A Medical Maelstrom

 When I first began working full time after Jeremy, my son was born, I had insurance through my job, which covered everything. I even had a cancer policy which carried me through everything associated with cervical cancer, not to mention Jeremy's numerous bouts with bronchitis, strep throat, and scarlet fever. 

I was making a little over $2.00 an hour, and I managed to get everything taken care of. That was before the For-Profit Insurance became so prevalent like it is in today's working world. My cost was minimal then, and I always made sure I carried as much as I could to cover Jeremy and me. 

In 1973 when the Health Maintenance Organization Act was passed, it took a little while for the insurance companies to catch up and realize what a profit they could now make.  "Aetna and Cigna were both offering major medical coverage by 1951. With aggressive marketing and closer ties to business than to health care, these for-profit plans slowly gained market share through the 1970s and 1980s."  These are multimillion dollar companies right now. Cigna had profits of $8.5 billion for 2020, Aetna, $3.07 billion, Blue Cross/Blue Shield, $30.2 billion. That is a lot of billions, so someone is reaping benefits.

I have not been without coverage since I was a young Mom, but have watch the cost, not only to me, but for procedures for which there is simply no reasonable explanation for. 

This was my latest experience so you can see why I feel this is a whirlpool of disappearing sense. I hurt my ankle in February of 2020. I had begun a walking regime with a friend and part of our walk was a spot that had no sidewalks along a busy road. I was walking on dirt and slipped in a hole covered by bushes. 

After several weeks of pain, tried to book an appointment to have it checked, but due to Covid restrictions passed in March, no one was seeing patients expect for emergencies. My first appointment was in June, 2019. The podiatrist I saw, advised me to stretch my Achilles tendon. It was tight. No x-rays, nothing. So I did. For three months with no relief from the pain. I switched doctors in September. 

The next doctor did take x-rays. He said I had a calcium deposit which was rubbing my Achille's tendon and needed surgery. I couldn't have surgery then because I am a teacher and could not afford to take the estimated 6 to 8 weeks off work to have surgery so he gave me a cortisone injection, sold me heel lifts for my shoes and sent me on my way. I was back in November and then February for 2 more cortisone shots. They helped the pain for a few days, but I limped a lot during those months, hoping to have the surgery he said I needed during summer break. 

In April, I tripped in my back yard over an aluminum pool pole and landed awkwardly on my butt with my right leg twisted. I heard something pop when I landed and the pain was incredibly intense. I crawled from my front yard inside and called a friend who came over and took me to the hospital. There, they put me in a wheelchair, elevated my leg and directed me to the waiting area. After an hour, they came to take me for x-rays and 2 hours later, after seeing no doctor, only the person responsible for getting money out of me, a PA with a EMT from the ambulance told me my ankle was not broken, only slightly sprained, fitted me for a boot to wear for six weeks, gave me one pain pill and a referral if it got worse. That little 4 hour trip cost me $800 because I could have been seen at a walk in clinic. Plus the $200 for the doctor who I never saw. Plus the radiologist bill. I cannot imagine the costs if I had not had insurance. 

Almost a week later, ankle is no better so I call the referral. I reached a very rude person who informed me that although the referred doctor had been on call the night I visited the hospital, he only dealt with ankle trauma. She couldn't refuse me an appointment, but I should really see my regular specialist. 

I called them. They didn't want to see me because I had a referral from the hospital but they would if absolutely necessary; they could set the appointment for 2 weeks out. Once again, no treatment. 

So I missed a week of work, wore my boot faithfully for 6 weeks, then took it off and tried to go back to my regular schedule. My ankle still hurt all the way to my physical appointment with my GP in July. She could not believe my ankle and set up an appointment with a new podiatrist in their practice. Yay!

Now remember, each time I visit a doctor it is a $20 co-pay. So I go see this new doctor and he asks a bunch of questions and his final question was, "Who did the MRI?" Guess what, no one ever ordered an MRI because the original diagnosis from the hospital was a slight sprain. So he said he wanted to see what he was dealing with and ordered an MRI. That makes another $400 to meet my in-house deductible and then they would pay. 

Three days after the MRI, I get a frantic call from the nurse. The doctor wants you back in the boot and on a knee scooter; absolutely no pressure on that ankle. It seems I have a broken ankle and a ripped Achille's tendon. Wow. You would think someone would have believed me. 

Next doctor's visit, two weeks and he orders a prescription for Vitamin D and a bone stimulator because the break is from April. I pick up the prescription, more money, and wait for the company to call me on the bone stimulator. They call and after a series of speaking to several different people, it was determined that after my insurance paid, my portion of the bone stimulator was going to be $700. 

STOP! I am a teacher with insurance and cannot afford to keep paying out these astronomical bills because the insurance company doesn't want to pay because_____________? So I told them no and I let the doctor know. They called me back and figured out of my charge would only be $100. I can do $100. (Bone stimulators have not been conclusively proven to help heal old fractures in all instances) 

So I am taking my meds and using the stimulator and then receive a call from a nurse trying to figure out if they are even going to pay for the bone stimulator. What? So I once again relayed all the information and am hoping in four weeks I can come out of this boot, off the scooter and try to rebuild my ankle using physical therapy, another $20 a visit. 

I wonder how much money could have been saved if the first doctor I went to in my plan actually took the time to listen to what I told him and diagnosed me correctly. Now, beginning in January, my plan is switching to a new plan and a new company. The only redeeming value in this is next year I will be 65 and eligible for Medicare. Although I am still working I think I will take my chances with them. They can't be any worse.

I am sorry for people who must fight this crap on a daily basis because of life threatening illnesses or simply age. I am relatively healthy and can still advocate for myself. I hope that doesn't change any time soon and I still hate insurance companies.