Not quite. It seems reality is a bit of a mismatch with this idea.
I came upon an article in the New York Times that illustrates very well the nature of so called health insurance: Insured, but personally bankrupt. The article highlights how most people who become personally bankrupt after illness in USA, are people who actually have insurance. Unless you pay an insane amount of money every month, like $1.000,- (which is equivalent to 5425,- NOK with todays currency rate. Per month.) - you're basically left in the gutter if you should be so unfortunate as to need serious medical attention. If you're in a risk category, like - having a potential heart condition, your insurance will be so expensive that you might be better off without it. Then at least you're not up for surprises. A quick glance at the readers comments to this article shows very clearly how a lot of Americans feel about their health insurance system. Words like fraud, scam, inhumane reappear several times.
I have gained an experience of my own with the health insurance while living here. Now that I'm pregnant I need to visit the healthcare provider on a regular basis. We are covered well through Helge's employment and financing health issues should't be a problem. So then it should be easy, right?
This is the country of freedom of choice - so choosing the right provider is the first step on the journey of being looked after. But I got to learn quickly that as a patient - you don't choose a provider, they choose you. They will "accept you" only if you have an insurance that they are dealing with. So choices are quickly limited to providers "in-network" with our insurance company, and the easiest way of finding a doctor will be from an address list of in-network providers - from our insurance company.
Fair enough, limiting my choices might make it easier to find the right place. It would have been really helpful though if the insurance company also had some kind of information about the different doctors in their network to prevent me from going for a bad one. Like, feedback from other users, reputations they knew of - anything. But hey - they're an insurance company not a service provider. They guard the finances, not the people being treated so it is kind of a long shot to ask for.
So I picked a bad provider. And before I could see any health assistant, I had to fill out a chunk of paperwork for the insurance company - with questions regarding my health history, my husbands health history, my family's health history and my husbands family's health history, questions about recent medications taken and a whole bunch of declarations to sign that stated everything the provider would withdraw responsibility from in case of things going wrong. The paperwork took me about 45 minutes to complete. Then I waited for about an hour more before I was called in. My first visit lasted for nearly 3 hours all together - nearly 2 hours in the waiting room, 5 minutes with the doctor and the rest of the time with a very unfriendly nurse. To be fair I can't really blame the insurance company for that.
I went to this provider a couple of times, but after they lost my urine sample, asked me sensitive medical questions in front of other patients, made me pay extra for having blood drawn (which is kind of standard procedure during pregnancy) and generally treating me like a parcel on a factory belt - I thought I'd better find a different doctor.
So I did. I picked another one from the list and this time I did some research on the internet as well to check possible online user reviews. I called to book an appointment and the first thing they asked me was "What kind of insurance do you have, m'am."
This reply seems to be a standard procedure when you call a new provider but it strikes me every time what a financial engine the whole healthcare system is. The providers are not even concerned about your reason for calling before they know how you'll pay for it.
I told them "Europeiske - or Euro-center."
"We don't accept international insurance" was the brief reply.
"But you're on their list of in-network providers" I argued.
"But we don't accept international insurance" She said again.
"I got your phone number from my insurance company, and they're not international!" I said.
She got annoyed and repeated "well that doesn't mean anything - I believe it is international and we do not accept that insurance! Sorry. Have a nice day."
And so started a long string of phone calls between me, our insurance company and the doctors office which ended with our insurance clerk booking an appointment for me.
The new healthcare provider was - after finally being able to get an appointment with them - far better than the previous one. They could also offer me a choice between seeing a regular doctor, like in the other place - or a midwife with 30 years of experience and very good documentations. I was open to meeting the midwife and check out the natural birth thing and I've continued seeing the midwife regularly. She's great and things have been going well so far.
Then on my last appointment I was faced with another insurance issue: At the counter, when signing in for my appointment, the assistant told me that my insurance company had refused to pay the charges up till now because they've discovered I'm seeing the midwife and not the doctor. They will not cover midwife assistance, only doctor. So in order to see the midwife that day I had to pay out of pocket right there and then or else we had to swop the care plan and continue the follow up with the nurse and the doctor instead.
"Is this real?" I thought. My insurance company wants to decide how I'll give birth to my baby and who is entitled to do the regular prenatal check ups on me? They could't care less wether I'm seeing a good or a bad provider, wether I feel well looked after or terrified - but they do want to decide wether I give birth in a safe birth center (with a doctor back-up), or in a hospital, and wether a midwife or a doctor is assisting me.
"... so how much money are we talking, exactly?" I replied. She said they'd allow me to pay half of the sum to make it easier for me - "that would be $1997,-."
I tried to do the maths to grasp the amount she was asking for but I was too focused on concealing my anger and avoiding breaking out in tears. I decided to refuse being dictated by a totally f... up insurance regime so I pulled out my Norwegian Visa card and drew the 11.000,- NOK from my account. Then she let me through to my prenatal appointment with the midwife.
The receipt is on it's way to the insurance company and hopefully with a lot of pressure from my husbands employer - they will reimburse it. After all, as expats for DNV we are supposed to be well covered. Still don't know what will happen with the rest of my prenatal care, though. Would be really nice if my own preferences was prioritized. This is the country of freedom of choice, isn't it?
Thank God I'm not having complications. With all this hassle for a regular check up, I don't even want to think about what insurance joy we might face if I need any care out of the ordinary. Thing is - you really need to be mentally fit for fight to put up with all the negotiations, questions, paperwork, disappointments, reclaim rejections, arguing, phone calls and emails required to get the coverage you're supposed to have. And who are really up for that when they got serious health issues to worry about ...? Be sure the health insurance companies are well aware of that.
There are several actors in the healthcare industry that contribute to making general healthcare appear inaccessible and problematic. Although the actions and interference by the insurance companies can cause a fair amount of frustration, they are not running the show alone. Medical companies, lawyers, greedy doctors, front ends in the doctors offices and politicians all play their parts. Bottom line is - the health industry is a race about money, leaving the actual patients - who should have been the centre of attention, as nothing but peasants on a large chessboard where profit is at stake. I feel sorry for Americans, and I feel kind of grateful for being Norwegian. In Norway, healthcare might not be perfect, but it is free, covered by the government through taxes. I know that for a lot of Americans this sounds like boundaries of socialism and lack of individual freedom. But at as far as I know - nobody feels like peasants on a chessboard in a game to large to grasp.
A typical Norwegian mentality when traveling/living out in the big world! Exploiting and taking advantage of every little piece of that we find positive about the culture, and bashing whatever is negatively different from our home country. For instance, making big bucks and enjoying being able to afford stuff you wouldn't be able to in Norway! Once a Norwegian meet obstacles or find one or two negative features about a system we start to complain! Worked in the US for 12 years, and had PPO insurance through my job for 112 bucks a month! I contacted folketrygden to check what they could offer, and they were gonna pull 16% of my annual salary to cover my ass! It was either PPO, which covered everything including dental and physical therapy for about 7000 NOK a year or about 80,000 NOK to folketrygden, which only cover medical care! I find your story very naive and ignorant. How can you compare a multicultural and multilingual country with 310 million people (+ illegal immigrants) to a tiny country like Norway. There are more people living and working on Manhattan than there are in Norway. A classic Norwegian traveler in the US! You have probably saved a shit load of money by paying cash for your midwife compared with signing up for this unbelievable support from the Norwegian folketrygden! Start enjoying land of the free, home of the brave! Enjoy the rest of your stay!
SvarSlettDenne kommentaren har blitt fjernet av forfatteren.
SvarSlettHello Anonym, thanks for reading and commenting my blogpost! I'd love to hear more of your experiences with the differences between Folketrygden and your insurance company in the US - and there might be more similar cases out there. It would also be interesting to hear about a case where a person with your PPO insurance actually got seriously ill or injured ... Anyhow, my intention is not to compare USA to tiny Norway other than referring to the experience of stress regarding money when you need healthcare. I happen to be Norwegian, but I could have referred to any other country in Europe or perhaps Canada to make the same point.
SvarSlettIt is a bit sad to hear that you have the impression of a general "Norwegian Mentality" that "exploit and take advantage of every little piece of what we find positive about the culture" and "bash whatever is negative." Do you really mean that when we express the joy and pleasure of great locations, good food, exiting events and interesting people in the US - we "exploit and and take advantage of" the culture ...?
I've written more that ten blogposts from my time in Miami, all of them except this one is about everything I appreciate and enjoy in the area. When I write about my experience with an insurance system that I think has gone way out of control, I do that also to support a large part of the American population who feel the same way. You may find the stories of these Americans naive and ignorant too, but you should really check out the link to the New York Times article that I'm referring to, especially the comments from the readers. You'll be surprised of the amount of frustration.
I'm more tempted to call my story a "contribution" and "sharing" rather than a "bashing out" or "complaint." After all, freedom of speech is one of the highly valued democratic principles in the "land of the free, home of the brave." You are taking the opportunity to make a general statement and criticize the population of a whole nation, based on one blogpost from a single Norwegian. One could argue who's actually "bashing out" here.
It would have been great to have a discussion about American Health insurance pros and cons on my blog. But when arguments are wrapped up in general statements and preconceptions - they lose focus and significance and sidetrack the discussion, unfortunately.