As a nurse, I’m pretty up-to-date on the ins-and-outs of getting care, what is covered, how to access services, etc., but I also see it is very frustrating for the average person to navigate the system.
I’ve had two family members qualify for “Obamacare” (that’s what they call it), and both of them have had troubles getting appointments and services. Both have spent years without health insurance or health care and seem overwhelmed at the process. Most of the conflict occurs because they do not have much experience navigating the health care systems or understanding of how things work. The second source of conflict has been the particular doctors offices they have attended.
One family member went to a large, multi-service clinic. She had her initial office visit coded wrong and got sent some bills for the visit which totally freaked her out. It was an easily resolved issue but she just really didn’t know what to do or where to start. All she understood was that her “free” visit wasn’t free and she felt cheated/lied to/ripped off.
She also needed to make a follow up visit to evaluate a potential medical problem (a questionable mammogram that needed an ultrasound) that had a cost attached. Instead of keeping the appointment and paying the co-pay, she spent weeks trying to circumnavigate the system and find charity services with no charge. When she arrived at this charitable service on her appointment date, she didn’t have a referral, order or prescription for the service and so was unable to get the ultrasound done. Her understanding of this is complication is “They won’t let me get this done anywhere else for free because they just want the money.” Of course, she never informed the doctor that she was looking for a free or low cost service outside of the clinic.
Really, I guess she just thought her “Obamacare” somehow meant she would not have to pay for medical care. It does not mean that. It is health insurance like any other health insurance with deductibles, co-pays, a network of providers, etc.
The other family member went to a small, private practice where he has gotten terrible service. This office also didn’t bill correctly which got sorted out. He now has a new diagnosis of diabetes and prescriptions for two oral meds and a glucometer. But he has been unable to fill his prescriptions due the high cost of the prescribed items. The pharmacy was very helpful in making alternative suggestions for things covered by his plan and he followed up with the insurance provider to confirm the coverage and prices, but both he and the pharmacy have made several calls to the doctors office over the course of three weeks to get approval and prescriptions for the alternative items and the doc just won’t follow through or respond. I believe he is going to call the insurance company and ask to change his primary care doc today.
not what you’d expect’s insurance cost seems quite high to me (and there are likely reasons for that, such as not what you’d expect covering the whole cost himself without an employer contribution).
My insurance is about $350 a month for a family of four. However, what I pay is not what insurance costs. My insurance is actually about $18,000 a year. My employer pays a large portion of that for me.
Regarding not what you’d expect’s dermatology visit: I’ve always found that derm visit do take a while. It seems they are in high demand and many of their services aren’t covered. They also seem to like to work limited hours.
The refusal of the dermatologist to remove a benign and cosmetic cyst is standard. I’m kinda surprised to hear that you were able to have this done in the past as a covered benefit. Perhaps you had a better plan that covered this kind of procedure or had a doc that knew how to get such a thing covered (as Jackmannii suggested). I recall that in the past a doc might have a patient come to the office a couple of times to build a case for coverage of a questionable procedure. For example, a woman might come to the derm a couple of times to build a case for a mole(s) or skin tag(s) that gets irritated by a brassier or clothing. Or a PCP might build a case for a breast reduction if it can be shown that the excess tissue causes medical problems such as back or skin injury.
The derm could also offer a good price for the removal of a non-covered lesion if the patient is willing to pay out-of-pocket but may have some kind of restriction regarding the offer. Perhaps he or she cannot make the offer during a covered visit for fear of being seen as steering the patient to cash services inappropriately. Maybe a call back for a cash price would be in order here.
Finally, there are as many different kinds of dermatologists as there are people. Some just want to treat acne on a M-F, 9-4:30 schedule. Others are only interested in aesthetics and focus on laser cosmetic skin treatments and chemical peels. Still others are very into the huge varieties of skin disease and complex-skin-condition diagnosis and treatment. Perhaps you just didn’t find the right clinic for you.
