If you've been following me since cancer, you know that I've come up against the bureaucracy of the medical industry many, many times. I've won some, I've lost some. I'm at it again.
In a middle of the night panic attack, I realized that the non-stress tests I've started are being done at the hospital. The reason this matters is that for all outpatient "procedures" done at a hospital, I have a copayment of 20%. If these were done at a stand alone office, they would be covered at 100%. On Tuesday, I began making my calls to confirm that yes in fact these would be billed as outpatient, and asked what the actual cost will be. With the potential of up to 16 of these appointments, it is more than possible that I could actually meet my annual out of pocket maximum.
I'm not interested in talking about money here, it is more what I am dealing with from a bureaucratic standpoint. I have an HMO plan. The benefit of a plan like this is that you can generally plan for and expect your out of pocket expenses, and they are relatively minimal. I have no annual deductible, or crazy copayment percentages. The downside is that you are limited with which doctors you choose, and facilities are limited. It has served me well, even providing me with excellent doctors through out my cancer journey and now pregnancy. I've felt lucky and rarely missed my Kaiser team, despite the ease with which I could navigate that system.
Today, that has changed.
I am continuing to battle this latest in a crack in my coverage. The reality is that when you look at my coverage, the intention of the plan, including the copayment percentage, is to limit out of pocket expenses. I didn't even meet my out of pocket maximum in my year of cancer treatment (as a point of reference). All my doctors visits, crazy tests, chemotherapy, surgery and radiation, still did not add up to that amount. So to think that one simple, and relatively standard test for pregnancy would have me hit that, clearly strikes me (and everyone I've spoken to) as crazy. And also not the intention of the structure of the plan. Even outpatient surgery would cost the same as
one of these appointments.
Why do I have to go to the hospital? It is apparently the only place in Marin County that handles this service. In my last pregnancy my OBs office handled it. You literally sit in a chair (or on a bed in the hospital), strapped to the fetal heart rate monitor, and contraction monitor, and wait for about 20 minutes. As long as baby moves, and has heart rate accelerations in accordance, you pass. That's all there is to it. They do also do an ultrasound to verify that the baby is still head down and to check your amniotic fluid levels. Not rocket science by medical terms. And yet, apparently no one else does it in their office.
On top of all of this, the primary doctor at my OBs office called me today in response to my inquiry regarding options to deal with this. I had offered a suggestion that actually would have been sufficient for their needs as well as my own, and was open to discussing other ideas. Her message was short, almost rude, and essentially punitive. The message was clear "no alternatives, you must do these, and by the way you need to deal with the blood sugar issues once your pregnancy is over". In other words, not only do you need to spend potentially thousands of dollars on tests because no one else can be bothered to offer them in office and we are unwilling to consider any other options for you, but this is all your fault anyhow so suck it up and get healthy.
Yeah- suffice it to say I am not in love with the medical world today. I'm not done with my fight yet. I plan to call everyone involved (insurance company, medical group, and hospital billing) to get someone to find the exception and how to make it happen since clearly this is not the intention of my insurance policy. I also intend to let the doctor know that the way she handled me was unacceptable. I was never saying I wouldn't do the right thing for the health of my baby, I was simply saying "work with me". She shouldn't speak to any patient that way, ever, but in light of my recent medical history, I feel that if anyone deserves some kid gloves, it is me.
I keep reminding myself that I have six weeks or less, and then this beautiful baby boy will be here and I can stop seeing all of these freaking doctors. All I know is that something has to change with this industry. I think the doctors and patients ultimately all want the same thing, but being caught in this crazy system no one is getting what they want and lots of people are getting lost in the process. Shameful really.
