A hypochondriac in America

TLDR: If you don’t have a GP, go get one now. Don’t wait until you get sick. And download the GoodRX app for cheaper prescription medication.

Being a hypochondriac

That the American health care system is extremely convoluted was something I already knew before moving to Illinois. Even the extremely helpful America Josh blog doesn’t say much about health insurance beyond asking for help understanding the topic. That still did not prepare me for the tangled mess that I faced upon getting sick in my first few months here.

When I landed in Chicago, I didn’t have a job or a social security number, so I extended my travel health insurance as a stop gap until I could find a job that provided health insurance coverage. One of my neighbours* told me that I should find myself a primary care doctor ASAP because it took her 8 months to get a doctor’s appointment when she moved here. I was feeling very healthy, and very cavalier about the future (despite seeing the doctor near monthly in Australia) so I nodded along and promptly did nothing.

In Australia, I could see my local doctor relatively easily. I was lucky to live and work near a very big Medical One centre, where there were twenty doctors, plus a pathologist, dentist, and pharmacist all the same building. It made it very convenient to get a same day appointment - even a same hour appointment - and all my tests done in the same place. It wasn’t the cheapest of places, but sometimes the doctors would decide that they’d seen enough of me for a month and bulk bill my visit so I didn’t have to pay anything. Blood, swab and urine tests were free, and from memory, my ultrasound and live tissue biopsy from a hospital was about AUD$200. (It’s nice to have your suspicious lump be confirmed as benign within the course of a few days.) I was a spoilt hypochondriac.

Of course, a person prone to sickness does not miraculously obtain a fantastic immune system upon moving overseas. It took three months of being carefree, but I did eventually need to find a doctor. Here is where I had to plunge straight into the mouth of the maze.

*I’m using a very broad definition of neighbour. All my “neighbours” live in the same neighbourhood or the neighbouring neighbourhood as me.

Finding a doctor

So I thought finding a general practioner (GP) would be nice and easy. Nuh Uh. GPs here are called primary care physicians (PCPs) and they are associated with preferred provider organisations (PPO)s**. It’s important to find a doctor that is “in network”, or costs will skyrocket with zero assistance from your insurance provider.

Another neighbour told me that when she had her first child, her husband forgot to add the kid onto their family health insurance during the two week grace period after the baby was born. They went to their family doctor for the first check up, and discovered that the baby could not go to their family doctor. At that time, Illinois had set up a brand new state health insurance policy, so they purchased that for the baby.

And then they found out that there were only two family doctors that were in network in the entire state of Illinois.

One doctor was several hours drive away. The other doctor, thankfully, was only a few minutes away. They got lucky.

With that in the back of my mind, I hopped onto my insurance provider’s website and picked out a few nearby doctors in the PPO. The next morning, I phoned the numbers I found.

Me: I found this doctor through my insurance company’s PPO. Can I make an appointment?

Receptionist: This doctor is a maternal health gynaecologist. Are you pregnant?

Me: Um… no I don’t think so.***

Clearly I did a terrible job of sorting out the PCPs from all the other kinds of doctors out there in Chicago. The receptionist recognised my plight and patched me onto the NorthShore physician referral line, who gave me a list of internists that were accepting new patients to call. No, not interns. Internists, which is just another word for a GP or PCP. And yes, only some internists will take new patients. A lot of doctors will refuse to see you if they’ve never seen you before.

I called up one of the internists, and thus commenced the half hour conversation with the receptionist to figure out if my insurance would cover my visit to this doctor.

It was okay. We figured it out. I could go visit this doctor.

Awesome, we were getting somewhere. So could I make an appointment?

Receptionist: The doctor is indeed taking new patients. The next available appointment is in late January 2020.

That was nearly three months into the future. Best case scenario I’d be completely healthy in three months time and I’d have no reason to go to the doctor. Worst case scenario I’d be completely dead and I’d also have no reason to go to the doctor. I made the appointment anyway, because after that first appointment I’d no longer be a “new patient” and getting further appointments would not be so difficult.

My neighbour said that I was lucky, and that two and a bit months was a pretty short wait time to see a new doctor.

Regardless, I still needed to see a medical professional and couldn’t wait months to do so.

**I think. I don’t actually know this stuff for sure.

***Although half the time my symptoms can be ascribed to either pregnancy or cervical cancer. I’ve taken precautions against both these things, so it's likely that it's my uterus being it's usual hysterical self.

Halfway between the GP and the ER

Here in the United States, there is a thing called an urgent care centre, for when you cannot wait several months to see a doctor, and you also cannot justify visiting ER. Urgent care centres will accept walk ins and same day appointments, and will address things like flu and broken bones. There was an urgent care centre near me. It was even in the same system as the doctor I was going to see in January. I could go there.

Or so I thought.

Receptionist: I’m sorry, it doesn’t look like your insurance can be used here. You can still be seen here, but you might get a bill for $800 afterwards.

Oh, great.

The receptionist gave me the address of an urgent care centre that would see me. It was only a train ride away, but it was also an entire train ride away. I went home and hopped on live chat with my insurance provider. The live chat confirmed that yes, my soon to be doctor was in network, and yes indeed, the urgent care centre that was part of the same system was out of network. Oh, and yes this other urgent care centre was in network for me.

I made an appointment online, and hopped on the CTA to an entirely different neighbourhood to be seen to.

Money matters

Now, I don’t have a job yet. I had only just received my employment authorisation in the mail a few days ago. Therefore, I don’t have a lot of disposable income. I wanted to know how much my visit would cost me so I could work it into my budget. I asked the receptionist at the urgent care centre.

Receptionist: Well it depends. Your insurance will look at the costs and send you a bill afterwards. So I can’t tell you how much it will cost.

I was seen by a few nurses and a physician’s assistant (PA). They were lovely, and the PA took some tests and gave me a prescription.

So how much would the prescription cost?

PA: I don’t know for sure, but your insurance should cover it. But if your insurance doesn’t cover it, there’s this app called GoodRX that gives you coupons for cheaper prescriptions. I’ll get your prescription sent to your local pharmacy for you.

The staff at the urgent care centre were lovely, even if they couldn’t tell me how much their services cost. My next stop was Walgreens, which reminds me, I don’t think I’ve seen an independent pharmacy here yet. There are a lot of Walgreens and CVSes though. I’m sure they exist out there but I wouldn’t be surprised to learn that they’re being pushed out of business.

At Walgreens, I got my very first cost estimate from the pharmacy cashier. After investigating if my insurance would cover the costs (it wouldn’t), the prescription would cost me $40. Not terrible, but not a great price.

I whipped out the GoodRX app on my phone. It gave me a coupon for $18.

Pharmacy cashier: Actually, the Family Wize coupon will come out cheaper for $14. Can I use that instead?

An even better coupon? Why, there’s no need to ask!

So far, my medical hijinks have cost me $14. This does not include the cost of health insurance, or the cost of my medical appointment because I still don’t know how much that costs.

I still haven’t seen a doctor yet.

My shower thoughts

I have a bunch of hypotheses about the medical system here. I haven’t read up terribly much about this so I may be completely wrong, or I may be parroting needlessly.

1. Wait lists are a good thing

On the internet, Redditors will often get into circuitous conversations about how the American health system is expensive, but it’s not a bad trade off because countries with universal health care systems have very long wait lists for medical procedures like surgeries.

In my opinion, having a long wait list for a medical procedure is a good thing. It means that everyone who needs the medical procedure is going to get it, even if they have to wait several years for it. (Or they can go to a private hospital and get it done faster if they’re willing to pay more money.)

On the other hand, if there is a smaller or no wait list for a medical procedure, that means that there is either more supply (of time and doctors), or less demand. I think it’s probably the latter. If poor Americans can’t afford a medical procedure, it stands to reason that there are less Americans having the medical procedure. Not having to wait for a surgery might be a good thing for me personally, but I gain that benefit because so many other people are unable to access that medical procedure. That’s not a trade off that I ethically enjoy.

2. The United States of America has a shortage of family doctors

A while back I read an essay by John McPhee called “Heirs of General Practice”. The essay was about a couple of young doctors who were reviving family practice in the midst of a medical system that was becoming increasingly specialised. McPhee wrote the essay a few decades ago in the 80's - but I wouldn't have doubted you if you told me that it was written this year.

GPs are the professionals that see, diagnose, and treat the whole. They’re important for your general wellbeing and for proactively maintaining your health. It’s all very well to have plenty of good quality care at a hospital, but the aim should be to avoid entering the hospital in the first place.

But if it takes anywhere from a month to eight months to get into see a GP, that’s going to be of no help whatsoever. It is also not helpful if the local GP can declare that they are not taking any new patients because they already have too many.

Clearly the United States does not have enough GP hours to go around.

3. The lack of transparency around pricing puts patients at a disadvantage

I take a relatively tight grip on my budgeting. I try to make sure I can predict how much I will spend in a given time period, and I record all of my past spending. This helps me decide whether or not I can afford to buy something, or if I should chill it on the spending spree.

That’s probably the case for a lot of other people out there, regardless of how much they’re earning. It’s probably very true for people living paycheck to paycheck.

Unfortunately there seems to be no way for me to estimate how much my medical appointment cost me. And even after I get my bill (fingers crossed it’s not too much) I still won’t be able to guess how much it will cost me in the future, or how much the same procedure will cost other people.

If I had more financial insecurity, there’s a good chance I would not have gone to the urgent care centre or made a doctor’s appointment at all. Maybe I would have been able to afford it, but there was also a chance that the final bill could be outstandingly egregious and bankrupt me.

And financial insecurity aside, I can’t shop around for a doctor or insurance provider if I don’t know how much they will charge or cover. That’s absolutely terrible for market competition.

I don’t like making uninformed decisions.

4. I need better health insurance

Now that my EAD is here, I’m going on a concerted hunt for a job. It’s not even the additional income that I’m keen on. What I really want is a good health insurance policy.

Edit: A 6 month update on my low risk, high cost, medical journey.

PSA for expats with a vagina: The American version of Canesten is called Monistat, and using it is an extremely unpleasant experience. The label says, “apply for immediate relief”, but that is more than a lie. It hurts even more than the symptoms of candida. I’m not a pharmacist but I didn’t see any active ingredients in the cream that would address irritation or inflammation - just fungus killing stuff. If you are in a position to see a medical professional to get a prescription for diflucan, I highly recommend you do so. Getting multiple repeats of diflucan is even better.