Skip to main content

The Frustrating Thing(s) About the US Health Insurance Marketplace - Part 1

Let's be clear: I'm all for people having insurance.  I spent enough time working in the US healthcare system to see what a lack of health insurance does to patients.  It adds to the stress of their illness and sends many into medically driven bankruptcy because of their medical bill debt --something no one should ever have to endure.  I was thrilled when the Affordable Care Act [ACA] (a.k.a Obamacare) passed. With my policy training, I knew the bill was far from perfect but what was important in the US context was to get it through and then embed it in the bureaucracy, as happened prior to and continues since implementation.

But there are flaws nonetheless.  These are driven by the business of medicine and how it is funded in the US.

This is the story of my friend Eva.

Eva and I did our PhDs together. Instead of going into academia, she ended up in the corporate world with a good paying job and excellent benefits.  After putting in her time in that sector, she decided she wanted to make a change and work in the non-profit world.  Because of the ACA, she was actually able to make a major career change.  She'd planned to leave her job for six months, saved up money to live off of while she transitioned, and as soon as she left her old job she signed up for health insurance through the ACA generated exchange.  Yes, she could have signed up for COBRA but it is expensive, as anyone who's had it will tell you, so the ACA was a more affordable option. It gave her a few extra months for her career transition.  Her sign up process wasn't too bad, she told me, and she got a plan she liked and felt she could afford.

Now here comes the part you were probably expecting.  The other day Eva got a bad cold that included laryngitis. She first went to an urgent care clinic and they didn't take her insurance (even though her insurance company website said they did).  So she paid for the visit out of pocket because she had a big interview coming up and at least wanted to be able to talk.

She had the interview and the next day gets worse. We meet up for breakfast (to rehash the interview of course) and I realize she needs to be seen by somebody.  Since she's not currently based in New York but planning to be, she doesn't have a primary care provider (PCP).  I refer her to mine.

She calls my PCP's office. First, she's told there are no appointments until two days later and none til Friday for new patients.  I declare this unacceptable and get on the phone.  I play the card of being both a patient in the practice and a nurse. The latter generally assures the person answering the phone that this is not a hysterical hypochondriacal phone call that many who work in primary care manage. After the admin person relays the story to the docs, they agree to arrange for someone to see her --and that's one reason why I like the practice so much.

A triumph of system work arounds!  I'm psyched she can get seen.

Then they ask what insurance she has and Eva tells them.  Turns out, they don't take it for what are likely financially driven reasons around the amount they get reimbursed for services or the amount of paperwork hassle involved with getting reimbursement from private insurance.  This is a common practice among many primary care groups in the US.

#systemfail number 1

To be continued....


Popular posts from this blog

To Post-Doc or Not to Post-Doc, That is a Very Good Question - Part 1

Happy 2019!

Much to my surprise, I realized I went all of 2018 without posting anything. I got tenure in 2018 so technically, I should have had more time with that monkey off my back. Yet as a wise colleague told me, tenure usually means more work. Sure enough.

Nonetheless, let's start 2019 off fresh with a burning question I get from many of my PhD students: To post-doc or not to post-doc. For those of you not in academia, I post-doctoral fellowship (post-doc) involves additional training. You see, science has evolved so much these days that despite doing a PhD for 4 to 7 years, you might need more training.

I went into my post-doc reluctantly. After 5 years of PhD study, I was really hoping to have a just one job and a regular salary that might actually allow me to travel and start paying down my student loans. A post-doc just seemed like more years being poor.

It was, however, the best decision I ever made. I was lucky to have a great mentor who passed along many wonderful oppo…

There Are Other Masters Degrees Besides a Nurse Practitioner - Part I

It strikes me that many students and nurses do not seem to know about the "other" masters degree options for nurses.  Everyone seems to want to be a nurse practitioner these days.  Now, that's great news for the primary care provider shortage, but we need nurses with masters degrees who can work in other positions and have other skill sets.
Let's review the other masters degrees in nursing.  Nearest and dearest to my own heart is Nursing Education.  Remember that really cool clinical instructor you had in your entry-level nursing program --that could be you!  Do you like precepting new hires?  Are you the person on your unit who unofficially keeps everyone up-to-date on the latest evidence?  Do you really enjoy patient teaching, whether in the hospital or community setting?  Do you just like to teach?  Nursing education is the right masters for you.  Skills learned in a nursing education masters cannot be learned on the job.  Curriculum writing and program developmen…

Here's a Great Study Highlighting the Impact of Racism on Nurses

“I Can Never Be Too Comfortable”: Race, Gender, and Emotion at the Hospital Bedside
That's the title of a new study that just came out in Qualitative Health Research. The study of bedside nurses' diaries of their experiences reveals how nurses experience racism on the job. It comes not just from patients, but also from peers and management.
We have to talk about this more folks. It's time we deal with it better, in every setting.