Blue Cross PPO

(This is a guest post from Scott’s friend Eliana. If you are nice to him, he might let you write one too!)

I grew up in Australia, so the concept of “socialized medicine” isn’t the bogey man it may be to some of you. Since moving to the US, I’ve been pretty happy with my health care experiences but then again, I’m lucky enough to be a pretty healthy person. The events of the last few months have left me wondering how anyone in this country manages to simultaneously see a doctor, work full time and maintain a reasonable level of sanity.

Let’s start at the beginning. In school I made fun of the student health center along with everyone else, but the one time I really needed them I saw a doctor within 24 hours and the whole incident was resolved in three weeks for at grand total of $50 out of pocket. At my first job I had a choice of Kaiser or Kaiser. During that time I didn’t use their services very often but those few visits were pleasant, efficient and best of all about $20 each. To this day, I continue to sing the praises of the Kaiser website. You can find a doctor, read a mini-biography of the doctor, make an appointment, refill a prescription (and they mail it right to your house! For free!!!!), cancel an appointment all from the comfort of your own home at any time of the day or night.

I guess Kaiser was actually the one good thing about my last job. Now I have a fantastic new job. They offered me Blue Cross PPO and I thought “Why not, that is supposed to be better, right? You get to choose your own doctor.” There began my downward spiral into endless frustration. To be fair, I’ll start with the benchmark by which I judged Kaiser; the website. The large “Find A Doctor” banner on the Blue Cross main page is a dead link. When you get there through a back door, you unearth a list of names. Some of these names are not actually providers of the service you requested. Some of the names are associated with phone numbers for people in an entirely different profession. Some of the names are associated with maps in entirely different cities.

Through a combination of clever detective work and over an hour of phone calls, I eventually located a doctor that matched my need and was invited to see her between the hours of 9am to 5pm on Monday to Friday. Most people who have medical insurance also have a job, which would make this difficult enough. However, I soon learned that 9 to 5 is actually 9:30 to 3:30. The doctor is routinely late to the first appointment of the day, and is free to cancel the later appointments if there is no-one else coming after you and they want to go home. A week before my appointment in early August, I got a call asking me to reschedule my end of the day appointment for just that reason. Doesn’t that make it more of a date and less of an appointment? The only time they could reschedule me was in October. Eight weeks after my original appointment. It wasn’t particularly urgent, so I signed up for the new date. We’ll pick up this story later.

Back in June, I knew that I was going overseas in November to a country with a less advanced medical infrastructure. And malaria. And yellow fever. So I made an appointment for September to see a travel doctor. I’d learned that the coveted early and late time slots were in high demand. The day before my appointment, I got a call asking if I could postpone by a day because the doctor didn’t have any other patients after me. Seriously, I’m not kidding- I couldn’t make this up. This is a different doctor, different practice. Eventually I got the necessary vaccinations and was so woozy I thought the bill might be a mistake. It was a lot of money. A LOT of money. Alright, fine, I’ll tell you – it was $385. My husband got the same exact pharmacopeia at Kaiser for $10. I dutifully submitted the receipt to Blue Cross and they calculated that I should receive $5.19 in reimbursement. At least, that’s what they tell me. I never saw the check because they sent it to the wrong address.

October rolled around and I finally got to see the doctor I was scheduled to see in August. That all went fine, except for the fact that I had to go to an entirely different building and different organization (with its own very full waiting room) to have blood drawn. Doctors don’t do that anymore. A couple of weeks later I got two separate bills from the doctor’s office and the lab, each for a significant chunk of change. I called Blue Cross to ask why they were so high. Turns out the doctor wrote the wrong code on my forms which put these services into a category with a much higher deductible. To correct this mistake I had to separately call the doctor who told me I had to call the lab who told me that the doctor had to call the lab. When do I get to start charging for my time? How does someone without a PhD navigate all of this?

Meanwhile, I drove to Walgreens to fill my malaria prescription. It wasn’t until I got home and compared them with the ones my husband got from Kaiser that I realized there were only 4 pills in the package and I needed to take them every week for 7 weeks. My husband actually had 8 pills because the doctor wanted to make sure he didn’t lose one. I went back (billable hours anyone?) and learned that my insurance will only let me get 4 pills at a time. Of course, the pharmacist didn’t tell me that at the time, or give me the option of paying for all the pills up front.

It turns out that there was one vaccination that the travel clinic couldn’t do. I tried to go through Blue Cross to find a doctor to get the vaccination, I really did. Of the three real numbers I found, one wasn’t taking new patients, one wasn’t taking new patients until January and one didn’t return my very detailed phone message. So I went to the mobile County vaccination clinic. Yep, I have a job, I have insurance and I’m standing on a windy street corner waiting to get a needle from someone in a bus. I was the second person in line and the whole ordeal took 90 minutes. Unfortunately the bus only had the child’s version of the vaccine. That means I need to go overseas half immune and come back for the second shot as soon as I return. Oh, and I also have to go get more malaria pills while coping with jet lag, catching up at work and calming a kitty with a major case of loneliness. I ended up giving the clinic a donation because I felt sorry for the screaming kids waiting in the cold to get jabbed.

I think that’s the whole story, but there might be more. I’m feeling a little dizzy. It must be the vaccine kicking in.