American health “care”

The Alps left me with a festering shin wound, which had been difficult to manage for someone camping out in a humid climate and with no medical training beyond first-hand experience with various injuries. I was paying cash in Europe, but I supposedly had health insurance back in the good old U-S-of-A, so I thought I should take care of things there. What was I thinking…

As a borderline-poor resident of New Mexico, I am eligible for its Medicaid expansion, which has of course been contracted out to some corporate parasite calling itself “Western Sky Community Care.” When I signed up, some computer assigned me to the cheapest primary care physician it could find, in Las Cruces, despite my living at the other end of the state. It was relatively painless to change that to a person I have never met with an office closer to “home,” and the person to whom I spoke was used to handling such requests. Apparently this poor doctor in Cruces is a regular victim of WSCC’s algorithm.

Anyways… an open wound on the shin with redness, odor, and swelling demands the full force of Medicaid. After navigating some phone menus, I reached a registered nurse, who went through a scripted diagnostic checklist and advised me that I visit an urgent care within “3-4 hours.” Hah! The thing had been festering along happily for a month, so it could wait a bit longer. To be fair, on this rare occasion that I reached an actual health care professional, she was kind and helpful. When she asked me what might prevent me from getting the care she recommended, I should have said “my health insurance,” but I was neither quick nor bold enough.

The nurse also suggested using my supposed tele-health benefit, offered by teladoc.com. I could talk to a doctor (or at least a nurse practitioner), who could look at photos or video and prescribe the appropriate care. More transfers and menus later, I was talking to a slightly aggressive customer “care” representative, who walked me through a typical medical questionnaire (“do you smoke?”, etc.), and probably had me implicitly consent to share my medical records with various data brokers. Along the way, I had stupidly said I was calling from Colorado… big mistake. The “care” representative informed me that, because I was calling from out of state, I was not eligible for tele-health. Let that sink in for a moment. She helpfully offered to charge me $75 for Teladoc’s invaluable services, but I had exhausted my tolerance for the absurd. I’m sure she will do well on her performance reviews for call-time minimization and revenue management.

So I went to the clinic attached to a local supermarket, where they had me fill out a form and show my crappy paper “insurance” card. After some confusion, I finally saw a medical professional, who was again unfailingly polite and helpful. She treated my shin, prescribed an antibiotic, then talked for awhile and answered my questions about wound care, demonstrating either kindness or bedside manner. I admire the people actually providing care in this saga, working around scripts in the first case, and the clock in the second.

Unfortunately I was soon back in the profit-extracting machine. The workers at the pharmacy next to the supermarket clinic almost laughed when I showed them my WSCC “insurance” card. Of course New Mexico Medicaid would not pay for a prescription out of state. So I paid $21 out of pocket for the antibiotics, fully expecting to be hit with an arbitrary bill for the clinic in the coming months. Fortunately my friend Ted was kind enough to let me stay in his house until I could tell that I did not need to drive down to New Mexico for surgery. This would not be because the doctors are better there, mind you, but because Western Sky Community “Care” would have had to work slightly harder to avoid paying. Perhaps they only cover injuries that occur in-state, and in which I am not at fault.

Postscript: So the bills finally came, yielding a surprising and illustrative coincidence. My day in the hospital in Aosta, including emergency admittance, two consultations, two x-rays, one bag of IV antibiotics, and twenty stitches, cost €141. My 30-minute visit to the supermarket clinic in Denver, for which WSCC predictably denied reimbursement, also cost $140. I have abstractly “known” for years that American health care is deeply broken even for those with insurance, but this simple demonstration made that reality much more concrete.