Sunday, November 01, 2009

A Cadillac Medical Plan?

With so many people unable to afford medical insurance or be ineligible for it, I am very fortunate that we have a great plan through Stephen's work. We have no co-pay for doctor's visits or prescription drugs (unless we chose name-brand over generic then we pay $40). I do not need a referral to see a specialist and we have mental health benefits (which allowed me to see my Crazy Doctor for two years as well as allow Jax to see his psychologist for one year where they used biofeedback to teach him how to calm down when he is anxious).

This morning, I was able to take advantage of one of the other great parts of the plan which is a house call by a doctor. Yes, an actual house call! As I have mentioned in previous posts, I have not been feeling well for about a week but it was not until last night that I knew that I needed to see a doctor and it could not wait until Monday. I called our nurse line and after several questions, I was referred to the medical mobile service. They called a short while later to say that a doctor would call me. And he did and he came by to examine me. Sure enough, I have a severe sinus infection (which explains why it felt as though my head were about to explode and why I was coughing up icky stuff).

So, is my plan one of the so-called "gold-plated Cadillac plans" that people talk about?

It may seem like a very ritzy benefit to have access at home to a doctor but really it is less expensive for the company to send a doctor out than for a visit to an emergency room or urgent care center. I have had friends who have had the doctor come out to give their kids stitches, diagnose an ear infection or inspect an infection (possible MSRA). How much money did the company save? Probably a lot. I know last spring when I took Dex to the emergency room when he had pneumonia, our medical plan was charged over $500. And we were in/out in 40 minutes in which was probably the only one time in which the ER visit was faster than a house call (which I was hoping to get at that time but the nurse said that I had to get Dex to emergency ASAP). I will see when we get our explanation of benefits how much the medical mobile service charged for today's visit.

In the end, it was only four hours after I first called the nurse line to the time I was picking up my prescription at the pharmacy (they told the doctor it would take 45 minutes when he called it in). If I had gone to urgent care, I am sure I would have spent at least that long waiting to be seen due to the huge number of people who are currently ill with flu-like symptoms (probably H1N1).

So, is it a Cadillac Medical Benefit? Nah, probably more of a practical car like a Toyota (with some bells and whistles). ;)

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