Tag Archives: insurance

Don’t Take Your Emergency to the ER

I always thought the point of a hospital, its emergency room and those who work in it were there to help people. However, after a recent trip to the ER, I believe I was seriously misinformed.

At 8 p.m. on a Tuesday night, my husband was rushed to the emergency room with a dislocated shoulder. Running to be by his side, I was not greeted by the security guard, as he was too busy joking around with his colleague about the drunken woman babbling on about her shopping cart.  When he finally did help me, he failed to tell me where I could find my husband.

I walked through the halls and found my injured partner. He was propped up in a bed with a sling, and in a lot of pain. He had a nice nurse helping him who seemed to be giving him the attention he needed in a timely manner. She even had a back-up nurse who introduced himself should my husband need additional services.

Before I even sat down in curtain 16, an administrator came with her computer-on-a-cart to get our insurance information. That’s fine, I knew I wasn’t going anywhere anytime soon, but seriously, let me sit for a minute and see how my husband is feeling before you’re up my ass to see if and how I can pay for this shit.

Shortly thereafter, two doctors came around and explained the procedure they’d be taking – some pain meds, X-rays and a pop back into the socket.  Wow, maybe this wouldn’t be as long as we anticipated. Everyone was so helpful and attentive to my husband’s condition. It was really very refreshing. And then the shit hit the fan.

The second nurse came back and told us someone would be down “in a second” to take my husband to X-ray. In the meantime, he was given some pain medication to hold him over before the morphine started. A half hour later, after we had to have our original nurse paged, someone finally came.

I sat and read my magazine, catching up on the latest developments in the Natalee Holloway/Stephany Flores/Joran van der Sloot case, and before I knew it, an hour had gone by. Where was injured shoulder boy? I peered around the curtains, walked around the ER, he was nowhere to be found. I figured the doctors decided to go over his scans with him right there. Wrong!

Finally, as they rolled him back, he tells me how he waited in the X-ray hallway for like 45 minutes. His pain medicine had worn off and they shifted him in ways that put him in more pain than he originally was. No one looked at his X-rays, no one was waiting to give him the morphine, he was just left in a hallway while X-ray techs took personal phone calls.

Another hour or so went by and no one came back to curtain 16. Not the nice nurse, not her back-up guy, not the doctor, no one. The pain was getting worse and I was getting pissed. I saw all these doctors and nurses just sitting in this admin area talking, eating, playing on their phones, so I asked for help.

I was blatantly ignored. Someone picked up a phone, someone else walked away, another was ferociously typing away on their Blackberry. Seriously, come on dude, help a girl out here. Finally, after the finger tapping irritated them as much as it did me, and a woman asked what I needed. Well, geez, let’s see….

I didn’t need anything, but my husband, he needs some pain maintenance. We need a doctor. Oh, and the 90-year-old woman screaming, “Help me, can someone help me?” in curtain 14, she obviously needs something too. Can you help her out?

Apparently they couldn’t….and they wouldn’t. We were on the “Green Team” and these blokes were on the “Red Team.”  Translation: they couldn’t do a damn thing because they each work on different patients. I understood that, but if you have seven people who have the ability to help patients and zero who are actually around to do anything, isn’t there something wrong with your strategy?

All the Red Team did was page someone, but no one came, as they were attending to a critical patient. That was completely understandable – my husband was not an emergent patient, but did need care. Someone could have readjusted his arm, provided him a pillow, done something to show bedside manner still existed.

Finally, the original nurse showed up. She was kind and apologetic, yet baffled that no one else, like the floater nurse, had assisted, much less returned during that time. We told her our plight and she looked at us, sympathetically, like she’d heard this before.

Six hours later, armed with a sling and a prescription, we were on our way home. Of course, the hospital made sure we paid our co-pay upon our departure and surely, had provided enough staff to help us in this effort.

I’ve never had a great experience in an emergency room. I don’t know many people who have. I expect to wait, I expect to be ignored, and I expect to be asked for money and proof of insurance as soon as I set foot in the door. What is unacceptable to me is dozens of workers sitting on their asses while people cry out in pain or request help. There’s gotta be a better, more efficient process, even if you just  hide these people from the patients!

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If You’ve Ever Been Without Health Insurance, Please Stand Up

I have been hearing the most bizarre comments over the last few days regarding health care reform. Personally, I think the fact that uninsured people will now have access to health care is amazing. And if you have never had the unfortunate experience to be in that position, you should take a seat and reflect for a moment.

It seems that everyone has turned this bill into a political stance. It’s no longer about providing insurance to the uninsured, it’s really about the right versus the left, because if it was really about people having access to something they once were unable to attain, I believe it would be seen in a new light.

If you have always had health insurance, you’re a very lucky person. A majority of this country, especially in these financial times, are not so fortunate. I have played the insured / uninsured game a few times in my life. I have worked for companies where they didn’t offer benefits. At times, I have gone without health care because I didn’t have a job. I’ve been kicked off COBRA.

Since those tougher times, my insurance luck has turned around. My husband landed a job where benefits were immediate. Before that, we were both unemployed, paid COBRA and thankfully fell into the 65% subsidy. If we didn’t have those advantages, we’d be looking at about $1,200 a month on health insurance. But where does that leave everyone else?

Unless you have been in the situation where you have to decide whether to buy groceries or go to the doctor, you shouldn’t be arguing that the country doesn’t need health insurance. Until you work for an employer who does not offer you benefits, you don’t have the right to say you know what it’s like. When you are in the emergency room, worrying about the statement instead of the diagnosis, then you might understand.

I know everyone is entitled to their own opinion. It’s what makes America the greatest place to live. What doesn’t make our country so great is that people are dying because they don’t have insurance. Families are going broke because they can’t afford COBRA or medical bills that are piling up.  We’re fighting with one another but losing sight of the real issue.

Take a step back. Think about what it would be like to open up your mailbox and find a $100,000 medical bill for a simple procedure.  Stop thinking about your political agenda and remember your responsibility to the human race.

Does Your Doc Owe You Money? I’d Bet My Co-Pay On It…

How many of you actually know what your explanation of benefits are? Sounds boring, I know. Until recently, I never really knew myself, primarily because I didn’t bother to pay attention to them. If something came in the mail that said I was not responsible for any payments and/or it was covered by my benefits, that was all I needed to know.

Now that I am paying my own health insurance out-of-pocket (with some government aid thanks to Obama’s American Recovery and Reinvestment Act of 2009, which reduces the cost of COBRA for the unemployed), I look at everything related to my health bills a little more closely, including my EOBs.

It has come to my attention in recent months, that I sometimes pay a co-pay at a doctor’s office when I actually don’t need to. I’m usually only shelling out about $10 to $20 a visit, depending on the type of doctor I am seeing and I’m ok with that, because when I receive my EOB, it tells me if I actually needed to pay a co-pay or any other charges. The EOB is a complete breakdown of what my doctor charges for the visit, what my insurance company pays the doctor, what I am responsible for, and what costs were not covered, if any. It is, as it states, an explanation of your benefits.

As these annoying pieces of paper kept arriving in my mailbox, I started realizing that I was paying doctors when I didn’t need to. Since there were lots of lines and numbers and insurance jargon I didn’t quite understand, I called my carrier to make sure I was understanding this correctly.

What I heard on the other end shocked me. My doctor(s) receives these same EOBs. They see that I am indeed, not responsible for these co-pays and by law, are supposed to refund me my co-pay upon receipt of this document. Let me just tell you, checks are not miraculously showing up in my mail. Are they showing up in yours?

So I have to call my doctor(s) and explain which isn’t a big deal; well, most of the time. Sometimes they want a copy of the EOB (which I can easily obtain through my online account), sometimes they already have it on file. However, there are times when I get the run around for a measly $10. One doctor made me wait four months for a refund. I was told my doctor was too busy with patients to approve this. My insurance company finally called and just like that, the check was in the mail the next day. I’ve already been refunded nearly $100 in the last 2 months in overpaid co-pays! As I mentioned, it is against the law for physicians to not refund you your money (if you are owed money) when they receive this document, because they are receiving an overpayment; they have already been paid by your carrier. That is what you pay for by having benefits (whether you are like me and pay for them out-of-pocket or you are on a company plan).

I urge you to take a few minutes out of your hectic day to go over your explanation of benefits. While it may seem like only a few dollars, it all adds up in the end. If 4,000 people aren’t refunded their $10 co-pay, that’s $40,000 lost to working Americans. And we all could use an extra few buck in our pockets, couldn’t we?

How the Economic Crisis Changed my Marriage

I am one of millions of Americans dealing with the unemployment crisis, only I have not lost my job. Recently, my husband lost his job and our world has dramatically changed. Not so much because we are changing the way we operate our finances or dealing with new health insurance carriers, and all that goes along with a job loss, but our roles in our marriage have taken a drastic leap.

I am a media junkie. I work in public relations so maybe that is why I am constantly glued to all things news. Whether I am watching local or cable news, reading the paper or surfing the net, I am always plugged in. But in all the coverage on this unemployment crisis, I have seen nothing about the changing roles in marriages that take affect when a man loses his job.

My husband was the promotions director for the number one classic rock station in New York City . He worked there for 10 years; a third of his life. Working his way up the ladder, he met celebrities, went to hundreds of concerts and received lots of perks, but worked harder than anyone I knew. He had survived layoffs at this company before, but this time, it was a massacre. Nearly 90 people from his New York office were let go and over 1,800 nationwide.

Having lost jobs myself, I knew what my husband was about to experience. There would be many ups and downs, a roller coaster of emotions were awaiting him. He would soon feel angry, depressed, lost, alone, invaluable, scared; the list goes on. Anyone who has lost a job, no matter what the reason, knows what I am talking about.

When my husband called me to tell me he had lost his job, I ended up taking a personal day and left my own job to be with him. While he didn’t ask me to, I knew that he would not know what to do with himself after things slowly started to settle in.

I helped him sign up for unemployment and contact his now former employer about his contract and bonuses he had yet to receive. I made him lunch and stroked his hair and told him everything would be alright. I also told him that he’d have to be patient as he started looking for a new job. Forget the fact that it’s hard enough to find a new job, but in this economy, with this many people out of work, especially in the New York City market, there were a lot of odds stacked against him. My husband has a lot of patience with me and for friends and family, but when it comes to personal goals and ambition, he becomes restless quite quickly.

Aside from all the sadness and anger about losing his job, we also came to the realization that we would be losing a home that we were in the middle of purchasing. We had been approved for a mortgage, our bid had been accepted and we were in the process of setting up the inspection when this all happened. We knew we had to throw in the towel on our dream home when there was only one income supporting us, despite a severance package. I was fine with this, as I was not 100% ready to move, but it broke my husband’s heart in a million different pieces that this was happening at the same time that he lost his job.

I hate to admit it, but I am a bit of a needy person. I don’t handle being sick very well or making decisions on my own. While I like to think I am an independent woman, I do depend on my husband for so much. Suddenly, I had to step up and be this entire support system, something that my husband had never needed in this fashion. Don’t get me wrong, I have been there for him whenever he has needed me, but usually, I need him more than he needs me. Not only did I have to help him, I had to deal with my own emotions and fears about my husband, the breadwinner, the rock of our unit, losing his job and how that would affect us.

It’s been a roller coaster for us both, but I can’t share my peaks and valleys with him right now; not that he wouldn’t be open to hearing what is on my mind, but I don’t want to add that stress to his plate. He is up at 7:00 a.m. every morning looking for jobs, even on weekends! One Sunday morning, I told him, “It’s Sunday, a day of rest, give yourself a break!” It breaks my heart knowing what he is going through as a person and as a man; a man who feels he should be supporting his wife through a paycheck and not unemployment. Don’t even get me started on that one!

It has been more than an emotional ride that I have taken through this whole transition, and that is what I think people forget when they talk about this economic crisis. We hear about the families and how they may not be able to put food on their tables or the educations that may suffer. There is constant chatter about struggling two income families not being able to make ends meet to pay the rent or car insurance, but no one talks about the generation who doesn’t have children to feed or put through school, but still has the same challenges and struggles. I am one of those people.

Since my husband lost his job, I feel I have lost a part of him. A piece of his spirit is gone. And while that may not make a great news story on CNN next to the family who can’t buy milk and eggs for their family of six, it makes headlines in my house. I also have lost things through this life change. I used to relish in my time alone. My husband may have worked late or had an event or went out with friends or colleagues after a long day and I had some “Michelle Time” as I like to call it. There is less “Michelle Time” these days. I would never tell my husband that, because he spends his days looking for work and then looking forward to me coming home. He spends most of his days in front of a computer or on the phone; networking, emailing, job searching. Sometimes I want to come home and just do some personal things on my own and I feel a sense of obligation to be with him since he has been alone all day. We are no longer playing on an equal playing field and sadly, it’s not by choice.

I know my husband will find a job, and while it might take longer than he would like, it will likely be better than his previous gig. I know we will find a house when the time is right and it will be even greater than the one we originally found. This job loss won’t define us, but it will help us learn more about each other and grow stronger. It would just be nice if mainstream America and the media remembered that there are others who have been affected by this terrible economic downturn in our country.