I'm guessing this is what all of the hullabaloo was about during that whole Obamacare thing ... but honestly, I'm really shocked at the poor quality of the care we have received overall due to the way the medical system has to be set up.
Short history: It seems that, until about 1970, your personal doctor was able to keep track of your medical history and suggest the best course of action. Then, insurance companies realized, "wait a minute!," the cost of health care is going to skyrocket - we have to do something about this!
Enter the beginnings of the crazy system we have now. From my personal experience, because insurance companies are looking to keep their costs low, and they really can't pay for everything because there is so much illness going on (let's just assume that together, rather than they're greedy bastards). Therefore, the quality of care everyone receives totally sucks.
Take our case for example, my daughter has a pretty straightforward skull deformity. It usually requires surgery. Last November, I started the process to have that surgery done. By January, I had arranged the consult necessary and gotten the "OK, I recommend surgery" from Dr. Fearon. Due to Dr. Fearon's demand, we were not able to schedule until the end of March. So that's a four month turn around time. Not too bad for a serious surgery. Or is it .... is a four month turn around time really a good idea for such a serious condition? I mean, I was basically told my daughter would suffer insanely serious consequences, and it's takes several months to schedule the surgery to correct that. Something is a little off there.
But, wait, there's more! (eat your heart out Ron Popeil) Now our insurance company gets involved. We used to be part of a PPO and didn't have to get regular referrals and authorization, which are different, you know. We switched to an HMO last year, and I didn't do enough homework to realize the ins and outs of how this whole thing works. So then, we had to find a new in-network pediatrician and in-network doctors, which, in my opinion, aren't the greatest fit for our family, because we had a lovely relationship with our other doctors that are now out-of-network. But if I want to treat my one daughter for her skull deformity and my other daughter for some sensory issues, I need to beg my new pediatrician for a referral to those specialists I was already in a relationship with before I switched to my new insurance. AND THEN, even after doing all of that, I asked for a referral and didn't understand that an authorization was required for surgery. So, I wasted the time of those at my new in-network pediatrician's office (which they are a lovely and truly helpful bunch - they are working the insurance hoops too, otherwise, they don't eat), and I've now wasted a lot of other people's time (neurosurgery at Children's and Inova) and I've drunk a couple of glasses too many of the vino in the process.
So now, our surgery was cancelled because insurance didn't like the surgeon we wanted to go to. I have to go to surgeons who provide a surgery I don't want for my child. I'm having to visit providers I don't plan to go to, taking up their time and money from our insurance provider to see them. I've been of Children's National a couple of times now and I don't need to be taking up appointment slots. Furthermore, we received a second denial for our appeal and now I'm going to have to bother plenty of peoples at the Maryland Insurance Administration (also, a wonderfully helpful bunch and they have really caused all of this to move forward quickly).
All in all, this does seem like quite the broken system. Doctors are not able to practice medicine because they have to jump through hoops to receive compensation - doctors have to eat too :). They have to overbook themselves to make enough money to live and they aren't able to suggest the best care of their patients, only the care that is available in a small pool in their local area. That sounds like a recipe for disaster. We have experienced that disaster personally, and we don't have a truly complex case that involved multiple offices.
All in all, I've spent a ridiculous amount of time just in the last month going to appointments, making phone calls and writing appeals. That time should have been spent caring for my children, building up my husband and nurturing our family. I really feel for everyone who is at the mercy of this system and I pray that something can be done about it very, very soon.
