Medicine in America

As I sort through the piles of medical bills, insurance forms, and other paperwork related to my recent pregnancy, I'm reminded how complicated the health care system in our country has become.

Up until this past year, my family and I were fortunate not to have to deal much with health care issues – my dear husband (DH) and I were relatively healthy, so doctors' visits were few and far between.  But 2007 brought us our son, and consequently, more contact with the medical community than we'd ever had before.  I'm sorry to report, however, that it was extremely difficult to get the care and personal attention we needed.

From overcrowded doctors' offices with long wait times and rushed visits, to overworked (and sometimes indifferent) medical personnel, to battles with insurance companies over procedures that our physicians ordered but insurance wouldn't cover, we had to fight constantly to get adequate treatment.

One of the many battles we fought last year involved DH, who wanted a basic physical to make sure he was in good health before becoming a father.  We found an internist recommended in Washingtonian magazine's "Top Doctors" who participates in our PPO, but we couldn't get an appointment for over a month.

Once DH finally saw the doctor, he had a very good experience and left the office with a prescription for a CT scan that the doctor recommended based on DH's blood tests results and his family medical history.  The doctor warned DH, however, that he should only get the scan if our insurance company would cover it, because some insurances wouldn't cover the procedure.

DH called our insurance company, told them what the doctor said, asked them if the test was covered, and was told that the procedure “would not require precertification.”  DH took that to mean that the test was covered by our insurance, and went ahead and had the test done.  Of course, we come to find out that the test was not covered, and now we're out hundreds of dollars.  We filed two appeals with our insurance company, both of which were denied in letters that contained so much medical gobbledygook that it made legalese look like the ABCs.

Call me naïve, but I've been so surprised how much work the patient has to put in to get decent care nowadays.  When you're vulnerable – as almost everyone is when they seek medical help – everything becomes that much harder.  And I know we are some of the lucky ones; many people in this country have no insurance or access to decent medical care at all.

I'm probably biting off more than I can chew here, but I'm curious as to others' experiences with health care in America, and what (if anything) people think can be done to make things better for everyone.