Tuesday, December 11, 2007

Ho Ho Ho, HMO

We were about 10 minutes into "Sicko," when we realized the indictment about the health insurance industry may not be the best choice for Saturday night diversions.

Scene One: A guy losing two fingers and being told by insurance to pick which one he wanted.

"Uhhh ... you sure you want to watch this, Mo?"

Scene Two: A couple losing their house because of medical bills.

"Maybe we should just play Scrabble?"

Scene Three: An insurance executive telling Congress her job is to deny 15-25 percent of claims, regardless of merit.

"Alright! Turn it off already," Mo relented.

Like it or not, we're now at the mercy of insurance companies. It's something we'd rather not think about much. We know some daunting bills may be in our future. We're looking at co-pays of about $150 a month alone for specialists to maintain the status quo.

But mark today on your calenders: Thank God for soulless HMOs!

We're happy to report that Hope is approved for five Synagis shots. That's the hardcore monthly dose that costs $1,000 a pop and wards off colds and flu strains for preemies or newborns at risk for respiratory problems. We heard it could be a hassle and insurance companies were often reluctant to pay, but it was easy-squeasy and she'll receive the shots until the cold season ends in April.

That may be because we found a good pediatrician. Our man Muller called the insurance stiffs, lobbied the case and seems to be reliable about returning phone calls, writing referrals and being uber-thorough with Hope. We were sweating it for a while and had scheduled fall-back appointments with other pediatricians, fully expecting that finding someone we liked would be a struggle.

We're also grateful that he agreed to ease Hope's wait to see a gastrointestinal specialist by writing a prescription for infant Prevacid. The drug -- which is a lot like Zantac (not to be confused with Xanax) -- should help with her reflux. It's grown worse lately. Sometimes, she spits up food through her nose immediately after feeds. Others, she waits until it's a fully digested, chalky protein and lets it loose two hours later through her nose.

She's right on schedule. We've learned that reflux -- or Gastrointestinal Reflux Disease -- tends to worsen about 1 month after birth because infants' stomachs began producing more acids.

We have only moderate expectations for the Zantac. If nothing else, it should ease some of Hope's discomfort. But it's exactly what we wanted to try and we're grateful the doctors thus far have been so cooperative.

So who's with us? Three cheers for corporate muckety mucks making decisions about our health through spreadsheets in glass towers! Hip hip, hooray.... Hip, hip, hooray ... Hip, hip ... Aww, the heck with it.


Brooklyn Salt said...

Good news you got approved for the shots.

Bad news about medical insurance. I'm sorry that the medical insurers will cause you even more headaches.

Anonymous said...

Yay for HMO's, good docs, cats in sinks, and babies at Christmastime!! Double-yay for a smile!!! (Boo to reflux and teensy ear canals, but yay for meds and good docs again.)

She's a peach! Thanks for keeping the video coming -- we love it!!

Lotsa love from Maine!!