Between You and Your Doctor

I find it just wonderful that conservatives are still pulling out the “A government bureaucrat between you and your doctor” canard in their fight against health care reform. I guess I can see that argument working during the Clinton years, when things weren’t quite as bleak as they are now (although, being a teenage dependent with two well-off parents, I never had to worry about health insurance during the Clinton years, so what do I know?). But relying on it again now? Balls, folks: that takes some.

For a little under twenty years, I’ve been dealing with chronic pain. (No, not my back problems. I’m going to refrain from discussing my specific condition itself in order to keep the focus on the politics.) Because this condition is hard to diagnose and often misunderstood, I’ve gone without treatment for most of my life. In fact, the only two times I’ve had regular treatment for it were in college and grad school, when I had the twin luxuries of student health insurance and autonomy from my parents. In college, the doctor I found was well-meaning, but ineffective. In grad school I had a great doctor, and together we started to make progress. But then I finished grad school.

For about a year, I went untreated again until a flare-up made me realize that I needed to find a doctor despite the cost. My husband and I did some budgeting – I currently subscribe to Blue Shield’s cheapest plan, which only covers basic exams and major disasters – and found a doctor who charged a sliding scale. She was awful. For a few months, I went untreated again, and had another flare-up. It turned out that a friend of mine has a similar condition, and she gave me the name of her specialist.

Here’s where the story gets interesting.

I made an appointment with the specialist – and loved her. Within ten minutes of our first appointment, she’d described my condition with eerie accuracy and outlined what sounded like an effective treatment plan, with options that I’d barely even known about. Her bedside manner and level of expertise were terrific; she put even my grad school doctor to shame. At the end of the appointment we talked money. My current insurance didn’t cover regular office visits, so I’d be paying completely out of pocket. I gulped at her office visit fee – even paying for that first appointment was going to be interesting. I talked to my husband and we agreed that I’d have to get a new insurance plan. If we ditched the cable, the Netflix subscription, and a couple other amenities here and there, we could pay more for something better.

I looked at other Blue Shield plans while my husband looked at Kaiser. I figured that while I was getting a new plan, I might as well search for something that covered maternity. I looked at plans going up to $200, $250 a month – nope, nope, nope. Blue Shield doesn’t like its members having babies.

Meanwhile, my husband found a Kaiser PPO (at least, we thought it was a PPO, but I guess that’s kind of rare for Kaiser) just barely within our price range. It was $139 a month – yikes, but okay. It had a fairly good maternity plan. We called their office to find out if this doctor was in their network. They didn’t know. They gave us a regional number to call. We called. No, this doctor was not in their network.

Next we tried Blue Cross. I don’t even remember what plan we eventually found, because the whole website was so labyrinthine. We didn’t bother calling them before we filled out the form because, hey, everyone takes Blue Cross, right? The application took all morning – and we even left off in the middle because I needed to dig up some old information.

Later that day, I talked to the doctor to reschedule our next appointment, since it was taking so long to find a new plan. I asked if she took Blue Cross (just to be absolutely sure – because everyone takes Blue Cross!). “Uh, some of their plans,” she said. “I don’t know, some but not others. It’s all very strange. I don’t even handle that part of it.”

We called Blue Cross. No, the plan we’d selected didn’t cover her. Were there any plans in our price range that did? Tappa tappa tap, pause. No, there were not.

So we went back and called Blue Shield, told them I was already a member. We asked for any plans at all that covered this one doctor. Damn the cost! We’d use our savings! We’d move into a smaller apartment! We’d rob a bank if we had to! What was the doctor’s name again? We spelled it. Nope, they said. Blue Shield of California does not cover this doctor at all.

We called the doctor again, canceled the appointment, told her we just couldn’t afford her. I still owe her for our first (now useless) meeting – $150 down the drain. I cried, I was so disappointed. All that work, all that hope, for nothing.

I’ll probably never know why no insurance plan would touch her. She wasn’t some bizarre, esoteric practitioner or anything; my best guess is that only employer-paid plans cover her. But when I hear conservatives trotting out the specter of “a government bureaucrat between you and your doctor,” I have to laugh. Because right now, at this moment, I am gritting my teeth through 20-year-old pain while the doctor who could have treated me goes about her business 2 miles from my apartment. Bureaucrats are standing between me and my doctor.

On the one hand, if conservatives are going to try to block affordable health care, the least they could do is come up with a less insulting argument. On the other, I guess it’s to my advantage that they’re making themselves look like total idiots.

We’ll go ahead and give Pacificare and Aetna a call, but I think my course of action now is to go for the original Kaiser plan we found and hope that there’s a doctor as good as this one in their network. (Of course, the maternity coverage raises some troubling questions. Does Kaiser have midwives? Doulas? Birthing centers? Will I have to give birth on my back? But I’m not pregnant, so I can cross that bridge when I come to it.) If we ever get a national health plan in place, then sign me up – but I’m not holding my breath. My one wish for those who oppose it is that they someday experience health insurance that is comparable to mine.

(A note on comments: because I know what types of comments posts like these tend to receive, I am declaring myself Queen Tyrant on this thread and will delete offensive comments without warnings or justification.)

(Cross-posted at Alas, A Blog.)

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5 Responses

  1. At least in NoCal, Kaiser does have midwives and they won’t force you to give birth on your back.

    It’s probably not the insurance plans that won’t touch the doctor, but the doctor who won’t touch the insurance plans (assuming she’s board-certified and otherwise appropriately credentialed). Insurance plans don’t play doctors as much and they require a lot of paperwork and phone calls. In areas like New York and LA, more and more doctors are opting out of insurance enrollment and working on a cash-only basis.

    I have stopped listening to and watching coverage of this nonsense because it keeps me up at night. We already have rationing. We already have bureaucratic inference with the provision of health care. We are wasting billions of dollars – but hey, at least it’s not SOCIALIZED MEDICINE OOOGA BOOGA.

    Grrr.

  2. Though not really comparable in terms of scale and/or energy invested, I ran into a similar challenge trying to get my therapist covered. I just turned 23, so up until 5 days ago, was covered under my parents’ insurance – my parents’ really expensive, top-of-the-line, affordable because they’re upper-middle class but still a challenge to pay for, all the bells & whistles PPO.

    And it didn’t cover my therapist. It didn’t cover my therapist, my radical, political, queer, gender non-conforming, thoughtful, insightful, really-good-at-her job therapist. She was even willing to look into what it would take for her to be covered by them, what she needed to do to apply, etc. But it was SO many hoops to jump through…

    So when I really should have gone to therapy last winter, I went for one visit, and then haven’t been back.

    It was infuriating, and frustrating, and defeating – and it wasn’t even for something major and/or debilitating. It makes me so angry and sad the frequency with which people are forced to make sacrifices in their health care and self-care. It’s one thing when good treatment options can’t be found (and that is super shitty and awful), and then something else when they are present, and theoretically accessible, except that, as a society, we are collectively failing one another. Boo.

    I really hope you get things worked out, and are able to find an insurance plan that covers your wonderful provider, and do what needs to be done to make your life better.

  3. i just listened to the episode of this american life from 7.26 (“fine print”) and act iii has me convinced that if i buy an individual health plan and actually have a medical emergency, they will find any excuse – nay, lie – to rescind the policy i’ve been paying premiums on for years.

    i don’t know whether i think you should listen to it or avoid it. maybe you should just know to be outrageously overcareful on your insurance application and not forget to dot an i or mention your skin cream.

    (also, i’m so so sorry.)

  4. My insurance company just decided that one of my medications isn’t “medically necessary” which is a little fishy given that all my labs have gotten better since I started taking it. How is a government bureaucrat between me and my doctor any scarier than an insurance company bureaucrat?

    I have a sinking feeling that nothing’s goign to change.

  5. Julie! What an awful experience. This has got to change.

    By the way a friend of mind is trying to launch at “March on Washington — Close to Home.” The idea is that everyone shows up at the post office at the same time to send letters to their senators demanding health care reform and a public option or its premium-reducing equivalent.

    Check it out and spread the word.

    http://www.huffingtonpost.com/peter-clothier/re-high-noon-090109-a-hea_b_265311.html

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