Wednesday, April 7, 2010

Healthcare--No this isn't about the bill.

I was just curious, since all I've ever really known is Tricare (the military healthcare), as to how healthcare issues work for everyone else out there.

Tricare is great---in that it's free and if I'm willing to fight for certian things, then I can manage to navigate the red tape, push for a referral or prescription, and get what I need done. question is, how does your healthcare work?

If you need to see the Ob, do you have to go get a positive blood test from the lab, see your primary care doctor, get them to write you a referral, call you insurance and find a list of OB's who accept your insurance, insure/inform your primary care doctor of who you want to see, and then finally call the OB to make the appointment (upon which you must bring a copy of your referral that you will get in the mail about two weeks after it's submitted?).

Or perhaps you need a medication, Do you have to call your main pharmacy and see if they can fill it (the base in my case, which couldn't) and then are directed to your insurance company, do you have to contact your insurance (who will then send you to an off shoot branch who is contracted out to deal with pharamacutical information), contact the contracted company who tells you to try Walgreens, which can't do it, then have walgreens attempt to have the contract pharmacy who directed you to Walgreens fill your prescription, get a rejection letter WITHOUT the prescription attached advising you to find a local pharamacy but never stating which one, find a pharmacy that accepts your insurance on your own, contact that pharmacy and see if they in turn can fill said prescription. Find one that does fill said prescription and get AMAZING service (I LOVE WHEN CAPITALISM WORKS, people who want your business, like civilian or private pharmacy's go out of their way to get it!), get your prescription, but realize that you are charged the FULL AMOUNT and not your general $3 copay. Call insurance, get directed to contract company, call contract company, get told it was never filed, call pharmacy, they did file and gladly refile (with a smile I'm sure), call contract company, get told it was due to the pharmacy's improper entry into the system (you couldn't tell me that the first time?), call pharmacy and give them contract company's number and hope for the best.

Have a headache yet? No more minutes left on your cell?

Is this just something military families deal with or is it this difficult for those of you in the "real world"? And I did simplify the above events for your mental sanity.


Debbie said...

I have always seen Tricare or the military to be like the HMO's such as Group Health.

Our insurance is neither and no I do not need a referal from my Dr to see an OB, OB's are considered to be Primary Drs like Pediatricians. We do need referals for other specialists, but the only time our insurance company would ever not permit a service would be if it is not medically necessary. That would be more like cosmetic surgery unless it is after an injury. Prescriptions are easy, we can use most any pharmacy we desire and they really do all the work for us, we just call the pharmacy once the initial prescription has been called in. We do have co-pays, and some procedures fall under a 20% out of our pocket.

I just wanted to make one little comment, I have a hang up and this is nothing against your post, but no medical is free in our country, not even the military when we consider the lives that have been lost so that all our military families can have this medical coverage. Point in hand that is what fears me the most about the health care reform, at what cost?

Brandie said...

Absolutely Debbie. Nothing is ever "really" free, but most of society views it as so (speaking of Tricare). I was just curious (mostly because I don't know how any other system) how the "real" world works. I sometimes think I'd much rather pay more and have half the red tape!

Thank you for being so open, I sometimes feel like I shouldn't complain because we have "good" healthcare, but other times I wonder if it's really "good" or just it's all I know.

Debbie said...

I know what you mean, believe me. I have had insurance where we have had to go through all that red tape as well. That is where I brought up the HMO. Sure we pay fairly high premiums but I sometimes think we are paying for less red tape.

It's hard to know what the other side of the spectrum does and does not have unless we ask. We are lucky to have the medical we have, we've had better believe me, where our coverage was as close to 100% with no red tape as you can get without being a high ranking senator or president.

I suppose sometimes we have to realize we are lucky to just have the comfort in knowing that we have coverage at all.