Skip to main content

The Frustrating Thing(s) About the US Health Insurance Marketplace - Part 2

This post continues from Part 1.  Click here to read it.

This is the story of my friend Eva trying to get seen in primary care and how the insurance system foils multiple attempts and delays care. We left off with Eva's first attempt to getting an appointment failing.  Eva is a friend of mine from graduate school with a PhD and a good job she was able to take because it was easier for her to buy private insurance after the Affordable Care Act and work as a consultant.

Eva still needs to be seen. She's traveling for consulting work three days later --kind of important when you need to pay your bills while waiting to hear about full time work.  She doesn't travel, she doesn't get paid.

I dive into the bag of tricks most nurses develop when they've dealt with their health system after about a year.  I email a colleague I know who runs a nurse managed clinic (staffed by nurse practitioners) to see if she can get her in.  In 5 minutes, she gets back to me and connects her to the clinic's admin to get an appointment arranged. By this time, I've gone to work and Eva is waiting to hear from me by email.  Again, feeling triumphant that we'd finally be able to get her the care she needed and I'd once again figured out how to work around the system, I sat down at my computer and began to prepare to teach my class later in the day.

Several emails fly through the inbox and my triumphant feeling evaporates.  While my colleague's practice would have been able to see her, they didn't take her insurance either (even though the insurance company's website said they did).

They didn't take it for a different reason though.

Turns out, her particular insurance plan does not allow nurse practitioners to be designated as primary care providers, so my colleague's practice cannot take the insurance even though they would have been happy to see my friend the same day and treat her.  Many insurance companies and states in the US restrict nurse practitioner practice and require physician supervision.  Change that and physician incomes get affected.  Do you see why it  hasn't changed yet?

#systemfail number 2

Nonetheless, the nurse practitioner practice knew another group that would take the insurance and was a comprehensive, non-profit community health care center.  They were able to see her the same day.  As it happens, she had severe laryngitis and walking pneumonia. She got an antibiotic (appropriately prescribed) and was so pleased with the experience, she signed up for her first full physical health exam in two years.  She was able to travel, but postponed the social part of her visit (she was going a few days early to the city where her consulting was to visit friends) that would happen before her work started so she could rest and let the medicine do its work.

So what if I (or someone else) hadn't been there to help work the system to get her the care she needed?

To be continued...


Popular posts from this blog

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…

The 32 Hour Work Week for Nurses

Sometimes it's nice to see research that confirms a hunch you've had for a few years.  A recent study in Health Affairs, one of the most influential health policy journals in the United States, looked at the effects of 12 hour shifts on patient satisfaction and nurse burnout rates.

Turns out, results are not good.  The longer nurses worked in a day, the less satisfied patients were with the quality of care.  In addition, nurses working 12 hour shifts were more likely to become burnt out than those working fewer hours.

On the overtime policy front, that's good news for nurses.  The study adds just one more reason why mandatory overtime is bad policy.  It should create incentive for staffing units appropriately and closer to the California standards.

From another perspective, we know why nurses like 12 hour shifts.  Let's face it, 3 days a week of work and then a bunch of days off in a row, so many sometimes that you don't have to use vacation days if you can set y…

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.