Free Healthcare

“In America, no one should go without health care.”

~AFL-CIO

My husband is a teacher so we don’t have to pay for health care.  They just take $3,000 a year in premiums out of his paycheck.  We’ve chosen the most affordable “plan” his school offers.  This year they didn’t even increase our premiums, they just doubled our co-pays.

With our Vermont Health Partnership Plan we get a “Primary Care Provider,”  “preferred benefits,”  and a “three-tier prescription drug benefit.”  It’s fancy, and it takes an entire staff to explain the “features” of our plan each time we need to use it.  But that’s not too much of an inconvenience because we rarely use it.

Our family of four actually relies on traditional care provided by a Naturopathic physician.  Though Naturopathy is on the rise and is more affordable and effective in treating common ailments, it’s frowned upon.  Thus in addition to our premiums and co-pays, we dish out another few thousand a year to cover our “real” care.

On the other hand, given our limited use of “the system,” we’ve never had to  encounter some of the insurance sagas that we hear about from those unable to get the medical attention they need.  Until yesterday.

Yesterday was the first time we’ve needed something from a pharmacy other than an antibiotic.  A simple air cast is all we wanted.  At the cost of $180. Our Naturopath put the order in, but then called us right back to say that there was a problem.

Apparently, our insurance plan with Blue Cross and Blue Shield of Vermont would cover pharmaceutical prescriptions, but not “durable equipment” prescriptions because this pharmacy was not in our “network” as a “durable equipment provider.”

After an aggravating amount of time on hold, my husband was given the name of two “providers” in network and he scrambled to call them before the end of the work day.

Unfortunately, he discovered that the two local “providers” did not have air casts.  In fact, one of them was simply an oxygen supply company.  Didn’t the insurance company know this? Thus my husband spent another half an hour on the phone after which he was told that he would need to use an out of state provider if he wanted insurance to cover the cost.

This seemed a ludicrous request given that the same product was available in our town– immediately–and given that my husband was in pain and required the cast to support his leg from re-injury.   After another 20 minutes with the insurance company, they suggested we request “delivery” of the item, which was an additional expense that they would surprisingly cover. (Imagine how much that would cost from an hour away.)

However, delivery wasn’t available from the out state “providers” and neither was a cast– for 3 to 7 days.   Thus my husband called the insurance company again, punching in all his numbers, giving all the same information to a new person, and finally being told that he should call our physician to have her submit a special “pre-approval” for the local cast– which could also take up to 3 days to be “approved” by the special “pre-approval durable equipment reviewers.”

Unfortunately by the time my husband got off the phone with the insurance company and the various “providers,” the doctor’s office was closed.

During this circus, we learned that had he used the Emergency Room over the weekend, rather than wait for our health care provider to see him on Monday, the hospital could have easily issued the air cast and all expenses would have been covered.  (The system obviously doesn’t reward the cost-effective prudence of a doctor’s daughter who thought the Emergency Room wasn’t an appropriate use of our benefits in this instance.)

Toward the end of this escapade, I found myself wanting to rip the phone from my husband and scream bloody murder at the insurance company–or cry.     This was inane and cruel and despairing.  The poor guy just needed an air cast for his leg to relieve the pain and protect him from greater injury, but we had to play some crazy game to get it.  (Imagine how many insurance “players” it takes to “pretend” that this game actually works.)

“Be specific in the pre-approval request,”  our Blue Cross, Blue Shield  Health Advocate tells us.  “Make sure they know that it’s urgent.  Tell them that you can’t find a local provider.  Tell them that it will take a week to get one through the out of state provider. The “advocate’s” sincere (and misdirected) kindness makes me want to cry, and I’m appalled that I’m in the ridiculous situation of begging for a cast for my husband.

“Make sure the doctor includes all the details,” she repeats over and over again, saying “They can’t read your mind.”

Can they read an x-ray?  I wonder.  WTF!

This was our family’s first bitter “taste” of what many others endure in much more dire circumstances~ when it comes to having their medical needs met–or unmet–by our country’s “superior” health care system.

Our personal drama–and call to action– is aligned with the national one following the loss of Ted Kennedy’s seat (to a Senator who opposes health care reform) on the one-year anniversary of President Obama in the White House.

The politics of the healthcare debate may have changed,” says the Democracy in Action group MomsRising, ” but the needs of real people for healthcare have not.” Click here to tell your members of Congress to be strong and continue the fight for real health care reform.

Kelly Salasin

(Click here to see additional posts on health care reform at the intersection of life and politics.)

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Cat Scan 3:00 a.m.

Upon rising after three hours of sleep to sun streaming through crystallized trees in a tinsel-like forest, the late night trip to the Emergency Room seemed like a dream.

Morning After, Kelly Salasin, Vermont

When our eight-year old woke just after midnight with a throbbing headache followed by vomiting, we were scared. He had fallen at the ice skating rink that afternoon and whacked his head hard. I checked his pupils, tracked his eyes and asked him questions.  It was probably just the stomach flu–which didn’t seem fair either.

Handing him over to his father, I grabbed a flashlight in search of the computer to see what the Internet could tell us. As a last resort, I would wake our family doctor.  The phone line was dead… again.

If it hadn’t already, this three-day weekend now seemed solidly stacked against us.  We’d been without power since Thursday and our water supplies for washing and flushing were spent. Through each moonlit night, I imagined the welcome sound of appliances clicking back on.  My husband and I were “ready” the moment it happened. We’d run to flush the toilets, start the dishwasher–at least the rinse cycle– and refill the water jug and tub.  With trees still falling, we couldn’t count on the power to last.

But this was all a fantasy.  No electric truck had been to our road or any of the back roads of southern Vermont where the storm hit the hardest.  “It would be a week,” they told us. But they couldn’t mean that.

When I returned to our bed, I took my son from my husband to try and make some sense out of this predicament.  Watching him hold his head and writhe, made it hard to think. “Maybe you should run next door to the neighbor’s for their cell phone,” I suggested so that we could call a doctor.

“We won’t get reception,” my husband countered.

“What about driving into town for a phone?” I retorted.

Countered.

Reluctantly, I resigned myself to waking the rest of the family to make the twenty-minute drive to the nearest hospital.  It was 1:11 am when we pulled off of our road and onto Route 9–dodging trees and power lines along the way.   My husband sat in the back holding a trashcan under Aidan’s mouth while we marveled at the palace of ice that surrounded us.

The admitting nurse at in the ER was from our town and we commiserated about the condition of our roads while the boys watched ice hockey in the empty waiting room.  A half an hour later, a doctor examined Aidan before calling in the technician from her own deep sleep and tree strewn road.

At 2:30 am, she asked me to lie down on the special “bed” first– in front of a space ship like donut hole that would scan my son’s brain.

“I’ll use the lowest dose I can,” she assured me, giving me something new to worry about. Together we draped Aidan with heavy “pink frosting”– his favorite– to protect his body from the radiation– and then we left him alone with the machine as it carried his tiny, trusting body into itself and hummed, enjoying this late night snack.  Aidan looked delicately angelic and I forced myself to smile at him through the glass window.

“Stay perfectly still, Aidan,” the technician reminded him.  I watched her for any signs of concern or relief as she monitored the images on the screens. “Any history of cancer or brain surgery?” she asked, “No,” I gulped, as I tried to discern what the cloudy shapes appearing on the computer might mean.

In an attempt to shift this experience from medical to educational, I casually asked if we could get a picture of his brain for school the next day.  Aidan joined us in the computer room and we watched as it sent the scans to a radiologist in some country where there was one awake.  “See the two sides of the brain, Mom?” Aidan pointed.  “I learned about that at school.”

Before wheeling him back to the ER, the technician offered Aidan a stuffed teddy bear and some snowman stickers which made him very happy and gave me an eerie “children’s hospital” feeling.  “I’ll stay until the results come back,” she offered kindly, alerting me even more.

We rejoined my husband and teenage son in the curtained examining space–and settled in to wait.  To pass the time, I suggested we resume the family game of “Christmas Carol Charades” that we had invented on our first night without power.

During these evenings without power, we found ourselves turning to bygone pastimes like this, from music making to singing to simple games.   Once the sun would set, both boys would gravitate to the candle-lit warmth of our bed where I would read the next chapter of Three Cups of Tea before sending them off to their own rooms.

The doctor reappeared just after my husband guessed Rudolf the Red-Nosed Reindeer.  With a smile, he pronounced that Aidan’s scan looked, “Great!”

With a collective exhale, we left the hospital a little after three, but not before we all enjoyed the convenience of a restroom with running water and flushing toilets.  To savor the good news, we took the long way home through the hushed town of Brattleboro, taking in the lights before we arrived at our road where the only glimmer was that of the bright full moon reflecting in each prism of ice.  My husband reloaded the woodstove and we were all tucked back in bed before four.

Upon waking with the sun a few hours later to the sound of icicles crashing to the frosted forest floor, Aidan immediately launched into recollections of the evening.  He pulled out his snowman stickers and hugged his new, snow-colored bear.  ” I like going to the hospital!” he said, a little too enthusiastically.

“You know you can get a job there someday,” I offered in the hope of channeling his pleasure.

My husband headed out to the pond for the morning ritual of chopping through the ice tofill a trashcan with water so that we could flush our toilets another day.

Rather than feeling victimized by the sleepless night and the demands of a fourth day without power, I began to see myself as a heroine on a Winter Storm version of “Survivor”.

It was a Sunday, so I ordered us all into “house blessing” mode despite the chaos that surrounded us.   Lloyd swept the floors and Aidan emptied the trashcans.  I cleaned the toilets and the sinks with the new waters.  Afterward, we all gathered to decorate the tree as Christmas carols finished off the last precious minutes of the computer’s battery.

(2008)

Related posts:

Survivor Sours

And Then There Was Light

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