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blue dragon


Or, Marie's adventures in learning what it means to be among the millions of uninsured.

On the evening of November 18th I was running through the house with my puppy.  I stepped on one of those little throw rugs that didn't have a sufficient rubber matting on the back, and it slipped out from under me.  I kind of windmilled for a few feet, and then performed acrobatics to avoid an antique wooden rocking chair as I went down.  I twisted as I fell, and landed on my left knee and arm.  My first thought, other than OW!, was "I don't have insurance.  What am I going to do?"

I had been fully insured through the end of September.  I lost my job due to a wave of layoffs at my company.  I ran out the COBRA, and when I had to start buying my own insurance I discovered that in the state of PA there's only one company obligated to sell to people with pre-existing conditions (a Blue Cross/Blue Shield division).  But they kept raising and raising the premiums, and by October I could just not afford $713 a month.  So 7 weeks after I had to let it lapse, I was injured.


So I didn't go to the ER, because I knew that if they found out that nothing was broken and my visit couldn't be classified as an emergency, I'd be hit with horrific expenses.  The next day I went to a clinic that just opened here to treat the under- and uninsured.  Even though the knee was swollen and leg was painful and I was completely non-weight bearing, the doctor didn't think my knee or leg was broken.  (He was able to palpate things without me screaming, and move my kneecap without any problem).  So we ended up with it wrapped in a wide Ace bandage, keeping it elevated, and taking Percocet. 

On the 25th I was back in to see the doctor, because there was still a lot of pain, swelling, and I was still non-weight bearing.  (Somewhere around this point the case manager at the clinic started the application for me to get emergency approval for Medical Assistance - Medicaid - to cover the costs of all this.)  He sent me to an orthopedic office that supposedly had a deal worked out with his clinic to treat their patients.  The doctor there looked at it briefly and said I needed to go to the hospital for X-rays.  (Which is a whole other issue -- the understanding with the clinic had been that any necessary X-rays would be done at the ortho's office, so there wouldn't be a charge.  But I was there at the end of their day, and I truly feel they just didn't want to be bothered to run the equipment.) 

So I headed off to the hospital.  (Every trip in and out of the car is a nightmare for me, and involves my mother having to pull up, go in and get a wheelchair, wheeling me in, then parking the car and coming back to me.  Mom's 68.  She's getting tired.)  The hospital informed me that they'd give me a 20% discount because I was "self-paying," but that I needed to hand over half of the money up front before they could treat me.  The girl was new and guessed at the cost based on an X-ray she'd processed a few days before, and they told me my charge would be $82.  So I paid the money, and waited, and was X-rayed, and waited while their doctor looked at them, and then waited while they called the orthopedic surgeon attached to the office that had sent me, who just happened to be in the hospital.  He announced that I have a broken tibial plateau.  It looks like there's 2 fractures running down the bone.  There's also a chunk of bone where it shouldn't be.  So I need surgery, including screws and a bone graft from my hip, to fix it.  He'd see me the next day (the 26th) in his office.

The morning of the 26th, literally as my head was hanging over the sink and Mom was helping wash my hair, the phone rang.  The orthopedic office wouldn't see me until my Medicaid was approved, unless I could hand over a $250 down payment, which would eventually be reimbursed.  I couldn't.  So I waited, making lots of phone calls and more office visits to the case manager, for the Medicaid to get approved.  The approval process ran into Thanksgiving weekend, which slowed things down a bit. 

Then I got a call on 12/3 from the hospital business office, telling me they'd made a mistake when billing my knee X-rays, and I really owe another $500 dollars.  If the Medicaid got approved, and was retro-acted to a date prior to the X-rays, I'd be in the clear.  Other than that, I'd owe the money.

12/4 I got the call that the Medicaid had been approved, dated back to 11/1 (so yeah! the X-rays are paid for) and oh yeah, get in to see the orthopedic guy that afternoon.  He went over the X-rays with me, and talked about the surgery, and his staff had me fill out a lot of forms.  They also X-rayed my ankle, elbow, and wrist, because by now my arm is so sore I have very little mobility.  It's most likely a tendonitis caused by using a walker when I get out of the wheelchair, and from heaving myself around to spare my knee. They also decided that they needed medical releases from some of my specialists before I could have surgery.  They decided this late on Thursday, for a surgery scheduled for Monday 12/8.  So this morning I had to go to one office for them to sign off.  This afternoon I went for a CAT scan.  (The other two specialists are currently balking at signing off on the releases, saying it's been too long since I was in the office.  I had cancelled the October appointments due to the lack of insurance.)  So Monday morning I go to the hospital at 9 for pre-admission testing, and we're hoping the extra bloodwork added to the lab tests will be enough to placate the two remaining specialists.  The surgery is scheduled for 12:30, so they need to get everything approved and wrapped up by then. 

So the injury happened on 11/18, and the surgery is set for 12/8.  One day shy of three weeks after the injury occurred.  I've been here in pain, with only an Ace bandage around a broken knee, for almost three weeks now.  I've had insurance coverage all my life, other than this past October and November.  And this has been a hideous introduction to what so many other people have been dealing with. 

The costs of health care and medications in this country are obscene.  Everyone seems to agree, but  no one seems to be able to do anything about it.