Tuesday, April 13, 2010

A Day In Our Dangerous Life (added bonus: My Insurance Company Rant)

Do you know what to do in an emergency? Good, but do your kids know what to do if you’re not there? These are questions we were forced to consider these past few days. I thought we were pretty prepared and we were, as long as the person handling the emergency knew to pull off all the other extraneous papers thumbtacked to our bulletin board to uncover the emergency information with phone numbers and addresses for hospitals and Urgent Care.

My oldest son had a swing accident. He wouldn’t want me telling you that, but since he doesn’t read my blog he’ll never know. He was swinging on our playset on Sunday morning, going very high and fast, as 13-year-olds are prone to do on a swing, when the swing broke. I’m sure your first thought is that he went flying through the air and cracked his head. This was my first thought too when my younger two children tracked me down on the neighbor’s property where I was riding my older horse and ponying (leading) my in-training horse. (It was very good that my in-training horse didn’t freak out when two children in pajamas and boots came running through the woods yelling at the top of their lungs and waving their arms wildly or we would have had two emergencies instead of one.)

Luckily my son didn’t go flying across the yard and land on the metal fence posts around the herb garden or the wooden corner of the fort or the sharp edge of the garage - all things I pictured in the brief moment before the kids caught their breath and clarified what they meant by, “Brady’s hurt, the swing broke, Daddy took him to the hospital!” No, he didn’t crack his skull or snap his spine because he had his arm wrapped around the chain of the swing, so when one side gave way he was entangled in the chain of the other and the momentum of his 70 pound body and the speed with which he was swinging cause the rubber coated chain to gauge out a big chunk of his arm. I’m very glad I didn’t see it.

Brady ended up with 20 plus stitches at the juncture of his arm and body and as my husband said when they were finished sewing him up, “He looks like somebody sawed off his arm and then reattached it.” He was lucky. I’d post a picture, but you really don’t want to see it. Yes, we do have pictures. My hubby, being an engineer who works in quality, needed to document it so he can send it with the bolt that broke to the company that built our swing. (No we’re not looking for millions; he just thinks they’d want to know.)

The one thing that this episode brought home, besides the fact that Insurance Companies are stupid (more on that later), is that we need to have a clear plan in case an emergency like this happens when there is not a parent home. We leave our kids home in the care of our 13 year old sometimes and they all need to know what to do if someone gets hurt. (Or if their crazy mommy gets thrown off the young horse she’s attempting to train). As I am prone to lists, here’s some of the things I’m going to do to prepare for the next inevitable emergency:

1. Post 911 in large clearly visible numbers on the top of the kitchen bulletin board and near each phone. Remember that even if you and your kids know to call 911, in an emergency your mind can go blank and you should have the actual numbers written somewhere near all of your phones.

2. Post a list of who to call in a near-emergency in a clearly visible spot and explain this list to the kids. We do have numbers for grandparents, neighbors, family doctors, and poison control posted, but over time they have been buried under more important information like the birthday party invitation for next week (plus the three or four that were last month), the coupons for free movie rentals, and several political pins. We’re making a new list and resolving to keep it clearly visible. We’re also going to number the list in the order in which the kids should call. Like, the first number to try is the neighbor who is also an EMT. The second number to call is the neighbor most likely to be home and to remain calm. Then we’ll list 6-8 more numbers because people are just never home when you need them to be. (side note: using the phone is a skill your kids should be comfortable with. If they’re not, get them used to it by asking them to make calls for you and allowing them to talk to their friends on the phone.)

3. Talk to the kids about when to call 911 versus the neighbors. Lots of blood, unconscious person, fire, etc., call 911. Dog bite, broken bone, smaller cuts, call the neighbors (and Mommy’s cell phone). We also need to talk to them about being safe when parents aren’t home. Of course, we all would consider swinging on a swing safe, wouldn’t we? We can prepare all we want, but life is unpredictable, as apparently are the bolts that hold swings together.

4. Have a good first aid kit available. Some items you should have are saline wound wash (do not use tap water if you can avoid it, you want to use something sterile like saline), betadine antiseptic scrub (just like at the hospital), small, medium, large and gigantic sterile pads, kling gauze wrap, butterfly bandages, and triple antibiotic ointment. These are some of the things that were necessary to care for Brady’s injury, but we didn’t have many of them on hand. We do now.
5. Know where the closest ER is located and also the closest Urgent Care center. You might want to do more than write down the address; it might be a good idea to drive to it (and save it in your GPS, if you have one). Remember what I said about it being hard to think clearly in an emergency.

This is the end of the useful information. You can stop reading here or you can listen to me rant about Insurance Companies for just a paragraph or two.

I consider the insurance we receive through my husband’s work pretty good. At least comparatively speaking I’m sure it’s as good or better than most people’s insurance. So I’m guessing that we’re not the only people who have spent hours on the phone or sleepless nights stewing over the stupidity and waste of insurance companies. When my son was hurt, my husband took him to the ER. He paid our $200 co-pay and waited to have a doc stitch him up. I’m sure there are plenty more bills coming our way, plus a few thousand letters explaining how the insurance company is going to bill us, what exactly he was treated for, who treated him, and the letter bragging about how they negotiated a great deal, plus then the actual bills from the doctor, hospital, and a few other extraneous people who eye-balled my son. Those will be followed by more letters that state “THIS IS NOT A BILL” from the insurance company until we are thoroughly confused. We’ve taken to not paying anything until the doctors, hospital and insurance company come to some kind of agreement and the collection agency starts sending notices. It’s ridiculous and I feel kind of guilty about it, but if we don’t do it this way, we end up paying for things we weren’t supposed to pay for and having to fight to get our money back. Much better to let them work it out before our check book gets involved. OK, that’s annoying, but it’s not the part I need to rant about. Here’s that part:

At the ER my husband was instructed to bring our son back in two days for a “wound check” so they could assess its condition and change the bandage. He was also told to have the stitches removed in 12 days. Then he was given minimal instructions plus a prescription for an antibiotic and one for pain. Once home, my husband just shook his head when I asked questions like, “Can he take a shower?” (just in case you don’t have one of your own, 13-year-olds smell) “Can he play soccer next week?”Should we change the bandage?” “Shouldn’t we take off the bandage and let it get some air at some point?” and lots more. The ER wasn’t forthcoming with much of this information and we decided they must be planning on telling us at our follow up in two days. I had a lot of questions for the doctor at our follow up visit. Just to be sure we were on the same page as the insurance company, my husband called them to find out if the visit in two days falls under “follow up”. We learned that because the wound check would not be on the same day as the original claim, it doesn’t count as “follow up” and we would be required to pay another $200. This seems crazy, does it not? Aren’t we “following up” on the injury they treated just two days ago?

After multiple phone calls to our pediatrician, Urgent Care, the insurance company, the hospital, these were our options: 1) sneak in to the ER and walk right past the registration to the trauma center and tell them we’re here for a wound check (and hope no one asks us to register) 2) go to Urgent Care and pay $100 co-pay for them to check the wound (but they weren’t willing to treat the wound when it happened on Sunday, so we’re doubtful about their capabilities) 3) check it ourselves, hope we don’t yank out a stitch when we remove the bandages or infect it when we put the new one on, and take him in only if it looks infected.

I found it ludicrous that these were our only options. Why do we have insurance? What, really, is the point? Does it really cost $200 to change a bandage? I’m assuming it costs much more since that’s only the co-pay. Lucky for us, late last night I realized we have another option! A dear friend who lives nearby is an emergency room nurse! So that’s the option we’ve decided on. We’ll take him to Sue and pay for it with fresh eggs and gratitude. As far as our insurance is concerned, we never followed up. Do you think anyone will notice? Do you think anyone will care? I’m not holding my breath.

Here’s why I need to rant – most people don’t have those options. I’m an educated, assertive, insured parent. If I had to, I could fork over the $200, but that’s not the point. Doesn’t the insurance company want patients with serious wounds to have them checked out? Charging that patient another $200 to have it checked does not encourage this behavior. If I didn’t have the money or an ER nurse friend or the wherewithal to argue with my insurance company, I might end up with a kid with an infected arm. And that’s going to cost the insurance company a lot more than a quick ER visit. It is ridiculous that as people with “good” insurance we were even considering sneaking around the registration desk at the hospital and conning our way in to treatment. Maybe if they didn’t send out 15 first class mailings for every phone call or strep test, they wouldn’t need to charge me $200 to have the Band-Aid changed. Maybe if they made decisions based on what’s best for the patient and what will prevent larger expenses in the long run, we’d be healthier and they’d save money. Maybe if they incentified preventive procedures and behaviors, they’d reduce the number of ER visits in the first place. Maybe if they had someone with a brain and a conscience running the place things would make sense! UGGGGGH. OK, done. Thanks for listening.

2 comments:

  1. You can only imagine what a parent that visits 4 different specialist a week goes through. Ohh and they all call to confirm every week. Fun.

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  2. don't get me started... but in PA you can go back after 48 hours but not MD. That is becasue state laws are different... and insurance companies are different, and hospitals are different, and the people who work there are all at different levels of understanding of all this. Stupidity on a massive scale. All hail the hillbilly healthcare system or we would have been in teh ER for 12 hours to change a bandage for $200.

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