Thursday, June 23, 2011

Leaping

Last month was open enrollment at work.  If you wanted to change insurance plans, that was the time to do it.

I have had the same insurance for 15 years.  Corey has been with the same pediatrician 16 years (plus one year with the doctor who retired from there).  I love the pediatrician.  Love him.  And his wife, who was also Corey's pediatrician at one point.  And his staff, most of whom I've known since they were interns or fresh from training.

I really like my OB.  I guess since having my tubes tied, he's really just a GYN for me, but that's not how I think of him.  Naked hugs and differing views on prenatal testing, circumcision and vaccinations aside, that little old man never fails to make me smile when I see him.

I even like my general practitioner.  I don't care for his front office people, but he and his physician assistant have given very good care to me and all of my local parents.

Then why even contemplate switching?

Because it took three weeks to get a referral for Mad to see a neurologist after having what we're all pretty sure was a seizure at her birthday party.  When the pediatrician sent the request to our medical group, it was marked URGENT!  Maybe it was written in some special ink that only we could see, because it was only urgent to us.

When we did receive the referral, it had a doctor's name, but no contact information.  At all.

We asked our ped (Mad calls him Dr. Present) for help (we had an appointment with him the same day) and his assistant was able to track down the doctor.  We saw her fax the referral and Mad's file to the neuro's office, again marked URGENT!  But again, it was only urgent to us.  We were told to wait for someone to call us the next day to schedule the appointment.

When no call came, Tom called them.  They hadn't received the referral and wouldn't discuss anything until they received it.  They would call when they had it.

Dr. Present's office re-faxed it.

Again Tom had to call them.

They had everything, but it would take a week to review Mad's file.  It had already been a few days, so we should hear from them in a few more.  They wouldn't schedule an appointment during this call because May was booked solid.  So was June.  And it was too soon to start scheduling July.  They'd call us when they were ready.

At two other appointments (Fynn gets vaccinated monthly instead of the standard schedule, so we've been there a lot), Dr. Present had someone call and see if they could move things along.  They couldn't.

Despite all of this, we hemmed and hawed about switching.  This wasn't from one (sub)standard HMO to another; this was Blue Cross to Kaiser.  If you're not from these parts, Kaiser is a whole different insurance beast.

I was born at Kaiser.  Like a lot of stories about Kaiser from back in the day, my birth story often ends with "and yet we lived."

But the newer stories, say in the past five years, are overwhelmingly positive.  After questioning every Kaiser patient within our circle, we made the decision to switch.

I am going to miss Dr. Present and his staff tremendously.  Where else will I be able to walk in with Fynnie Fynn and have someone ask about Corey?

We are eight days from becoming Kaiser patients.  Corey and Madelyn need to be seen right away.  I called to see if I could get a jump on scheduling.

I could.

Mad will see her new pediatrician in twelve days and we should be able to leave with a referral to a neurologist   We probably won't get our initial consult with the Kaiser neuro as early as we would had we stayed with Blue Cross (yes, that's me rolling my eyes).  The Blue Cross neuro's office called last week and had an appointment available for the middle of July.  Yes, of this year.

Corey's needs will be met around the same time as Mad's.

I did lodge a grievance with Blue Cross.  This is my daughter's brain we're talking about here.  If something is really wrong, we should already be doing something about it, not playing power struggle games with egotistical neurology practices or slow moving medical groups.


After a few surprisingly simple and very helpful calls to Kaiser today, I'm feeling hopeful that this was the correct path for us.

5 comments:

renegademothering said...

She had a seizure? My goodness that is scary. And what fuckers for not getting her in sooner! That's not like a sore throat situation. Unbelievable. I hate insurance companies with wild abandon.

Please keep us updated on the little one.

mama to j and bean said...

Wow! I dare say that neurologist is negligent on not scheduling sooner. I hope you have a (much!) better experience with Kaiser!

JT said...

This is so scary. A seizure! I hope it turns out to be nothing. Insurance woes also terrify me. I got a huge bill (over $10,000) for prenatal testing NOT covered by my insurance. I fought it, and won- didn't have to pay a cent, but my god. I had to fight hard. And not being able to see whatever doctor I want, when I want... makes me crazy. This just illustrates how our medical system is broken, IMO. So infuriating and sweet little Fynnie should NEVER have to wait. Or your other kids. Ugh. Access to quality healthcare is something I feel very passionately about. I'm so sorry you're going through this. Hope Kaiser is better.

Anti-Supermom said...

You always amaze me when you drop a little post in about her having a seizure, like it's *no big deal*! You are one strong woman!

But I hope that you find exactly the place, the right doctor, everything comes into place and you get the answers you need.

Janette105 said...

I just read this, finally. My two cents? I LOVE Kaiser. They're not perfect, but they've come a long way in the past 10 years. I've had them off and on (mostly on) for 20 years. I could not have asked for better care than when I lost Camellia and when the boys were born, again, they were just wonderful. For the Camellia factor alone, I will always appreciate the very kind way we were treated.

I wish you much luck. I know insurances can be a giant pain in the ass!! Sign up for their email. It's so GREAT to be able to email your doctor.

Nettie
xoxo

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