Elbows and the American Healthcare System

A couple weeks ago I went to an orthopedic specialist to find out what was up with my arm. She had two theories: one was that I had chipped some cartiledge off my elbow and it was floating around in there causing a mechanical blockage. The other was that I’d fractured it very slightly (so slightly that it couldn’t be seen on an XRay). The first possibility would require surgery to repair. The second would require only physical therapy to restore range of motion. Suspecting chipped cartilage she ordered an MRI to confirm it — but not before she stuck 3 needles into my elbow to try and ease the swelling. When nothing changed within a few minutes, she sent me on my way with a referal for the MRI.
ElbowAbout an hour later though (after the pain of 3 giant needles died down) I noticed that I could move my arm a few more degrees than before. At that point, I decided (in all my medical wisdom) to gamble that it could be fixed with physical therapy and started my own regimen of increasing my use of the arm as much as I could take. Each day that I pushed myself brought more flexibility the following day, and more confidence that I’d gambled correctly.

I did try to make an appointment for an MRI but all the dates available were close to the due date and I didn’t want to risk being late for my baby’s birth, so I got scheduled for one on January 22nd. With my daily improvement of useage, I decided I wanted to see the specialist again, to show off my progress and see if it changed her diagnosis at all.

Here I’ll interrupt my story to tell you Canadians some thing I’ve learned about American healthcare — in the form of definitions.

Referral: We have these in Canada, often for discretionary treatments, but they’re nowhere near as important as they are here. You can’t get anything done without a referral in the States — or you can, but you’ll be paying for it out of your pocket. There are rules about how much you can get taken care of without a referral, and everyone just assumes you know what those rules are.

Copay: Apparently only to discourage you from going to see the doctor every time you get a hangnail, a copay is a small sum that your insurance company requires you to pay with each visit. For an isolated incident, it’s usually small enough to only be a nuisance. But after an ER visit ($50) and 4 different doctor’s visits ($25 each) these get pretty annoying.

Primary Care Practitioner: This is the gateway doctor. As far as I can tell, this doctor only exists to treat colds and write referrals. From what I’ve seen, your primary care practitioner practices nearly zero medicine, and will send you to a specialist for almost anything. Nonetheless, this doctor is the originator of almost all referrals (you’re only allowed a single referral from an ER doc) and is therefore very important to the health care system. I went nearly a year without ever meeting the man, but his name is on all our paperwork.

When I attempted to arrange a second appointment with the orthopedic specialist — and even when trying to book my MRI — I found out very fast that if I didn’t figure out American healthcare, I’d be paying a small fortune to get use of my arm back. Once you know how it works, it’s very easy, and man are the doctor’s well equipped (apparently every doctor here has their own XRay machine). But unless you follow the steps in the right order: Primary Care Practitioner, Copay, Referral, Specialist, Copay, Referral, etc… you’re on your own.

At any rate, I did finally jump through all the hoops and get back to the elbow doc. She agreed with my conclusions and, once I provided the copay, gave me a referral to see a Physical Therapist. She was pretty impressed with my self-treatment progress — I’m only missing about 10 degrees of bend and 10 degrees of extension. Enough to hold my baby when it arrives, but not quite enough to be carrying computers around the way I usually do…

Update: Nic reminded me that I forgot to mention the most disconcerting part of the American Healthcare System — the lawyers. Last week we got a very threatening sounding letter in the mail that referenced my accident and talked about recouping costs. Nic wasn’t exactly sure what it meant, but I’d read about this kind of thing online, so I knew pretty quickly what was going on. A friend had already asked if, as a matter of course, I’d be suing the church where I tripped and fell. Such a suggestion is completely foreign and distasteful to me, but apparently it’s not an uncommon way of dealing with medical bills. I explained that our health insurance would cover it, and that I wasn’t eager to take a church to court over my stupidity. I didn’t realise, at first, that our health insurance company would be happy to be that litigious on my behalf.
The letter said that my accident seemed to suggest the responsibility lay with some 3rd party, and would I provide information about that party and the name of the lawyer I’d retained to sue them, so that they could join the suit and recover some of their costs in paying for my healthcare. I, of course, called them and explained that the third party was a curb and assured them that the responsibility lay in my clumsy footwork, and nowhere else. They seemed disappointed, but I understand that they’re obligated to pay my bills anyway.

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