I sent the following account to my representatives (and selected others) today.
This letter is to describe my experience today trying to access health care while on vacation in San Antonio, TX. The reason I believe this anecdote will be of interest is that I think my experience is a microcosm of the ills plaguing health care reform and access in our country.
I am employed at Texas A&M University, and have Scott & White health coverage through my employer. While vacationing with my family in San Antonio, I began to have pain in my eye, and after it grew worse after two days, I decided to see a doctor. I studied Scott & White’s website and then contacted the TAMU Employee Services office as well as Scott & White’s help line and determined that since there were not any network providers in San Antonio, I could be seen at an Emergency Room for $150 or an Urgent Care facility for $40. Armed with this information, I researched Urgent Care facilities in downtown San Antonio. Finally I discovered that Alamo City Medical Group’s 24-Hour Urgent Care facility was just blocks from my hotel. This was especially fortuitous since this was the only Urgent Care facility listed in the downtown area.
I walked to the Riverwalk Urgent Care center, checked in, completed paperwork and had my medical history taken by the nurse before the receptionist informed me that Scott & White wouldn’t pay any benefits for my visit (this despite my working for one of the largest employers in the state of Texas, and Alamo City Medical Group’s brochure claim that “we accept all Major Network Insurances”) and suggested I call Scott & White to locate a clinic that would be covered.
I called Scott & White for the second time, and spoke with another friendly but unhelpful associate, who suggested that I call information to find an Urgent Care facility since Scott & White will accept Urgent Care billing from any clinic. I relayed this information to the Alamo City Medical Group Urgent Care receptionist, who then let me know that they have two different tax IDs, one of which is Urgent Care, the other is Family Practice, and that they are only contracted with certain providers to bill as Urgent Care. Ultimately, I discovered that my options were to pay Alamo City Medical Group’s $140 (minimum) office visit charge or find an ER and pay my $150 copay. I decided to just wait until I get home next week to see a doctor instead.
While this might not be the best decision medically, it is the only one that I felt comfortable making considering my family finances and how I had been treated as a health care consumer. What I discovered was that, even though I have insurance, and even though I did the due diligence necessary to find an appropriate doctor while out of my regular coverage area, the most attractive option offered to me is to visit an Emergency Room.
The national health care debate has highlighted the overuse of Emergency Room medicine for reasons other than medical emergencies. My experience today has underscored that one reason for this is the general availability of the Emergency Room and the relative stability of this definition across insurance providers. My experience today would have been far different if there was some sort of regulation of the term “Urgent Care,” which seems to be loosely used by Alamo City Medical Group when it is in fact a technical term in the medical industry. I would have experienced no issue at all if we instead had a national, single-payer health provider.
I have to admit that in the grand scheme of things, my little malady pales in comparison to the chronic pain and illness that millions in our country suffer every day. These uninsured and underinsured are often the poster children for universal health care, but I hope that my experience helps illuminate the fact that fully-insured Americans stand to benefit from a health care system that is seamless and transparent, too. To that end, I strongly encourage you to fight for a universal, single-payer plan such as the Conyers-Kucinich plan, HR 676. Why an expensive, expansive, and ultimately handicapped plan like HR 3200 is even being considered is beyond me, and suggests that insurance lobbies have more clout than voters. Please consult this beautiful comparison of HR 676 and HR 3200 and fight for health coverage that will benefit all of us.