Our daughter’s health insurance

In March, I lost my job. That led to my family losing our health insurance. That led to losing access to our pediatrician. We loved our pediatrician. Her practice is a few blocks from our house. She carries a little knitted basket in the shape of a monkey to hold all her pens and doctor accoutrements.

We debated different plans, called insurers and health sharing ministries, Googled who knows what. We eventually found some new insurance on the government marketplace. That’s the only place we can get insurance now that Christine and I are both self-employed business owners.

Our plan is the second best plan offered by Blue Cross Blue Shield, but it’s an HMO, which means it has very limited selection of coverages and doctors. No plans offered to us covered the hospital system we were a part of with Camille’s care. There are five hospitals within a mile of our house—we live near Medical City Fort Worth—but finding a doctor covered by our insurance is slim pickins.

While we were leaving our last pediatric visit in April, I asked the front desk woman what it would be like to pay directly with cash. “It’s $130 for the visit,” she said, “and about $14 per vaccine.” Okay, we said, that’s doable.

Sometime later I called the front desk to see if we could schedule a visit to get her four-month vaccines. The woman said that the cash option would be around $1,200. What? I asked. “Each vaccine is about $200,” she said.

“I thought they were $14,” I said.

“That’s if you don’t have insurance. The vaccines are provided by the state. But since you already uploaded her new insurance information, we can’t give you that rate.”

“Even though you don’t take our insurance?”

“Right.”

“What does it look like to pay for her next few appointments with cash?” I asked.

She rattled off all the vaccines Camille would get over the next year. Each appointment consists of two to five vaccines every few months, totaling somewhere around $5,000. That’s a lot for something that apparently costs the uninsured a few hundred dollars (which is why we debated not having insurance).

Sometime later I asked if we could see another doctor for her vaccines but continue to see this pediatrician for consultation. The answer was no.

After weeks of searching and several phone calls to insurers and doctors’ offices, we found a new pediatrician. We scheduled an appointment for a few weeks later.

In May, Camille got sick, Christine got sick, and I got sick. My ER visit ended up costing over $2,000 out of pocket (the total bill was $10,000) since we have a 25% coinsurance proviso. I’ve been afraid to go to the doctor ever since.

On Saturday, Camille got sick. We didn’t know what to do. We didn’t have a pediatrician anymore, and our insurance didn’t cover many of the providers around us, namely, a children’s hospital network. It did cover another hospital network close by, but that urgent care office wasn’t open at night and they didn’t specialize in children. We went to our former urgent care anyway and paid cash. No worries, we thought, since we’re going to our new pediatrician Monday.

When we got to her new pediatrician appointment on Monday, the front desk person said two things that frustrated me. First, the doctor we were seeing wasn’t a pediatrician. This was despite the fact that I said I needed a new pediatrician, having explained our situation. Second, we couldn’t see this doctor unless we all switched our primary care physician to this doctor. Both pieces of information would have been helpful weeks ago. We left the office without seeing the doctor.

The next day I called a new pediatrician’s office, and they got us an appointment for next week only after I called our insurer to switch Camille’s PCP to this new doctor. Finally, we got our issues resolved.

Camille’s sick again. Fever. She’s sleeping next to me on Christine. Since we haven’t yet started with our new pediatrician, we’re still calling our old pediatrician’s office. I hope they don’t bill like lawyers.

That’s just the thing. I never have any idea how much care will cost. Even if they do provide a quote, I’m learning there are so many nuances and loopholes that I never know the true cost. Hospitals will tell you one thing, but individual doctors, vendors, and labs cost another, and they bill separately. A letter is bound to unexpectedly show up in the mail.

To be clear, I’ll spend an infinite amount of money to ensure my daughter’s okay. Perhaps medical institutions know that and they therefore charge a higher rate. We’re a captive audience racked with new-parent sweat stains. This is already a terrifying experience, but adding onto that the complexity and uncertainty of American health insurance is a whole new level of anxiety.

I found out this week that we also lost access to our dermatologist. The reason, they say, is that our plan is a QHP, or quality health plan. Just another acronym I now have to pay attention to when selecting a health plan—HMO, PCP, QHP, okie dokie.

I’m not an expert in healthcare or its economics or insurance markets. I believe Americans have among the best healthcare in the world, despite what some aggregate statistics will tell you. But I do know our personal experience dealing with health insurance specifically, and it’s been a nightmare plaguing an already stressful time in our lives.

Alas, in the end, it’s all worth it to see this little dumpling smile.

None of this is a surprise to someone who’s been around a while. I guess this is part of growing up and learning new things, just as Camille’s growing up and learning new things too. Hopefully someone smarter than me will find a way to improve health insurance and outcomes for future generations of Americans, including our stuffy sleepy baby angel.