for her services. And no one knew whether she was part of our insurance plan. But here’s the rub. It had just gone five o’clock so our insurers weren’t answering the phone and we couldn’t find out if she was part of their ring of coverage. At this point, J made a very loud mental note to only schedule doctor’s appointments during office hours so we can speak to our insurers and find out if whatever it is we are being told we need is indeed covered. We were stuck. I needed something on my finger. It was by now throbbing. Kay the cast lady, who was lovely and obviously very skilled, couldn’t tell us how much we would be charged for her services as it was now after 5:30 and her billing lady had gone home. We didn’t have a choice. J was furious. We should have been told when we made the appointment with the doctor—whose sole purpose was to remove the plaster on my hand and forearm and x-ray my hand—that we would then need another totally different appointment to have a cast put on. I assumed (one must never assume when it comes to healthcare here) that if a doctor is going to take a cast off, then surely he or she will also be responsible for sending you home in a decent state with a new cast. Obviously not.
We were sent to Kay’s office where J silently fumed in the corner. I was hoping that his bad mood would not affect her handiwork. She soaked some plastic in hot water and while it was still pliable she made a mould around my finger. The whole thing was pretty cool, but of course I just kept wondering how much it was all going to cost. It seemed very high-tech and therefore expensive.
At the end of it all we headed out to the car. I was in a bit of pain and feeling tired and had forgotten my paperwork in Kay’s office. J went in to get it and was gone for some time. When he came back he announced that Kay was upset at our predicament and had offered not to charge us for her work.
“Why?” I asked.
“She wants us to like Missoula,” J replied.
We drove home feeling somewhat guilty and didn’t talk about it for the rest of the night. We haven’t called our insurers to see if physio is covered. We can’t quite face it. I want Kay’s act of kindness to linger for some time before we have to head back into the depths of insurance hell. My finger hasn’t fallen off. I’ll be fine. And for now that’s what matters.
Here are Ten Top Tips for non-Americans in the US on an ‘Indefinite leave to remain VISA’ who might need to access healthcare:
1) Avoid ER. Most insurance does not cover it. And it costs a bomb.
2) When you speak to your insurers about what and who is covered, speak to several different people at your insurance company. You will get a different answer each time and you have to make a venn diagram of their answers to find out what is actually correct.
3) When you get a bill, call your insurers immediately and bargain with them. Yup. Bargain. I did it and it worked. I got a 10 percent reduction for being on a low income and then a further 15 percent reduction for agreeing to pay it all in one lump sum within two weeks.
4) At every stage of treatment CALL YOUR INSURERS. This is crucial. Just because you need something done and a doctor is telling you this, it may not be covered, and you may have to forgo whatever it is you need or simply cough up the dough.
5) When you are told that a certain healthcare provider (i.e. doctor) is covered on your insurance, call them well ahead of time. They can reject you. In which case you need to start from scratch and ring your insurers to see if any other doctor is covered by them.
6) Book appointments between 9 am and 3 pm so that if you are told to have treatment, there is time for you to call your insurers before they close shop for the day. See number 4. This is the most important point.
7) Keep calm and make sure you gird your loins with Yoga, Whiskey, air guitar, whatever relaxes you. If you are freelance and are doing your own healthcare, it will be a rocky road. You will not be dealing with doctors, but insurance companies who will do everything they can to get you off the phone and not pay for your treatment. Schedule time for your phone calls. J has sometimes been on hold for hours.
8) Start applying for your insurance plan well in advance. We started applying in July 2014 and have only just been able to access ‘free’ healthcare in April 2015. The online procedure for Obamacare is lengthy and difficult. It almost turned J into a Republican.
9) Remember that with most plans, as with ours, even when treatment is covered, you will still need to cough up a co-payment. This varies depending on what treatment you need. But even with your monthly insurance payments and your coverage, you will still need some money in the bank for treatment. And prescriptions are not subsidised as they are in the UK. And you pay for children’s prescriptions (unlike in the UK).
10) If none of this is your cup of tea, get a full-time job with health coverage or emigrate to Canada or the UK.