Thursday, February 2, 2012

"If This Is a Medical Emergency, Please Hang Up And Dial 911..."

"... or proceed to your nearest emergency room."

5 times today I've heard that message. 5 freaking times.

My head's about to explode. Does that count as a 'medical emergency'?

Or, how about if I don't get somewhere soon, I'm gonna kill someone. That would be a medical emergency for them, right?

Can I call 911 and just vent?

The Ginger has a nodule (the dentist's word, not mine) in his cheek. It just sprang up 2 days ago. A hard knot, right near his jaw, that doesn't hurt him unless I'm squeezing it and pushing at it. So, I called the dentist yesterday and they had an opening right then. Grabbed The Ginger from school, hauled ass to the dentist, thinking it's an abscessed tooth, and after xrays, it is determined that it's not an abscess.

The dentist thinks it's a blocked salivary gland, but he wasn't sure. So, he gave us a dental (please note the italics- you'll be quite familiar with them by the time this post is done) referral to an oral surgeon, one that is covered under our dental insurance.

I called the oral surgeon this morning (Medical Emergency automated intro message #1), and this ensued:

Me: Yeah, my son was given a referral to your office for a knot he has in his cheek. You all take (insert name of dental insurance here) insurance, right?
Oral Surgeon's Office: Yes, ma'am, but who is your medical insurance through?
Me: (name of medical insurance company given)
OSO: Ma'am, we don't cover that insurance.
Me: What does that mean?
OSO: That means we can't help your son under your insurance.
Me: Why not?
OSO: Because your dental insurance only covers the teeth and the jaw.
Me: Well, the dentist didn't know what it was; it could be attached to his jaw.
OSO: Is it an abscessed tooth?
Me: No.
OSO: Then we can't help you, because we don't accept your medical insurance here.
Me: Aren't you all an oral surgeon? The problem is in his mouth.
OSO: Yes, ma'am, but your dental insurance only covers the teeth and the jaw, not his cheek, or his tongue or anything else in the mouth. That's covered under your medical insurance, and we don't accept that here.
Me: (Extremely frustrated at this point.) So what am I supposed to do?
OSO: Hold please. (Puts me on hold for like 2 minutes.) Yes ma'am, you are going to have to go to the nearest military base and talk to someone in your medical insurance office about getting a medical referral.
Me: That's an hour away, and it's not even the right branch of service.
OSO: Well, ma'am, that's what you have to do. Maybe call your insurance company.
Me: Whatever. Thanks.

So, I decided to call the dental insurance people to get this cleared up (Medical Emergency message #2).

(For flow and length of post, understand I explained everything to the dental insurance operator.)
Dental Insurance Operator: Yes, ma'am, we only cover the teeth and the jaw. If your son has something wrong with his cheek, that's a medical issue.
Me: So what am I supposed to do?
DIO: I advise for you to call your medical insurance company and see what they tell you to do.
Me: Whatever. Thanks.

So, I call the medical insurance company (Medical Emergency message #3).

(Again, explained everything to the medical insurance operator.)
Medical Insurance Operator: Yes, ma'am, we do cover any problems with the mouth that aren't associated with the teeth or jaw.
Me: Thank God. So what do I need to do? Who would be seeing my son?
MIO: Well, ma'am, we can't give you a referral over the phone. What you have to do is take your son to his pediatrician, have them check him out, and if it is indeed a problem for an oral surgeon specialist, then your child's doctor will give you a medical referral to an oral surgeon.
Me: But I already have a referral to an oral surgeon now.
MIO: Yes, ma'am, you have a dental referral to an oral surgeon, not a medical referral.
Me: Holy crap, seriously?
MIO: Yes, ma'am.
Me: Okay, so I need to call and make an appointment with my son's pediatrician, and they'll handle everything if it needs to go past that?
MIO: Yes, ma'am. I advise you to tell them you need an urgent care appointment, though, so you don't have to wait possibly weeks for a regular appointment.
Me: Okay, call pediatrics, get an urgent care appointment.
MIO: Yes, ma'am. And, if you feel that this is a medical emergency, then you can of course head straight to the emergency room without having to call us first. (#4) Medical emergencies are automatically covered under your insurance.
Me: Good to know, thanks.

A fourth call is made, this time to The Ginger's pediatrician (Medical Emergency message #5).

Me: Hi. I need an urgent care appointment for my son.
Pediatrician's Office: Yes, ma'am, I can tell you right now we are extremely booked today, so the earliest I can get you in is 5 o'clock this evening.
Me: Umm (thinking about how I have to work today), okay, that's fine.
PO: What's wrong with your son? (What a loaded question. He's a ginger? He randomly breaks out in Star Wars light saber fights with no one? He sometimes pretends he's a Lego mini figure, and walks around with his  hands cupped like theirs? What are we aiming for here?)
(I explain everything.)
PO: Oh, well, ma'am, for that kind of appointment, the quickest I can get you in is 9:15 tomorrow morning.
Me: But...
PO: We're only doing emergency strep throat appointments today.
Me: Wow, thanks for warning me that my kid would be around strep if he came in today. Yeah, I'll take the 9:15 tomorrow. Now, if the doctor can't help him with like, antibiotics, he'll put in for a medical referral to an oral surgeon, right?
PO: Yes, ma'am, if the doctor can't help him, we'll put in for an insurance approved specialist appointment.
Me: You have no idea how happy that makes me. Thank you very much.
PO: You're welcome, ma'am, we'll see you tomorrow at 9:15.

Son of a b*tch I needed a drink, at 9:30 in the morning, after all of that.

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  1. I'm sorry but I had to laugh out loud because I've had so very many conversations just like that. Freakin' Tricare.

  2. Our nation's military are forced to fight battles on many fronts. Obtaining medical care for their children shouldn't have to be one of them.

    P.S. Once your head finally does explode it is no longer a medical emergency (nothing we can do at that point). Please come see us during the 'worst headache of my life' phase. :)

  3. This is the first real problem we've ever had with them. They've always handled my crazy mental referrals and appointments just fine, lol. ;) And, I'll keep in mind heading to the emergency room pre-head explosion. Good advice; have the ER clean it up, hahaha. ;)

  4. Oh how frustrating!! I wonder what would have happened here in Canada? We need insurance for dental but if it was considered medical it probably would have been covered by the province.

  5. That sounds amazing. Not dissing my health insurance here (too much), like I said above this is the first problem I've ever really had with them. Just caused a big one.