Followup - State of Health

Well it appears the sickness at my daughter's elementary school is subsiding.  Keeping the kids home for 48 hours when sick and having disinfected the school helps a lot.  But, boy a few kids sure have been hit hard.  I feel sorry for them since they will have missed a lot of school.

I can remember when during my first year of high school I went on an over night camping trip with my scout troop.  It was to a special location on the marine base in California that the scouts have access to.  On top of bringing a not so good sleeping bag, the temperatures at night got very low.  I came home and had to stay out of school for a week with pneumonia or bronchitis.  Not fun.  I missed a lot of semester finals and it hurt me a bit.

But, what I'd like to talk about is the over lapping insurance coverage and the like. The issues associated with contracted plans and the like.

My daughter due to her genetic condition and associated orthopedic condition has been going to the local Children's hospital for some years now.  Recently due to changes in the insurance she ended up going from a EPO to an HMO and getting dumped in with a new primary care physician who frankly from our one and only visit has no bedside manner.  But, what is causing the most trouble is the fact that the "medical group"  is not contracted with the local Children's hospital and thus we are ending up with some bills we did not expect.  But, due to overlapping coverage there seems to be some confusion as to why these bills are coming up in the first place.

When my daughter broke her leg for the first time we were investigated by social services.  It was a long day to resolve things and be cleared.  They though I guess that we were abusing her or something of that nature.  And at that point she had not even been diagnosed with her Neurofibromatosis (NF), by the way NF is not Elephant Man's disease, just the pseudoarthrosis in her right tibia.  In the end the county placed her on something called CSS or California children's services.  This was helpful when it came to her surgery a little less then one year later.  They covered everything and we really have no idea what it cost.






So since this insurance was provided to deal with her chronic issues with her leg we thought it would cover even her follow-up care and all the resulting further annual, semi-annual and in between visit to the orthopedist and the radiology department for X-rays.
Since we were never really total a whole lot about what this CSS was really covering we are now at a loss to under stand the bills.  And the people at children's hospital simply say - "that 'medical group' is not contracted with us and for that reason they are not covering everything."  So they recommend when making any changes to make sure that the new primary care physician and his 'medical group' are contract with the hospital.  And pay the bill so it will not ruin your credit.

First off it is hard as heck to find a good doctor, one you can trust and feel comfortable with and then you find out they are not fully covered etc.  But since we have this overlapping insurance thing it make it even harder.  Did they not bill the right people?  Are we mistaken about the coverage?   These and many more questions we do not have answers for.  And when my wife calls to get answers it is always so muddied.  For the longest time they could not provide and accurate up to date list of doctors we could choose from as primary care physicians.   When things changed from EPO to HMO it all went to pot.  And the worse part was that some thought the change had already gone through while others saw that it had not so it made matters even worse.  No one seemed to have the most current up to date information and for the longest time in the transition period my daughter really had not doctor to go to.  The old very wonderful pediatrician was out and the new doctor had not been identified as of yet.  What a mess.    And much of this due to the fact that the state was not paying the bills in a timely manner.  Many good doctors quit dealing with them as it was such a hassle.


So as I've heard one - medical bills and the such are one the biggest causes of middle class families going bankrupt.

So as the various parts of Obama care go into effect let's see if it help.  The interesting part is that they need the young healthy people that rarely see a doctor in the program to balance out those that are over 65 and seeing the doctor 2-3 a week in some cases and needing heavy amounts of medications or multiple surgeries.




So hopefully some of these changes will make things easier to understand and less confusing and provide in the long term better care..... we need choices that will not break the bank.  Unfortunately, I don't see any just around the corner.

And then maybe we will end up with a system similar to what they have in Brazil.  Everyone pays into the system kind of like medicare taxes and then they all have access to the government run system of health care.  At times you might have to wait in a mile long line to get treated and having a surgery is another issues all together but, everyone is covered.  You want better care, quicker care you usually go to a private clinic and use insurance you paid yourself.  So it does not help for the guys in the middle.   The ones that are currently being squeezed in our system.



We may never win since every system has it downfalls.  Pray we just end up with one that that is better then what we have and has less problems or draw backs.  But, then again the life choices of some people can have a big effect on how healthy we are.

Buaidh - NO - Bas