So I have an ulcer. I dry heave at least once a day and I haven’t eaten in 21 days. (Please do not give me advice, I hate it, I don’t want medical advice from people over the internet. At best, if you do, I’ll respond with a “thanks.”)
I’m in a somewhat smaller town, not really small, about 80,000 people maybe. There is exactly one gastroenterologist in this town. I went to him when I hadn’t eaten in 6 days. For a $50 copay, he said to take some Mylanta along with the Protonix I was already taking and call him in two weeks if I wasn’t better. So I call him yesterday. I talk to the nurse. I tell her all my symptoms, none of which have changed. She sounds very concerned.
I hear nothing all day. This morning, I call again. The doctor hasn’t even gotten to my information. So the nurse sends a message that I called again, which he probably also won’t see.
I have tried to get a second opinion, or just another prescription for something, but there is not a single gastroenterologist within a 90 minute drive that would see me within three months. I’m pretty sure if I don’t eat for three months, I’ll be pretty dead. I mean, I’m living on Ensure and Gatorade, but I doubt that will get me to three more months.
Oh, and this is the second time this has happened. The first time, I had to take a bunch of tests like a CT scan and an X-Ray and a blood panel and they found nothing. I had a scheduled colonoscopy anyway, so they just went down my throat as well and that’s when they found the ulcer. No one even suggested an ulcer before that.
Why am I saying all of this? I’m not even complaining about all of this. I’m complaining about the fact that this has cost me almost $2000 already and I feel lucky because I have good insurance. I’m not poor, but I don’t really have $2000 to spare. I’m paying it off in installments, but god damn, I have to pay all of this money and they have stopped even giving a shit about me.
What would someone in my position without insurance even do? Die? That’s what conservatives fucking want.
We need universal healthcare and a complete overhaul of the healthcare system now.
And any time you hear someone complain about how long a wait you have in Canada or the UK to see someone to help you and how America has the best healthcare system in the world and how people from other countries come here for treatment, send them to this post before telling them to get fucked.
TL;DR No one gives a shit about you in American healthcare except maybe the nurses and all they do is suck money out of your bank account.
OECD data actually puts the USA in the middle of the pack for wait times for specialty care for developed nations. I believe it could largely be solved by companies switching to advanced access/open access scheduling models, but most are too afraid to upend their business model.
Lmk if you have any questions about navigating appointments, I’m actually in grad school studying healthcare business. My only real suggestion at this point is to use your doctor’s electronic portal for communication. In many cases it’s more effective than a phone call, plus you have written records.
I know you said no medical advice, but I’d ask a doc about H Pylori. Always something that should by ruled out in cases like these.
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What would you recommend I do? Because we have very few ideas left.
I live in a city, near a hospital and sort of medical district, so do have easier access geographically than most; also as a legacy of the time when Florida was more rational the insurance has always covered dermatologist, gynecologist, midwife, not just annual visit to GP.
Even so:
Dentist must be scheduled 6 months out.
Dermatologist and almost any specialist 4-5 months wait (basically if you are going each year better to schedule a year ahead of you want to get an appointment).
And cost-wise, the cost in total of insurance and out of pocket cost is batshit insane. Just have to hope nothing happens. Broke my finger, surgery & rehab $5,000. Status migraine, turned away from urgent care, they said I had to go to emergency room, $4,000. If you are designing a system to move money up away from people it’s working as intended.
And on top of the private insurance that only covers anything after I spend thousands of dollars in any given year, we also pay in taxes to cover the sickest and oldest. So insurers are cherry-picking populations. If we had ONE healthcare system it would be cheaper for us. But all my cost is someone’s paycheck and those someones have lobbyists to keep their money coming.
That is awful. I am so sorry squid. I am glad they did find the problem hopefully before things get worse.
Thanks. They found out the problem in July. Now I need them to finally do something about it that works.
My problems aren’t anywhere near as bad as yours, but I’ll add my own complaints to comiserate at least.
My wife is a type 1 diabetic. I have a pre-diabetic A1C (type 2) that i inherited from my mom. My insurance (Blue Cross Blue Shield) claims they cover preventative care. But they refuse to cover our regular A1C tests - it’s not preventative because they already know what you have. As a BCBS support person told me, if they’re throwing spaghetti at the wall, its preventative. If they’re aiming for a spot - it’s no longer considered “preventative”. So thats like $600 - $1000 a year. Chump change compared to many in this thread, I know.
Also, for some reason, they only offer coverage for one type of insulin - novolog - which happens to be the one insulin that causes my wife issues. She’s type-1, so her immune system killed her insulin production at around 5 years old. She’s dependent on insulin to survive and uses an insulin pump. Novalog is less effective than literally every other insulin for her - which means she has to take more - which means more risk of long term problems. This insulin also requires a pre-bolus (basically taking insulin) of 1-2 hours before every meal. That means every meal has to be preplanned and prepared for or she starts a rollercoaster of highs and lows. Humalog, aphidra, fiasp? All work more efficiently and within like 15-30 minutes.
The local HMO my work used before offered tiered options. We could pay a bit more for a better option. I would have no problem paying double to get her Humalog. BCBS says no. Novalog or pay out of pocket.
I have occasional headaches that start in the back of my neck that turn into bouts of depression followed by mania a few days later. My neurologist wanted to do a full MRI panel to look for issues. Insurance denies it - medically unnecessary. The neurologist appeals and they’re like “fine fine, but we’ll only cover the head, not the neck” even though the pain started from my neck. They don’t find anything in the head. So the neurologist says, “well unless you want to pay out of pocket, we can’t check the source so…assume it’s just migranes?”
Oh and by “cover”, I mean they paid a small part of it. It still cost me $1,500 to do the ones that were “covered”.
That’s a smattering of the interactions I’ve had with my insurance that I can remember right now.
My parents are retired and on medicare. They pay far less and get way better medical care than I do with one of the biggest private insurance chains in the country. Go figure.
I’m really sorry to hear all of that. It’s ridiculous how expensive insulin can be. It’s not that expensive in other countries.
Thank for your sympathy, friend.
What’s hilarious is that the government recently passed legislation to cap the cost of most formularies of insulin to $35…for medicare recipients. I’ve checked, the vast majority of formularies are participating now.
But if you are reliant on private insurance (because medicare is for seniors), you can fuck right the hell off. You pay what we tell you to. BCBS has not expanded their preferred formulary list beyond this one shitty formulary and I don’t expect them to.
Oh and if you’re like my wife and your insurance only covers a formulary that causes you problems and a demonstratively higher A1C as a result, well you can buy vials out of pocket for $600 - $1000 for a month’s supply.
I’m glad that medicare is as great as it is and have no problem paying into it as a tax-paying citizen, but private insurance is the problem that most of us are dealing with and nobody is doing anything to address it.
This probably won’t help you since you live in a small town.
Finding a doctor in the united states sucks. Literally the worst experience I have ever had was transitioning to a PPO insurance policy after being in a combine managed HMO / healthcare group.
People told me for years “oh, that health care provider sucks. You get sub par care and nobody ever knows your name.” You know what else I got? Same day doctor visits and same day specialists, literally anytime I wanted or needed anything. I had reasonable medical care at a reasonable schedule for a reasonable price.
When my insurance switched to a PPO, people told me “oh, you will love this doctor! He is so great!” And… every… single… time… it is exactly as you described. “New patients are 6 months out.” And when I finally got a primary care doctor, they would recommend specialist who were their friends also in private practices with 6 months waiting lists.
Private practice medical care is an absolute joke. It’s another shitty system the boomers saw their parents use successfully that simply doesn’t work today.
The solution was to find a high quality medical group in my city. It took me nearly a year to figure it out. Same day doctor visits? Done. Same week specialists? Done. Same system / in network urgent care at the same price as a regular doctors visit? Done.
I don’t care which doctor I see, I just need medical care.
Exactly. I just want someone to help me. Apparently that’s too much to ask.
What state are you in? I’m curious because I have long term medical issues and need frequent care and the cost is terrible but the care and physician availability is really good.
I’m in Minnesota, in the metro area so I’m sure that factors. I’ve just seen a lot of articles about healthcare and physicians in decline in the red and purple states lately.
Terre Haute, Indiana. The armpit of the Midwest.
My gastroenterologist story:
Chronic GERD. Talk to family doctor, who refers me to a gastroenterologist (one that is “in network” for my insurance"). My insurance is from my wife’s job, who works at a hospital, which you’d think was good. More on this tidbit later.
Go to Gastro doctor (took 2 months to get in), recommends an Endoscopy, which is scheduled for 1 month later. Initial visit is covered (mostly/kind-of) by insurance.
One day before Endoscopy, get a call saying my insurance won’t cover the procedure there, and I’d have to pay out-of-pocket if I proceed ($5k estimate). I say no thank you.
I call insurance company about better location, and am referred to another gastroenterologist. I tried to just get an Endoscopy at new location, but they refused to do so with an Gastro doctor visit with THEIR doctors. I schedule visit at new office (1 month to get in).
Go to NEW Gastro doctor, recommends an Endoscopy, which is scheduled for 1 month later. Visit is covered (mostly/kind-f) by insurance.
One day before Endoscopy, get a call saying my insurance won’t cover the procedure there, and I’d have to pay out-of-pocket if I proceed. I say WTF. Turns out the Insurance company recommended me to a Doctor who was In Network, but their procedure location is NOT in network.
Apparently, despite having a PPO insurance, there is “In Network” and there’s “in IN network”, since my insurance is through my wife’s hospital plan. I have to have the procedure at an official hospital location that is part of my wife’s hospital network.
I schedule an endoscopy at a 3rd location (1 month out again). Finally get an Endoscopy completed.
From initial referral to Gastro, until completion of Endoscopy, was 6 months. This was on supposedly good insurance (which was obviously a lie). We don’t have that insurance anymore.
Did you ever figure out what the problem was? I have a very similar issue and a very similar story though the endoscopy just said yeah you got GERD bro lol and I’ve been taking meds that barely work ever since
Nope. The Endoscopy results said: “Evidence of Gerd present”, and gave me a prescription, that kind of works (sometimes).
Oh god that’s so frustrating
I take the prescription (pantoprozole) as directed each morning, and then a Pepcid in the evening, if I happen to eat something that causes trouble. That more-or-less seems to work for me.
Our prescriptions are pretty much the same! Panto morning and dinner time, pepcid before bed. Stay away from triggers or I’ll pay for it regardless if I take medicine or not
This kind of thing happens all too often. Going in for a surgery that your insurance will cover? Oops, we forgot to mention that the anesthesiologist is actually out of network, so you’ll have to pay out of pocket for that part.
Just another symptom of how rigged our economy is!
Unless this is ever addressed, the symptoms will only get worse over time. The system is designed to siphon the nation’s capital to the owner class, they aren’t interested leaving you enough to get medical care, quality food, acceptable education, etc. You are nothing but livestock to the people that control this nation through the economy and the fully captured government, and they use it to make sure you don’t have a scrap for yourself.
Not even livestock. At least most farmers realise they need to keep their livestock healthy and fed in order to keep milking.
I lose people with my preferred term: disposable capital batteries.
You’re 100% correct though
Wait, they didn’t prescribe you anything when they found the ulcer?
They did. Protonix.
Huh. That doesn’t seem like much for something that stops you from eating, but I guess I’m not a doctor, or privy to the details of your ulcer. I remember when I went in with an ulcer they acted like it was full red alert.
Anyway, I sympathize. I still have to bounce around between gastroenterologists because I have the same problem getting in - and half the doctors in my area leave after a short time here. “You need a new gastroenterologist” invariably ends up with a lot of “We’re not taking new patients, please call back in a couple of months”.
Thanks. We did research on it and loss of appetite is one of the symptoms. See here, for example under ‘loss of weight.’: https://www.manhattangastroenterology.com/8-signs-you-may-have-a-stomach-ulcer/
Sorry to hear that…
I appreciate it.
I canceled my dermatologist appointment last winter because it was a 30 mile drive to the clinic and it was the worst blizzard we’d had all year. The soonest I could reschedule was 7 fucking months out. In truth all I needed from that visit was for him to renew my prescriptions, but I’m forced to go in and pay $300 for an office visit to do it.
Does your dermatologist not offer telehealth as an option? I’m usually able to just have a phone or video call with my PCP to see how things are going and renew my prescription. Not offering telehealth seems very odd in our post-2020 world.
Edit: Unless you needed to go in for a scan or test. Sorry, I didn’t even consider that possibility.
Wow. Pay money to have prescription renewed. Here in Sweden I just send a message online to my doctor that I need it renewed. No charge or anything like that.
Sorry to hear about everything you’re going through and how much it costs for no treatment. I think a lot of doctors do care but they are overworked and have to constantly battle hospitals and insurance companies. A lot of them seem to be seeing less patients which is not going to be good, and many are retiring or burning out. There are also now more seniors than people under 17, the seniors require more care. Article on the doctor shortage: https://time.com/6199666/physician-shortage-challenges-solutions/
Thanks. I understand what you’re saying, but when I tell a doctor I’m not eating twice and he says to me keep taking your pills before you eat, I don’t think he gives a fuck. He seems like a nice enough guy, but he’s apparently a terrible doctor. And I don’t have anyone else I can go to. I mean I know why. This is one of the shittiest towns in the country, Terre Haute, Indiana, but still…
Yeah that doctor definitely is not doing their job. What do you call the person that finishes LAST in medical school? Doctor.
I was concerned when I first met him. The guy has terrible teeth. That alone is not a good sign of a doctor. A doctor that doesn’t care about his own health?
Yikes. He doesn’t sound like the guy for the job.
Is there any way you can see a doctor near Indianapolis, or maybe one of the towns between you and there? I know that places a burden on you, which should not be necessary. However, one unfortunate aspect of our healthcare system is that you often must advocate for yourself to get decent results. This is even true (especially true) of mental health, which doesn’t exactly make a ton of sense.
My PCP and a treatment center I go to for one of my medications are both about a half hour away, because I don’t want to change away from them. If you can make a one-hour drive to a new doctor happen, it may be worth it for your health and sanity.
I’ve called those doctors and none of them have time to see me. No one within a 90 minute drive. Although I’m wondering if I just go to an ER in Indy and demand to see a gastroenterologist if that would work.
Jeez. At this point I might just make appointments anywhere I could get them, even further away, and see if I like the first ones to get me seen. Granted, that’s easier said than done.
The ER route might have some potential as first step too. A legitimate one ass well. I mean this sounds to me like an emergency that is threatening your health in the short term.
I just don’t know if the ER route would work and it would end up with another huge bill.
It has been 50€ after refund in total to fix my ulcer. I don’t know the full price of the two medical procedure to check for it and the meds shouldn’t have cost too much.
My colonoscopy with insurance in the USA cost two weeks pay. It would have been 33% of my annual take home pay without insurance.
To your point about delays, I waited over two years to see a psychiatrist in a huge university hospital system – one of the only places which would even accept my shitty insurance – as a person with suicidal ideation. It’s so fucked.
