IT HAPPENED TO ME: Health Insurance Prevented Me From Seeing A Doctor
From August to December of 2013, I had no health insurance. I graduated from law school in May, and the health insurance I had through my university lapsed at the end of the summer. I was unemployed, and I couldn’t afford to purchase insurance independently.
I know this isn’t a particularly long time, and many people are uninsured for much longer -– I am young and relatively healthy, so I rode it out. No biggie. I had a few minor health expenses, but I paid for them out of pocket without too much trouble.
When the healthcare.gov exchanges opened up in October, my mom “suggested” that I sign up for a plan. (My mother works in healthcare policy, so she had a bit of an ulterior motive in asking me to use the Exchange. She kept asking me to “write up my experiences.” I choose to believe that she also spent long nights in a state of slowly rising hysteria thinking of me without health insurance. Poor Mom.)
I made an account in October, and had a lot of the same problems with the website that everyone else had. Finally, in December, I tried again and was finally able to purchase a plan. Since I was still broke, young, and relatively healthy, I signed up for one of the catastrophic plans. It was an HMO plan through Humana, with a $128.73 monthly premium and a $6,350 deductible.
In retrospect this probably should have tipped me off, but it was what I could afford, and I figured it would come through for me if I got hit by a truck. It went into effect on January 1, 2014.
On January 25, I started experiencing excruciating pain in my left foot. It was completely out of the blue -– no precipitating event, no trauma, just randomly started to hurt like a bitch while I was doing the dishes. At first I thought it was a weird muscle cramp, but by bedtime I couldn’t put any weight on it at all, and it was obviously more serious.
The next morning, my boyfriend J and I consulted; it was Sunday morning, so our only options were urgent care or the ER, or wait until Monday. J’s brother, a doctor, advised us to avoid the ER –- he told us that they would probably just confirm that it was hurt, maybe broken, and refer us to a specialist.
We would be lucky, he told us, to pay less than $3,000. He suggested that we just take some Tylenol, try to stay off it, and go straight to a podiatrist on Monday. We ordered a fracture boot and a cane on Amazon to help me get around, and first thing Monday morning, I found a local podiatry practice and made an appointment for that afternoon.
Shortly before my appointment, I realized that since my plan is an HMO, I would need a referral from my primary care physician to see a specialist. I have only lived in our current city for a few months, so I don’t have a primary care physician. I haven’t needed to see a primary care doctor since I moved here, and I had no health insurance.
But Humana had my back –- they assigned me a doctor. I figured I’d call that doctor and explain the situation, and hope they could help me out. Unfortunately, Humana did not provide any contact information for the PCP they assigned me. I thought this was weird, but went to Google, like any self-respecting twenty-something in 2014. Intense Googling finally revealed a disconnected number and a page indicating that the assigned PCP was no longer practicing in this state. I began to worry.
J took a half-day from work to take me to the doctor. When he came home I explained to him about the PCP referral problem. After a brief consultation, we decided to just go to the appointment and hope for the best -– worst case, we’d just pay out of pocket and it would still be cheaper than the ER.
Doctors want to help hurt people, right? I figured I’d just deal with the “assigned PCP doesn’t actually exist” problem with customer service later.
I hobbled down the stairs from our third floor walk-up, into the car, out of the car, and finally into the doctor’s office.
J ferried insurance ID cards and paperwork back and forth between me and the receptionist.
About 10 minutes after we arrived, the receptionist said, “You know you need a referral? We can’t see you without a referral.”
We were ready. We said, “We don’t have a local PCP, and it was an emergency. We’re happy to self-pay if necessary.” We pointed out that since I have such a high deductible, we’d basically be paying out of pocket anyway.
The receptionist looked concerned. She said, “I’ll check.” We sat in the waiting area while she had a hushed, worried conference with another staff member.
She called Humana. We could hear her working her way through the voice-activated directory: “Speak to a representative. Speak. To. A. Representative.”
Almost an hour after we initially arrived, she looked out over the desk again and said, “We can’t see you without a referral.”
“Can’t we just self-pay?”
“No. We can’t see you.”
“Why not? Can’t we just not use the insurance? Why would the referral matter then?”
“If we see HMO patients without a referral, we violate our contract with Humana. In case you file a fraudulent claim.”
We started to get very concerned. J ventured, “What if we sign something saying we won’t file a claim?” (I wasn’t too optimistic about this one.)
“I’m sorry. We can’t see you.”
Still trying to get a handle on the problem, I asked, “So you mean, you could see me if I didn’t have health insurance?”
“So if we just hadn’t told you about my insurance, you could see me?”
“Can we just pretend we didn’t tell you?”
“That doesn’t make any sense.”
“I get that a lot.”
After a few more rounds of this and a desperate attempt by J to appeal to her sympathy (“We live in a third-floor walk-up, the worst thing to do with a broken foot is walk around, there must be something you can do!” “Sorry, we can’t help you.”) we were forced to accept that it was a no-go, and we went out to the car to plan our next move.
It was clear that we weren’t going to see a podiatrist without either getting a referral from a PCP or lying about my health insurance. Since it was almost 3 PM, it was starting to seem increasingly unlikely that we were going to see anyone today, and thinking about navigating those stairs for nothing (and doing it again tomorrow) was sending me dangerously close to a hysterical meltdown.
Eventually we regrouped and made a game plan –- if a referral was what we needed, we would get a referral. The assigned provider was a bust, but Humana has a list of other covered providers in our area –- we’d call them, tell them our sad story, and hope that someone would be able to help us out.
This still didn’t seem like the end of the world –- doctors want to help hurt people, right? Right.
So we called. We sat in the car and pulled up the provider directory and called four different doctors’ offices. All of them said the same thing: “That's very sad and I'm sorry, but we don't accept your plan.”
“You don’t take Humana?”
“We take Humana PPO, not Humana HMO.”
“But you are listed in the provider directory for my HMO plan. I got your name from their list, for my plan.”
“I know. We get that a lot. Their directory is wrong.”
Finally we gave up and went to a local urgent care center. J was hesitant, not wanting to spend the money when we would probably need to go see a specialist anyway, and knowing they wouldn’t give us a referral. We called them from the car and asked how much it would cost for self-pay.
The nurse quickly rattled off prices: “$100 for the visit, $75 if we have to X-ray you, $75 if we put you in a splint.” That didn’t seem too bad, and I could get what I wanted the most: something stronger than Tylenol to manage the pain.
When we got there, the place was clean and seemed new or at least well maintained. We only waited 20 minutes to see a doctor, even though we had no appointment. After the usual blood pressure and temperature checkup, the doctor came in to look at my foot.
She told us that the boot we had purchased on Amazon was exactly the right thing –- thank you, Internet –- whether the problem was a fracture, gout, or something else. Unsurprisingly, they did not take my insurance, but they did let us self-pay -- $100 for the doctor, $35 for a visit to a nearby radiology lab. $135 total, which is roughly the cost of my monthly premium.
The awesome and great doctor to whom I am forever indebted gave me a prescription for Norco, which we got in generic form at Sam's Club for $9.50, and with the fracture boot and cane, we ended up spending about $200 on the entire adventure. Exactly none of these things were subsidized in any way by my health insurance plan. When we told the urgent care doctor about our day, she said, “Oh, yeah, next time you should probably just tell them you don’t have insurance. You’ll be better off.”
“What?” we said.
“Yeah,” she said.
Later that night, I was talking about this with some friends on Facebook. One of my law school friends asked, "What kind of bad experience was it? Like you think they're violating the terms of your policy?"
J replied, "No, the insurance policy does what it's designed to do. It's just designed to do absolutely nothing." Based on our experience, this seems pretty much on-point. I am paying $130 per month for the privilege of not getting health care.
(By the way, it turns out I had a little stress fracture. This all happened about two weeks ago, and I’m feeling much better now.)