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I miss you, HMO

  • Tagged The emotions, The kids
  • Commenters star, Dawn

It turns out we might need to redo our 20-week ultrasound after all. Not because they couldn’t see Rummicub’s gender, but rather because the radiologist couldn’t make out quite the level of detail he needed to see on our baby’s heart, spine, kidneys, or face. You know, just the small stuff.

In my old HMO life, I would have already scheduled a second ultrasound, without even thinking about it. In my current reality, as a subscriber to a high deductible individual plan, I’m spending a lot of time worrying and making phone calls, trying to even pin down an answer to the simple question, “if we do this again, will we be billed again, even though it was really your fault?” I don’t even know how to find out to whom I’m supposed to address that question.

Oh, the luxury of the HMO for the basically healthy. The occasional copay. The leisurely decisions about whether to see a specialist or take a second blood test just to be sure. The blithe confidence that by following the rules, by always calling my Primary Care Provider first, I would never be confronted with an unexpected charge or claim denial. I know it’s why health care costs are out of control. I also miss it so much I want to cry.

The truth is, it’s probably not strictly necessary to do another ultrasound. They certainly didn’t notice any major abnormalities, and I clearly remember the ultrasound tech showing us the baby’s kidneys, spine, and heart. She just didn’t take the best photos. It would be nice to have the peace of mind, though. But how much is that worth in dollars? Would I pay $300 to make sure the radiologist was confident about Rummicub’s kidneys? Would I pay $400? $700?

The simple fact of having to make that decision is hard enough. What makes me feel like I’m in a Kafka novel is the fact that you simply cannot find out how much it’s going to cost. Every single person who is involved in a medical procedure bills the insurance separately. I just finished paying for my 12-week ultrasound in August this week, after the bills finally came through for the ultrasound machine, the ultrasound tech, the radiologist to read the ultrasound, the genetic counselor’s fee, and the blood lab charges. Actually, I can’t be sure I’m done. Every time I think I’m out, they pull me back in.

Ultimately, we chose this stupid high deductible plan on purpose, trying to save some money. I did a lot of scribbled math in the margins of health insurance application forms, and it all seemed to make sense. If I had known then that I would be pregnant by the time my coverage started, my math might have come out differently. This is the cost we’re paying for getting pregnant earlier than we expected. In the long run, we’re happy with the trade-off. We just wish it wasn’t so stressful.



Oct 6 / 14:57


Oct 6 / 15:26
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