I have lived in the United States long enough to acclimate to most cultural differences, starting with 20% tipping and ending with the usual address to foreigners as “sir” or “ma’am”, as opposed to British hesitancy . uh, excuse me? The exception to this, of course, is health care in the United States, which will never seem less than far-fetched to me. This is what happened last week when I had to call 911 in the middle of the night, but only after calling my insurers to request pre-authorization.
Taking the narrower view, some aspects of American health care are superior to the British and European models. In the early hours of last Thursday morning, I knew, for example, that an ambulance would arrive at my door within 10 minutes and probably sooner, no questions asked. I knew that once I got out of the emergency room, I would be able to choose my own doctor for follow-up care and have a say in how, where and when I was treated. I also knew, with the certainty I suspected that the back spasms that had started this whole affair had gotten worse, that if I didn’t take the necessary steps, I would receive a $3,000 bill from my insurers for the cost of the ride – and that even if I did everything right, there were no guarantees.
For reasons that have never been clear to me, my insurer’s call center – a policy purchased through a broker in Dubai, regulated in the Channel Islands and under one of the most major insurers of the United States – is located in Scotland, ensuring that the man who answered my call tried as hard as I did to pretend that this situation was normal. I gave him a brief overview: excruciating pain; inability to move; shortness of breath as the spasms deepened; above all the concern to avoid bankruptcy by reminding him that I had no control over the hospital from which the ambulance came, that is to say whether or not it was part of my insurance network.
“Good,” he said. “RIGHT.” I asked him if he could pre-authorize coverage and he said he could certainly try, but of course “that doesn’t mean…” He trailed off. “But it can’t hurt, can it!” » he said sharply, at which point I started breathing heavily and with pain, taking us from one scenario (the policyholder asks for prior authorization) to another (the woman is nervous, requires careful handling). “I’m just going to talk nonsense to you, if that’s okay?” » he said softly and started to tell me about the weather in Scotland. It was lovely, in its own way, but after a few moments things didn’t seem to be going well and I hung up to call 911.
Pro Tip: If you’re ever in New York and suffering, the phrase “I just need a little fentanyl to get me moving again!” » will not have the desired effect. Ten minutes later, two paramedics at my bedside sternly informed me that the city’s paramedics did not carry painkillers, for obvious safety reasons. This is a very bad moment for me in terms of my confidence in consumer choice in American health care. “Look,” I said desperately, gesturing to a bottle at my bedside, “I have two oxycodones left since this happened four years ago – that’s how much. not of a drug addict that I am! “I doubt it will work that far,” the paramedic said – no shit – and carried me on a stretcher to the ambulance, yapping.
I could emphasize here the limits of choice in health care or the desperate anxiety over the cost of emergency care in the United States. Truth be told, though, the sweet relief of not being in pain hasn’t completely worn off yet. In the emergency room, the doctor, when she finally saw me, offered me a pathetic lidocaine pain patch, which might as well have been a wooden board to bite on. “Uh,” I said, sweating and shaking and trying with every fiber of my being to convey a non-opioid-addict vibe. A man in the hallway shouted, “I’m hurt!” I’m in pain” – shut up, idiot, you’ll ruin it for all of us – and the doctor sighed. As if to give in, she ordered the nurse to put me on a morphine drip until morning, which was certainly paradise, but the price would be expensive. Now I’m home, feeling better, and preparing to take on the cost: bill, appeal, escalation, possible arbitration, and the enormous expense of time and money that is a guaranteed part of getting sick in the States -United. The real pain begins.