My Experience With the American Health System...

Let me preface the upcoming rant by saying I love America and its people, everyone I have encountered during the following experience were, nice, pleasant people. It may not be these people that are at fault, it is the system. The US health care and insurance system is CRAZY. Add onto that my own company's HR department incompetency and you have a hot mess of confusion for an expat.

I earn a good wage, I work for a very big corporate company and I have, what I am told by other Americans, '"very good" health insurance. 

Coming from the UK it's all very complicated. When I first came over to the US, I signed up to my companies insurance scheme provided by United Healthcare. I was told it was going to be $200 a month to insure me and my wife. Not bad I thought, if that's what it takes to avoid the crazy prices for drugs and care here. There was a lot of documentation that came with it and about 3 different websites, 1 of which I had to take a short Health Risk Assessment for and sign up to 1 other program to be eligible for an improved insurance deal called the Advantage PPO. I chose to do a "Health Coach" program which involved me speaking to a person over the phone once a month about how much exercise I had done and how I was definitely going to do more next month. Either way it ticked the boxes and I got a better insurance deal for some strange reason. The deal mentioned deductibles, out of pocket costs, in network and out network. I didn't understand any of that. I spoke to colleagues, read documentation and thought I had a basic grasp of it eventually.

My first doctors trip was last year and it was just to get a new asthma inhaler. Surprise no.1, I had to pay $25 just to see a doctor - this is called a co-pay and is pretty much standard I found out later. I waited about 45 mins to get in & he asked a few questions took a few tests and then prescribed a few different inhalers for me to try. Pretty much a standard doctors visit. I trundled on down to the pharmacy to pick up my prescription and showed them my Health Insurance card.  After checking their system I was told my insurance doesn't cover prescriptions. "Are you sure? I asked - I have a very good insurance program, or so I'm told". He was sure and was about to charge me $100 + for an asthma inhaler, I said I'd pass and stormed off to talk to my insurance provider.

Surprise no.2., my main insurance didn't cover prescriptions; however, I had another company who covered prescriptions (I found out after hours on the phone to our useless HR) and the card / details had gotten lost in the post. They had another website I needed to register with, so that's 4 websites now and three different companies to deal with my various insurance (I haven't even dared find out about dental yet! That's different too!).

While these two things were annoying and very confusing apart from a few other admin errors in my first year, financially it wasn't THAT bad, a few $25 fees here and there to see the doc and that's it.

This year that changed. I wanted to join the gym at work - it's $10 / month and is pretty new so I went and did a Health Risk Assessment again (a pre-requisite every year), as I had asthma they said they'd need a doctor's approval. OK I thought, I'll give the boy a call, fax it through he'll sign it off and bingo I'll be lifting weights in no time.

No such luck, he asked to see me. Fair enough, I thought, he's thorough and doesn't have my full life's medical history. I went there expecting to be charged the usual $25 but as it was my 1st visit of the year I apparently qualify for a FREE full body check up! Sweet! This time I waited about an hour, I walked into the office handed him my consent form to sign and said I just want to join the gym, I haven't suffered from asthma in months and its pretty much under control. Just sign it and I will be out of here! Nope. We did the full body check up. I wont go into detail but lets just say he was very *cough* *cough* thorough. It took over an hour, a little excessive I thought just to get sign off for asthma at the gym. All the tests were done and I passed with flying colours, fit boy! I asked for his signature on my consent form, but he said he needed to wait for the blood results to come back, so to come back and see him next week.

I did just that, next week I returned and waited another HOUR AND A HALF, all blood results came back good so I thought I was good to go. Then he said that there was something in my EKG that he'd like to investigate further, it was probably nothing, in fact it was, and I quote, "99.9% of the time" nothing, especially for men my age and fitness level. OK, I like those odds, but what was it that he wanted me to do? "I'll refer you to a heart specialist, just to be sure".

Two weeks later I arrive at the heart specialists and sat in the waiting room, which can hold about 40 people. I was number 30, approximately. I looked around at my audience, they didn't look happy. They were hot and frustrated. After half an hour an old man dressed as a sailor (?) got up and started angrily gesturing something in Spanish to the lady behind the desk, he turned round to the room as if to get some support and thats what he got, more grumbles in spanish I didnt understand, but I got the gist, people had been waiting a while. Another half hour passed and I was starting to get very annoyed with the infomercial i'd seen for the 10th time and the recurring local news items. I'd also had to jump to the aid of at least 3 old people who had walked in and barely been able to walk the 10ft from the door to the desk without collapsing. This was not a healthy room and being the youngest person in there by a good 40 years and the only one who could walk without falling down I was made an honorary member of the emergency staff for the time I was sat waiting. An hour and half passes and I get up and ask whats going on, "oh you're next sir" I was told and sure enough I was moved inside to another room where I was told I was going to have a heart scan, another EKG (despite the last one being just 2 weeks ago), blood pressure test and a stress test. I asked how long that would take, she said "about an hour and a half." WHAT? Why?! Its just how long it takes to see all those people for all those tests. I said I couldnt afford another hour and a half off work so is there a way I could do some now and the rest of the tests at a later date. We agreed that was a good compromise and I reluctantly made another booking for the week after for my stress test and scan.

The next week I slip out of work again (no evening time scheduling) and open the door to the waiting room, to my horror its even busier than the last time. Arrrrrrrrrrrrgggh!! People are talking amongst themselves relaying their own horror of how long they waited today, its a far more vocal crowd than last week but thankfully the TV was off so I didnt have to sit through the local news....

2 HOURS I WAITED THERE.

It was so long I had to go and move my car cos I had a 2 hour park limit. When I was finally called in I was in a hideous mood, they did a scan of my heart and I can only imagine that it was bursting out my chest from sheer anger, they put me in another shitty room while they got the next test ready and 15mins later I was hooked up with wires attached to my chest and on a treadmill running. This was the stress test. I ran for 20mins at increasing levels of speed and by the end I was pretty tired. At least it was over though. The doctor came in with my list of results (about as long as his arm) and declared I am completely fit. There is nothing wrong with you, in fact you are in very good health. Great news, anyone else would be happy with that news Im sure, I wasnt, I knew all along I was fine, but the great American health service had just earnt themselves a few thousand dollars from my insurers for getting me to jump through their hoops all because I wanted a signature to join the gym.

I couldnt help but feel like I was taken advantage of by my need for a signature.

But thats not where my story ends. You'll notice that I didnt mention costs during the heart specialists appt, thats because at no stage of any of my appointments with the doctor or my heart specialist were costs mentioned, I was not given options as to whether I would like a) b) or c) tests and this is the cost YOU will incur for each, I was not told that my insurer would only cover PART of any costs, In fact the only cost that was mentioned in the total of my EIGHT hours in "care" was that my physical was free.

I therefore naively thought i have very good insurance, im sure they'll cover it. Boy, was I wrong.

About a month after, I got a confusing bill from the heart specialist, it seemed to total up something like $3000 of tests and said that my insurance paid for some of it but $150 is due by me. I didnt really believe that, so looked online at one of my several websites as I thought that I would be covered somehow, maybe in a savings acct or something, or something to do with a deductible (still not really sure what that was). I noticed while doing that though that my deductible was now $1000, I seem to remember that being $500 last year. I looked further into it and after further investigation I realised that I was no longer on the Advantage PPO - the better insurance plan, I was, in fact, paying more / month for a worse plan. I still havent figured out the extent of how worse this plan is, all I know it costs me $40 / month more, my deductible has doubled and it doesnt appear to cover all of the tests I had for my heart.

I couldve swore I jumped through those hoops which allowed me to get onto this better insurance plan though. Hoops that are put there by my own companies HR btw. I hadnt been told at any point that I had been downgraded, nor had I been told that I COULD be downgraded. I called up HR and they put me through to one of the companies that runs one of the websites that are something to do with health. They said they had no record of me doing the health coach course or the assessment. I claimed that I had, and I had proof of the calls, but no proof of the assessment but Im sure they could get it up on their system. "Actually sir, the company that did the assessments last year was not us, your company chose a different provider last year". I then went on another round of different help desk calls to find out who it was that did do the health assessment last year and eventually got told of another company whose website I did have access to at some point which now no longer exists. I emailed the company in question and as of right now I have never heard back from them. So Im stuck on the Standard PPO shitty insurance for the remainder of 2013.

I called up the heart specialist to pay my debt;
"would you like to pay all your bill sir?"
- Sure, $150 wasnt it?
"Actually no Sir, its $550"
- Errrr, what?

Apparently I had not received the 2nd bill for an additional $400 which my insurer had originally said they would pay and then decided actually no, they dont want to.

By this point, I wanted to cry. I dont even LIKE going to the gym and its cost me HOURS of frustration, confusion and anger and now its going to leave me $550 out of pocket for a non-existent health issue.

It shouldnt be me thats crying though, America - you are being robbed on every level by your country, its the most corrupt, unfair public service I have ever had the misfortune to experience. When people diss the British national health service, they throw back stuff like "long wait times", "Poor quality service" "Dirty hospitals". The fact is I experienced all these things in America and I pay a HELL of a lot more for it here than I do on the NHS. The NHS wouldnt send me around the houses to get a gym signature, they only treat people that really need treating cos they're not making money by treating non-existent illnesses like in America and they dont have the resources to mess about like they do here.

If you live in Britain and you dont like the NHS - firstly, at least the NHS is your base level, you can pay to get better service on private health. Secondly, spend some time in the US and you wont say a bad word about our system ever again.


UPDATE

So, the saga continues, I had the above written for a while and never got round to posting until today when I got a mail from my useless HR / Health affiliate program through work. It said this "Advantage PPO eligibility extended to July 31st for 2014."

Now, "extended", gives the impression that there was a deadline to begin with that we were all aware of. I was not. This was the first I had heard of the deadline and the hoops I had to jump through to qualify again for the better insurance plan. Reading further, there were only 3 things that were possible to do now that you had enough time to complete before the deadline:
- Health Risk Assessment
- Physical Examination
- Biometric Examination

You have to have all these completed by 30th June and sent to X company so they have time to process it for the 31st July, so it wasnt really an extension for US, it was just an extension for them!!

I was apoplectic with rage, NO WAY was I getting put on the shitty insurance scheme again because of their complete lack of communication. I clicked the link to go through to ANOTHER different website and registered with this one. I swear this is the 5th different website to do with my health / benefits I have access to and I have no clue what each of them are for, there isnt 1 company that has an overview of everything, my company certainly doesnt and it would explain why I never hear about anything Im supposed to. I completed my HRA and it knew I had a physical this year (so some systems must talk to each other). So now I just have to get a Biometric Test and send off the results by next friday and Im in the exclusive club.

Wish me luck.

Ending note.

The sad thing is, my experience and rage is nothing compared to the millions of Americans who cant afford basic insurance, or those that can afford it, but still end up facing bankruptcy because their medical bills AFTER insurance are too much for them to afford. This is not a system for a developed country. Its broken and corrupt and it needs fixing.