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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...

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