Sondra Stratton: A not-so-pleasant experience with our HC insurance

From Sondra Stratton, October 03, 2006

Subject: yet another experience with our good old HC insurance

Many of you know a little about Brown County. We are a rural area just on the edge of the Appalachian area. We are about 30 minutes from the KY state line. We have doctors but not on every corner and those who practice in BC are very busy. It sometime seems that I have to schedule an illness as I usually can not get in to see her for weeks if not months. There are times that you can not even see the nurse practitioner ( not that I like paying the same price to see a nurse that I would pay to see the doctor). In other words, there is no over-abundance of doctors here.

Last winter, when I could not get in to see my doctor to get medication for a sinus infection, I was told that I could go to the Urgent Care that is being held in the building after the doctors' hours. It is open from 6 PM to 10 PM. While that is not a long time, it is good for needing to see a doctor as opposed to visiting an emergency. Abundantly cheaper and less time consuming.

As far as I know, this is the ONLY Urgent Care in the county. A welcome one at that!!! It would require 60-90 to get to one down around the city. Not something to look forward to when you are aren't feeling well in the first place. THEN they might not be providers....who knows!!! It would take HOURS to go to the Emergency room and then those who are in need of urgent medical care are always taken first as they should be!

Recently, I received an EOB from MMOH from last winter stating that I would owe something like $71 as the Urgent Care was not a provider for my insurance. I immediately called MMOH and talked to a representative. She told me that MMOH would not cover the Urgent Care as they had NEVER done any paper work and asked to be included as a provider. I told this lady that I thought they were just out to see what they could get out of paying which didn't set well with her. I told her we did not have doctors on every corner in Brown County and this are a better solution to the problem than the ER. I asked for papers to send to refute the decision. I intended to do this but somewhere in the line of cleaning I misplaced the papers. I also told this lady that I COULD have gone to the emergency room and cost the the insurance company a whole lot more money AND they would have paid for it. It made no sense to me that my doctor's office and the Brown County Hospital that operates the Urgent Care were all providers and it made absolutely NO SENSE that the Urgent Care was not also included in our insurance.

Anyway, I went in for sugar blood work as couple of weeks ago and asked about it. By this time there is a BIG sign on the window they are NOT MMOH providers. I asked why that was and why that has not been placed in view before now AND I asked WHY they had not applied to be a MMOH provider. I learned that, according to the staff,

they had indeed applied and had been refused for.....get this reason,,,,,,,,,,the Urgent Care was not open long enough so MMOH would not accept them as a provider. Someone is lying.....you figure it out! I KNOW who I think is lying!!!

SO our good old insurance company is at it again......working for our benefit!!! NOT!!!!!

It makes no sense to me that an URGENT CARE that is open for at least 4 hours longer than ANY doctor's office would not be granted permission to become a provider!!!!! It seems, according to my doctor's staff, that MMOH wants the Urgent Care to be open for at least 8 hours. Eight hours would be nice but I will take the extra 4 and be happy that I have some place to go when I need medication but not EMERGENCY attention. NOW I ASK YOU, is it better to have an extra 4 hours ( as opposed to no other option than going to the ER) to see a doctor to keep from going to the emergency room?

I could understand it maybe in the city where there are doctors on every corner and around every bend and Urgent care facilities in most communities or near-by BUT not in an rural area that is in need of doctors. I would think the company would be interested in saving money. It would seem to be that $71 would be a better deal for MMOH than say.....$3-400 for an emergency visit. I am not a brain surgeon but think that maybe that is needed by MMOH and its employees and if these kind of decisions are being made by STRS employees, then maybe they need to see the surgeon as well.

It really makes me angry to pay for the insurance and then be told that it is not covered. Especially in a case like this!!!! Yes, I now have a book that includes doctors on the plan. It was a new service and would not have been in the book in the first place. When you are sick, it is positively stupid to ask someone to CALL the insurance company and find out if this or that is ON THE PLAN!!! It sometimes takes a lot of time to get a representative and they are not available evenings and night-time. Besides, there ARE illnesses that need attention but not EMERGENCY ROOM attention!!!! PURE STUPIDITY!!!!!!!!!

I hope this situation gets rectified.....QUICKLY!!!!!!! STRS, are you listening??

SO, retirees BEWARE if you need medical attention and can't get in to see your doctor and go to an Urgent care facility, you need to ASK first if they are on your plan!!!!!!!

Sondra