I’m pretty clueless when it comes to medical care. I had some injuries when I was younger, and a couple of minor medical things like cat-scratch disease and a cyst removal. Other than that, it’s been a physical every two years when I was an active pilot. I’m one of the people (thank the gods) that has been paying into the ‘system’ for years, but who has taken very little out of it. And then I tried to get a flu shot…
In the past, I’ve worked for large companies where the shots came to the employees. A fin or a sawbuck, and you get your shot. Now I work for a non-profit with a bit more than a dozen people in the office. I have to get a flu shot on my own. Since I don’t know how, generally, to get medical care, I called my insurance company. I was told that I must get the shot from my primary care physician if I want to be covered. There would be a charge for an office visit, and a charge for the shot. I think I’d be responsible for all of it, as I haven’t paid anything on a deductible. Or I could pay out-of-pocket anywhere I like. A further complication was that my PCP does not have any vaccine. Too bad. If my PCP doesn’t have vaccine, then I must go out-of-network at my own expense. I ended up paying $25 at Walgreen’s for a seasonal flu shot.
I asked what would happen if I were in a crash and was unconscious. Would I be covered for the ambulance ride? Apparently, not necessarily. I would have to make the decision as to whether it’s medically necessary – which I couldn’t do, since I’m not a doctor and I’m hypothetically unconscious. I was told that unless I’m in danger of dying, an ambulance ride is not ‘medically necessary’. I was told that if I broke my leg I’d have to hire a cab to get to the hospital.
My impression is that insurance providers (mine, anyway) will allow you to pay for coverage, but you’re not allowed to use it. At least, it’s so limited that one might as well say it can’t be used.
In the American system, one has virtually no choice of insurers. You take what your employer offers, or you’re wealthy enough to pay the full premium for the plan that will actually allow you to use the coverage if you need it.
This isn’t right. If I’m sick, I should be able to go to a doctor. Not just the one who is my PCP, but any doctor. Things like flu shots should be covered anywhere. It’s a matter of public health. How many people will not get flu shots, just because their insurance is too restrictive? How many people will they infect? And how many people will they infect? Why should I be writhing in agony waiting for a cab, and be transported by a presumably non-medical cabbie, when I have broken bones? It all seemed so much easier when I was on CHAMPUS. That ‘government insurance’ worked well for me when I was a kid and had athsma, and when I broke my arm.
I want fully-portable medical coverage that doesn’t depend on my job, and that will allow me to get treatment if and when I need it.