This has nothing to do with horses, other than the fact that I wish I could be a patient of my veterinarian.
It is an aggravated, screaming in useless fury rant, so if you don’t want to be bothered, pass on by. I have to vent, somehow.
A non-American friend of mine mentioned that I may want to post this, to let all my European readers know what the state of American health care is today.
My American readers will probably not even bother reading it. They will be shaking their heads in sad recognition, having been through the grinder, in one form or another, themselves.
Do you believe the hype, that America has a good health care system?
We have very good doctors. They average 14 years of post graduate schooling before they are licensed as doctors.
Our nurses are even better.
We have the most innovative, high tech, best researched procedures in the world.
Here’s a scenario. You have just moved to a new city (because you lost your job in your old one).
You have an ingrown toenail. It’s very painful. You want a doctor to fix it for you.
You have many, many hoops to jump through.
First, do you have health insurance?
If you do not…and many don’t because it is so terribly expensive, your only option is to go to the Emergency Room at a general hospital, one that accepts anyone into their ER’s. Take a book, a good lunch, a blanket and expect to spend about 24 hours in the waiting room.
If you do have health insurance, you must go to one of their ‘approved’ doctors.
He may not be in your new hometown.
Let’s say he is.
You call him up. Is he accepting new patients?
Well, that depends.
How old are you?
You are 65. He won’t accept you because you are 65 or older. No doctors accept new patients over 66. The insurance companies won’t let them. If you are over 65 and don’t have health insurance, Medicaid, the government health insurance, will pay. Maybe. But you can only get Medicaid if you are worth no more than $2000. You are allowed to have a car, and a place to live. But you can have no more than $2000 TOTAL-that means income, pension (yeah, right), stocks, bonds, money in a checking account.
If you don’t have Medicaid, you must have an insurance company that will 1. accept you, and 2. WILL DEFINITELY charge you incredibly high premiums, costing thousands of dollars. You are not allowed to have ‘pre-existing conditions”. That means, if you saw your old doctor for heart palpitations twenty years ago (not uncommon in menopausal women), you have a ‘heart condition” and will not be covered as it’s a ‘pre-existing condition.”
Let’s say you’re under 65 and in good health. Let’s say this doctor accepts you as a new patient.
You and your ingrown toenail must have a complete physical first.
You will come back in a week for your physical.
You come back in a week. Your toe is worse.
You get a physical. Your blood test, urine test, hearing test, all sorts of tests, take a week or more.
Come back next week for your ingrown toenail.
You come back in a week.
The doctor looks at your ingrown toenail and declares that he needs an X-ray on it. Fortunately, X-rays are almost instantaneous, now, but they still need to be “read” by a specialist. Lucky for you, there is both the X-ray reader and the podiatrist who just happens to be doing nothing at the moment.
Your X-ray shows that, years ago, you broke a toe. You remember stubbing it, but had no idea that it was broken. Besides, there is no way to repair a broken toe.
The podiatrist, who specializes solely in feet, must look at it before your doctor may work on it. Someday soon, podiatrists will be will be specialized into those who only treat left feet and those who only treat right feet. The podiatrist declares that you need physical therapy, special shoes and orthotics. These will entail you coming back in for the orthotics specialist to take a cast of your foot. The shoes and orthotics are made in Tibet, and must be transported by camel over the Himalayas.
The doctor must submit all this information to your insurance company, to see if they’ll cover fixing your ingrown toenail as well as the special shoes, the therapy, the orthotics, and the specialists involved. The clinic has a contractor that does nothing but submit insurance claims to your insurance company. The Insurance company has lawyers (not doctors) who will look at the paperwork and the doctor’s notes to determine if surgery is warranted.
You come back the following week. Your ingrown toenail is now so painful that you can barely walk. In addition, it’s become infected.
The infection has complicated matters. Your insurance company must be notified. But because you’re in a great deal of pain, come back in a week, for surgery.
You come back in a week. You are ushered into a small operating room. There are three people in it: your doctor, his assistant, and another specialist who specializes in anesthesia. You are told to strip and put on a paper table-cloth. The operating room, by the way, is kept at a nice, toasty 32 degrees F. You ask for a heated blanket to keep you from freezing.
The tech swabs your foot with betadine. The second doctor administers the local anesthesia into your toe. This is his sole contribution to your surgery. Your doctor quickly cuts your now blessedly numb toe, and finds that the infection is pretty bad. He pulls the toe nail, cleans it all up, flushes the nasty stuff out of the wound, and is done. The tech bandages your toe. the entire procedure took seventeen minutes from start to finish. You pull on your sock, get up out of the chair, and are lent a set of crutches or a cane, given a prescription for antibiotics and a painkiller, and a leaflet on how to care for your wound. Part of it says to bathe the wound in saline solution. Part of the infected tissue will be sent to the lab for a pathology report. Come back in a week.
You take the prescription to the pharmacy. Do you have insurance? Yes? Okay, here are your antibiotics.
Pain killer? Hmmm. Give me your driver’s license. We have to do a background check. Half an hour later, you get your driver’s license back. Sign here. Sign here. Sign this disclaimer saying that you swear on your mother’s grave that this painkiller is for your sole use. It is a felony to use it in any way not prescribed. It is a felony to sell this painkiller to anyone. It is a felony to dispose of it an unauthorized way.
The pain killer is very, very expensive. Your teenaged son says, “You know, Mom, my buddy can get you boxes of this stuff for a pack of cigarettes.”
Saline solution? (a mixture of salt and sterile water.). No, we are forbidden to sell saline solution. It is a felony to buy saline solution. You might be making illegal drugs with it. No, no saline solution. Shame on you.
In a week, you feel so much better. Your toe no longer hurts. You’re taking the antibiotics even though they make you feel ill.
You come back in a week. The doctor takes a look at it, says, you’re doing a great job healing it. Oh, by the way, the path report says you had an infection in the toe. See you next week.
Why? But you come back next week, this time all healed, your toe looks great.
OK. You pay the co-pay…not much, about a hundred bucks, and you feel great.
A year later, when you’ve forgotten about your ingrown toenail, you get a bill from your insurance company. It tells you many things you didn’t know when you started buying the insurance.
All those visits when you weren’t actually being operated on? You pay.
The lab techs, the podiatrist, the orthotics specialist, the anesthesia specialist, the tech, the X-ray reader, consultants you never met but who glanced at your chart, the staff of the clinic, the Claims specialist, (a subcontractor separate from the doctor’s clinic that is paid by him to submit all the claims forms)-all are paid for by you.
The operating room, the amount of time spent in the operating room (counted in fifteen minute intervals, so the extra two minutes are counted as fifteen) the bandages, the instruments (used only once), the anesthesia, the electricity, the prepping of the room for sterile conditions, the betadine swabbed on your foot, the bandages, the disposal of the hazardous biological material (bloody swab and that little bit of flesh he cut off)-all are paid for by you.
The orthotics, the special shoes, the physical therapy, the heated blanket, are all nice little ‘options’, unnecessary for the actual operation, are all paid by you.
The cane/crutches are discounted by ten percent because you returned the equipment.
That toe cost about, oh, nine thousand dollars.
That’s the number on the bottom of the bill. It is due, in full, in ten days from the date of mailing. That due date is tomorrow. You may appeal, but you had ten days in which to appeal, starting from the date of mailing. That end date is tomorrow.
Your insurance company refuses to pay. Why?
The insurance company will not pay for any treatment you may receive for the infection, as it was a ‘pre-existing’ condition. You demonstrated willful negligence in allowing it to become infected, so they will not pay.
The insurance company will not pay because you had needless and superfluous procedures done. Why did you demand an X-ray? Why didn’t you tell them about your broken toe, something that undoubtedly caused the ingrown toenail? Were you hiding it in order to pay less for your premiums? That’s dishonest, and you are now considered a liar. Why did you demand physical therapy? Why do you think you need special orthotics for your feet?
The insurance company, which had received the claims paperwork a year ago, let it sit in a box somewhere for the required year. Now that year is up. You had a year to submit the claims paperwork, the ‘timely manner” is up, and they are off the hook for paying ANYTHING. What do you mean, you never saw the paperwork? Yes, the subcontractor does that job, but YOU are responsible for making sure they submit it in a timely fashion.
You can sue the insurance company, but lawyers are even more expensive than toes. In addition, the insurance company is nothing BUT lawyers, and they have time, they have all the time in the world, while you have nothing but a collection agency beating you up.
I wish I was making this up. I am not. Not even close.
If there was a veterinarian willing to work on people, I’d go that route.
In fact, a witch doctor or a shaman is looking better all the time.