Not That I'm Bitter

MDIPA is my health insurance company. More specifically, they are the cretins responsible for the tortuous system of paperwork and long hold times on the phone and changing rules that I have to navigate to get health care, more commonly referred to as an "HMO." I would not recommend dealing with them in any way, though the cheap premiums look appealing at first. Believe me, you will pay for them in other ways.

Specialist Referrals

It's a pretty common feature of HMOs to force you to get referrals to specialists from your primary care physician. This means that no matter what your problem is, you have to start with your regular doctor. Which means that if you need a specialist, you actually have to make two doctor's appointments, instead of just one. Let's say you need a podiatrist. Here's the steps you would follow:

1. Call your doctor and get squeezed into her schedule, probably at least two or three weeks later.
2. Use some of your sick leave to go to the doctor.
3. At the doctor's office, wait an hour to see the doctor.
4. Spend five minutes with the doctor, and receive a diagnosis that ends with being told you need to see a podiatrist.
5. Call the podiatrist's office and get squeezed into his schedule, probably at least two or three weeks later.
6. Use some of your sick leave to go to your appointment, making sure to bring your referral form.
7. Spend a couple hours in the waiting room, filling out paperwork.
8. Spend two minutes with the podiatrist, who concludes you need surgery.
9. Enter the ninth circle of hell.

Does this sound like an efficient process to you?

Weird Acronyms and Nonsensical Rules

The worst surprises always come at the worst times--when you encounter a health issue you've never dealt with before, and therefore need unusual health procedures. Like, say, X-rays.

Continuing our previous story, your podiatrist has concluded that you need surgery. But first, you need X-rays. Let's examine the carefully thought-out steps that getting X-rays involves under MDIPA's brilliant system:

1. The doctor decides you need X-rays.
2. The doctor sends someone to look up what X-ray facilities nearby are covered by your insurance, since the ones right down the hall in the hospital building are not covered by your insurance.
3. Find a place several blocks away that is covered, and walk there (on your bad foot that needs surgery).
4. Enjoy the irony on your walk over.
5. Arrive at the radiology center, and spend some time in the waiting room, filling out forms.
6. Get called up to the nurse's station only to be told that your insurance will not be covering your X-rays at this facility, even though they accept your insurance.
7. Call MDIPA in a confused rage.
8. Find out that they do, indeed, cover X-rays at this facility, but not for you. (Not joking.) They assign everyone an X-ray zone, which you can find clearly marked in strange acronyms at the bottom of your insurance card, that is based on the area your primary care physician is located in. As it turns out, they force different people to get X-rays in different places, even though those people have the same plan and pay the same money and work at the same institution.
9. Realize that despite having spent half a day (and half a day of sick leave) trying to get medical care, you are going to have to make an appointment and drive somewhere else entirely, on another day, just to get your X-rays taken care of, even though you are standing in the lobby of a radiology facility that is covered by your insurance company (just not for you).
10. Scream and swear to yourself that you are going to switch to Blue Cross/Blue Shield at the next opportunity.

The Last Straw

So, after the whole fiasco is finally over, you get your surgery. And since it's an HMO, it's pretty cheap, and you realize that despite all the shit they put you through, at least it's not expensive like a more convenient and sane plan would be. You've found the silver lining on the cloud of poorly managed health care: at least it doesn't cost much.

Or so you believe, anyway. When your opportunity to switch to BC/BS comes up at the new year, you spend some time trying to comprehend various insurance plans and give up in frustration, pretty sure that no matter which choice you pick you're screwed. So you decide to stick with the evil you know: it's cheap and you don't intend to need any more major medical procedures for awhile.

Here are the steps you will go through to find out that you made the wrong decision:

1. Go to the drugstore to get the same prescription you've been getting for years.
2. Find out that your insurance company will no longer let you pick up a 90 day supply of it, and will only pay for a 30 day supply.
3. Realize that this means that you will not only have to visit the pharmacy 3 times as often, but also pay 3 times as much for your co-pay.
4. When paying for your medicine, notice that the co-pay is now $40 instead of $20.
5. Notice that your medicine costs only about $43.05 total, meaning your insurance is only paying about $3 now.
6. Call your insurance company in a confused rage.
7. Get transferred to a third party, who tells you that you need to call the number you called originally, but also explains that prescriptions have now been reclassified so instead of all of them costing the same, brand names cost more than others.
8. Realize that your prescription is a brand name and there is no generic version in existence.
9. Do a little math and realize that a year of medication will now cost you $480 instead of $80.
10. Realize that your shitty-but-cheap plan is no longer cheap.

So that's the story of MDIPA and their amazing system of "managed" health care. The purpose of this system is to keep costs down by ensuring that you cannot get health care unless you are dead.

Blue Cross/Blue Shield, here I come.

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last updated 3 years ago #