Josiah Carlson (chouyu_31) wrote,
Josiah Carlson

my afternoon, aka health insurance fail

Around 2:45 I went to the Blue Shield of California web site and logged in, looking for urgent care facilities. Why? My girlfriend and I seem to be infected with some flu variant, and being that we both spent some time with a young lady that was in the hospital for H1N1, *and* that my girlfriend is leaving the country next week, we wanted to make sure she wasn't infected.

So I find a facility, conveniently located 1.5 miles away from my apartment. Great! So I go there. I was told, "not covered, call your provider."

So I sat in the parking lot and called my primary care physician, around 3PM. I was told that my primary care physician was in downtown Los Angeles, but that I couldn't see him, because he wasn't taking any new patients, and neither were any of his partners. I asked about urgent care facilities, which were in downtown LA or Pasadena. Those are 30-45 minutes away, without traffic. WTF? I had originally set up a primary care physician in Santa Monica, maybe 15 minutes from where I worked, but they switched me automatically for some strange reason.

A few months ago when I was bitten by a dog, I also went to an urgent care facility. I got a bill in the mail a couple weeks ago explaining that I wasn't covered because I want to a location that wasn't covered under my insurance. Again, a location that had been given to me by the insurance providers' web site.

So I call up the insurance provider, they tell me everything I already know. I then ask if there was a method by which I could go to an urgent care facility somewhere near to where I live, while also getting a primary care physician that would be reasonably close to where I live. She said that she could find a new group and a new doctor for me. Great.

At 3:30 I got off the phone, with information about a new doctor, and the address of an urgent care facility that takes walk-ins that was covered under my medical group. The lady on the phone said that if the provider needed confirmation that I was covered, that they could call them and they would fax over confirmation. Wonderful. So I drive to El Segundo and present my information.

At 4:30 I'm asked to the front desk. I'm told that my insurance company redirected them to my primary care physician (wtf happened to the faxed authorization?). My primary care physician's medical group doesn't contract with any urgent care facilities, despite the fact that 6 are listed on my insurance company's internal database as being contracted with that medical group. WTF?

So I talk with the front desk person at my primary care physician's office, and I get an appointment for 9AM tomorrow. Which, in my opinion, is preposterous.

The moment I mention that I've spent time with someone who spent time in the hospital for H1N1, they should be working hard to take care of me so I don't accidentally infect people. Instead, I'm told to not let the door hit my ass on my way out, and when I call up my insurance provider to explain the bullshit I've just been subjected to, I am told a lot of stuff I know. She calls up the urgent care facility and discovers that they don't contract with any HMOs, and says that she'll update the database so this doesn't happen to others. I explain to her how I got to the first urgent care facility in the first place, and she tells me that I should have verified the medical group at the urgent care facility I wanted to go to.

Wait, what? Your computer knows what group I am in. Your computer knows where I'm searching around. Your computer can't filter the list of the "thousands" of providers down to just those I can visit and be covered by? The mind boggles.

I'm certain that my experience is not unique; I remember having to jump through similar hoops to get Annie a primary care physician in a network with an OB close to where we lived.

To those people who don't believe that something needs to change with health care in America: you are idiots. I just spent 2 hours finding out that I can't actually see a physician today, unless I walked into an emergency room and waited 4 hours. Mind you, I have insurance, and/or could pay cash for any conceivable procedure they would perform on me today. But the two facilities I walked into today outright refused to treat me.

For reference, I'm with Blue Shield of California, and I have an HMO plan. I chose HMO because it limits my personal liability if, for example, I were to be severely injured in a car, motorcycle, surfing, skateboarding, ... accident. While I don't expect to be severely injured, I participate in at least 3 activities where severe injuries are not uncommon.

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