When your medical insurance status made a difference in the treatment you got.

In My Humble Opinion
21

I broke a finger drilling a 4" hole through the sill of a house - the drill caught on a hidden nail, kicked and I broke a bone for the first and hopefully last time in my life.

As I have no insurance, I visited a doctor friend at home. He’s an ER doctor as well as the on-field physician for an NFL team, so he knows a broken finger when he sees one. He taped it up, explaining what would have happened if I had had insurance. They would have X-rayed the finger, sedated me, straightened the finger, put in pins to hold it in place, etc. I might have even received some PT to return the finger to full functionality after it healed.

Instead, I got tape and painkillers (generic). And a crooked finger. But I’m typing with it.

22

No real difference.

When I was in college, I had no-name health insurance through my pizza job. A stubborn case of bronchitis led to a chest x-ray, led to the discovery of a potentially life-threatening, possibly congenital defect inside my chest. After seeing the pulmonolgist, but before the appointment with the cardiac surgeon, the insurance company denied my claims as a pre-existing condition. They paid for the chest x-ray and the antibiotics, but told me to piss up a flagpole for the specialist and the CAT scan. A few letters from an attorney later, it became clear that regardless of the merits of the case, I was not going to get blood from a stone and being a stupid kid, I gave up.

Nevertheless, I saw the surgeon and made it absolutely clear that I had no coverage and made about $10k/year. He said I would continue to be miserably sick and it would eventually, in months or years, kill me. Assuming that I could eventually make money enough money to pay him if I wasn’t dead, I opted for surgery the day after finals ended. When I scheduled the surgery at the hospital, I again explained my non-covered, penniless situation. They told me I could pay $100/month once I got back to work.

Things went poorly, I was in the ICU for a week, then, after another week, they determined that while I was no longer going to die, I would not have a normal, unrestricted life. I was out of danger, they had done the obligatory minimum and would have been within their rights to tell me to scram and make room for somebody with gold-plated coverage. Instead, knowing that I had no means to pay for it, they agreed to attempt to restore me to my former level of health. So they performed another surgery, fixed it up the right way, and a week later I was home. Only downside: no SCUBA diving, ever.

The surgeon, anesthesia, and radiology all billed separately from the hospital and I paid them $30k out of my own pocket over the next 4 years. A nice lady in the hospital’s billing department told me I should have driven a harder bargain when I agreed to pay by the month beforehand; then she wrote off my entire $70k bill as indigent and told me to get back to class.

TLDR version: Received perfectly acceptable and not excessive care when I had insurance, then got way more than just the minimum life-saving care when I had no insurance. Go figure.

23

Well, unless your reporting of that first incident is wildly off, neither a D&C nor a “morning after pill” was the correct treatment. Neither is appropriate for an ectopic pregnancy. So, either you “just” had a garden variety miscarriage, you are misremembering the treatment (methotrexate vs. “morning after” pill), or you’re dead.

Having had a miscarriage with insurance, I was offered the option of a D&C. The logic being, I think, that it would a) ensure that everything passed correctly (sometimes it doesn’t), and b) get it all over with sooner. I opted for the D&C, but might not have done so again. I was not pressured into it, beyond the note that I’d bleed, a lot. I’ve since learned that doctors do tend to urge them when they’re not strictly necessary.

24

In the late 80s I drove an uninsured friend to the hospital. She knew her appendix was the problem and told the doctor she saw in the ER. He patted her hand and told her it was a virus. She tried to explain that she was in the medical field and knew she had textbook appendicitis. He didn’t like her attitude. Tempers flared on both sides. There were many witnesses.

I drove her home. Six hours later, her roommate called an ambulance. Her appendix had ruptured, she was unconscious. After surgery her first visitor was an attorney representing the hospital. She agreed to sign a release in exchange for the hospital waiving all charges.

A week later she was discharged. When she was signing out of the hospital, the clerk presented her with a bill for her TV and phone service. She gave the clerk the attorney’s business card and asked that she check with him. After making a quick call, the clerk apologized profusely and we were on our way.

25

Having no insurance and being unemployed meant that for a while there, I was going to the public clinic. It was pretty awful.

Because of the inadequate funding, the doctors there were overworked, cynical, and hostile to many of their patients, and I was no exception. My visits were split half-and-half between “I am coughing up green stuff” and “my head is trying to explode”. While I got prescriptions for cheap antibiotics and cough syrup for the respiratory problems, I got zilch for the migraines.

See, migraines and other headaches are subjective. There’s no way for the doctor to verify you’re experiencing excruciating pain (well, there is, but it would require money they don’t have), and anyone can learn to vomit on cue. Being broke, you’re not going to get the abortive medications because they’re too expensive. If you tell them you’re already on a beta-blocker and anti-seizure medications don’t do anything, the only category left is narcotic pain killers.

No doctor working at a public clinic is going to prescribe narcotics to a patient for a headache. Ever. Doesn’t matter if you’re weeping. Doesn’t matter if your mom, an RN, is standing beside you, explaining your medical history in precise terms. Doesn’t matter if you brought previous medical records with you. Ain’t happening.

Why? Because the official line is that poor people take drugs for fun and fake illness to get them. None of the doctors are willing to risk the DEA looking at them funny. None of them have the time to determine if the patient is actually a drug-seeking addict or someone in genuine pain. You are just Shit Out Of Luck.

(I discovered nearly two years later that my migraines were due almost completely to my oral contraception prescription, which I was on to regulate my periods due to PCOS. Guess which disease won?)

26

I really don’t mean to be a jerk, and as this was years ago, I assume all is well, but…how would you know? Did you go through a similar health situation with someone who wasn’t insured, at the same hospital? Did you go through it with someone with impeccable, unquestioned health insurance?

I see a lot of people who say, “They’ve done everything they can for me,” and most of the time, it just isn’t true. They’ve done everything they *told *you about, but there’s almost always something else that you don’t know about. Something the doctor thinks might not work, or would have too many side effects or…something you couldn’t afford.

This affects doctors way more than nursing care, to be sure. While I *do *know if you have insurance or not (it’s on the admission form and in the computer), I’m not responsible for choosing $10 supplies or $100 supplies. If you need it, you’ll get it, at least until you get home and have to buy your own Telfa barriers and tape. (And yes, I’ll load up your bag with everything I can reasonably snatch out of the supply room without getting in trouble, 'cause fuck the hospital.) I don’t envy doctors one bit. How much must it suck for them to know this $1000/month pill would take care of it, but you’ll never be able to afford it?

But if you look at the Patient Bill of Rights next time you’re in the doctor’s office or hospital, read closely. There’s almost always a line that says something like, “You have the right to discuss more affordable options with your doctor,” or “Financial concerns are a valid consideration in choosing a treatment plan.” It’s just reality. Until we have single payer health care, it’s going to remain reality. Some people can afford some medical tests and treatments that others can’t.

27

Ouch. That’s insane. This is an example of where having insurance (and therefore access to other healthcare) definitely makes a difference. I know I’ve told this here before - but back in 2005, while on vacation three time zones away from home, I broke my elbow, went to the ER, was told it was NOT broken… and sent on my way at 2 AM with a scrip for Vicodin. Which, by the way, I did not ask for - was planning on using OTC Advil. I assume I didn’t meet the profile (what? middle-aged fat women don’t “use”?), or they ran a check and found I wasn’t known to the local hospitals as a seeker, or something, or maybe the hospital didn’t tend to get many seekers.

But if I’d gone to an overworked inner-city hospital with no insurance, I’d bet I would not have gotten the painkillers.

(Oh, and I found - and threw away - 2/3 of that Vicodin a couple years back. The elbow was broken, as confirmed by a doctor after I got home).

28

I cannot imagine how it could have been better. He came home in record time, healed normally with no infections or complications, and is still with us almost 20 years later. The question of finances was never even raised in any discussion. There was not really any less expensive treatment available as far as I know. The only alternative would have been to go home and do nothing until he died one day not too long afterward from a massive heart attack.