Both Sides of the Fence

A Tosa resident since 1991, Christine walks the dog, cooks but avoids housework, writes and reads, and enjoys the company of friends and strangers. Her job takes her around the state, learning about people's health. A Quaker (no, they don't wear blue hats or sell oatmeal or motor oil), she has been known to stand on both sides of the political and philosophic fence at the same time, which is very uncomfortable when you think about it. She writes about pretty much whatever stops in to visit her busy mind at the moment. One reader described her as "incredibly opinionated but not judgmental." That sounds like a good thing to strive for!

Insurance--can't live with it, can't live without it

HMOs, health insurance

In mid March I joined the 162,000 Americans who landed new jobs in the labor market. I seem to be always at the edges of economic trends. When I lost my job 18 months earlier, we were just beginning to understand that the economy was about to tank, misweighted as it was by fictions and other deceits in some parts of the financial sector. And now, things are looking up a bit, and many of us are cautiously optimistic.

Getting back to work has not been a problem. The job is interesting, varied, and useful. And goodness knows I’m well rested. Though job hunting is one of the most stressful jobs there is; I don’t want to underplay that.

And the job has benefits--among them, affordable health insurance. Priceless.

During the past year prayer and worry have been a large part of my “insurance.” Before the twins turned 19, we were covered by BadgerCare, Wisconsin’s very good program to see that children get the healthcare they need. But 19 is the cutoff point for kids and their mothers.

Ironically, healthcare may have been one of the reasons I got the job. I’ve been suffering from a chronic stuffy nose (rhinitis) and sinus infections for a long time. That doesn’t sound like much, but it keeps you a little below par all the time. And some people can’t stand being around the stuffy-nosed. It became so bad I had to seek medical care. I got the job following an interview during my first free-breathing week. Coincidence? Maybe. But it also illustrates why getting appropriate care is a worthwhile investment. Now I’m paying more taxes, with gratitude.

No story about health insurance in the US is so simple, though.

I spent hours this week trying to figure out which of the four available HMOs I should choose. If I lived in Madision, I’d have many more choices, including a number of nonprofits with 4-star customer satisfaction ratings. In Milwaukee, all the options are for-profit, and at best they get 2 stars. That may reflect a crankier, more critical population in Milwaukee and not worse care. Who knows?

The easiest way to choose, since all the plans seemed pretty comparable, was to find out which ones my current physician is in. Seems simple. So I called the clinic and asked to talk to the person who knows about insurance.

“Well, we don’t really know. We bill all the plans.”

“Okay, but do they all PAY?”

“You’ll have to call the (larger entity) billing office.”

I do, and ask the same question: “I’m trying to choose an insurance company. My doctor is Dr. X. Is she covered by HMO A, HMO B, HMO C, or HMO D?”

“We can’t really say. You’ll have to call the HMOs. But I’ll give you our (status) number.

I go to the website for HMO A to check the database. Is Dr. X one of their providers? Her name doesn’t show up on the search. But the site has a disclaimer: just because a name shows up doesn’t mean they are actually in the plan, and just because a name doesn’t show up doesn’t mean they aren’t.

Okay. I move on to the next HMO website. Ditto. So I call their customer service line.

“Hi. Can you tell me if Dr. X. is one of your providers, please?”

“You have to go to our website to see.”

“ I did. She didn’t show up but her clinic is listed. Can you double check to make sure she’s included?”

“You’ll have to call her office.”

Been there, done that, dead end. My blood pressure is climbing, I’m sure. Since it’s low to start, it may have gotten all the way up to 120/80.

One last stab. I call HMO C. “Hi. Can you help me? I need to know if my doctor is one of your providers and I haven’t had much luck with the website.”

“Just a minute, let me see.” Ten seconds pass, and she returns. “Oh yes, she’s a provider. But she’s not taking new patients.”

“That’s ok. I’m already a patient. Thanks so much—you’re the first person who’s actually helped me.”

Is there any question that the systems under which healthcare operates have some serious flaws? If the physician (who I emailed), her office, the billing office, and the customer service departments of insurance companies can't answer such a simple question, what on earth happens with complicated ones?

As you probably surmised, I went with HMO C. Not much better than a coin toss, but at least I know they have some positive attitudes about customer service. Of course, as long as the "customers" the insurance companies are interested in are their shareholders, not the insured, we can't have high expectations.

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