It's been 4 days since I injured my knee and in that time, at least 40 phone calls have been made either to schedule appointments or to settle insurance matters.
On Saturday, when I skied into the first aid office on the mountain, I was able to get medical treatment without paying a cent up front. However, I was given paperwork to fill out with my insurance information in order to cover the bills, as expected.
When I got home that night, I tried to call the local hospital to see if I could schedule an appointment with a specialist. After a few more calls, I ran into a dead end - the orthopedic center was, understandably, closed on weekends and I would have to wait until Monday to speak to anyone. I then tried to contact my visa sponsor to discuss insurance coverage, but they weren't open on weekends either. I should have stopped there, but I gave the insurance company a call too - to no avail.
On Sunday, I made zero phone calls. Instead, I mulled over my two insurance options - my parents' insurance and my co-op insurance. I knew I was covered for emergencies under my parents' plan, but I wasn't sure how extended the coverage was. For the co-op insurance, I was provided with very vague details by my visa sponsor, through which the insurance was obtained. This insurance seemed to cover most of the services I required, as long as I was not treated in an ER - which I didn't think I was.
Oh wait, I actually did make one phone call - to the ski clinic. I asked them if they could possibly recommend a surgeon since I probably wouldn't be able to get an appointment otherwise. That was my prediction anyway. They replied in the negative - patients were expected to know what was best for them and thus, find an appropriate surgeon themselves. Sounded pretty ridiculous to me, but there was nothing further I could do.
On Monday, as soon as I got into the office, I tried calling my co-op insurance company. I was told that I would probably be covered for my initial visit, but that wasn't for sure because the ski clinic may be considered as an ER. Apparently, depending on the write-up of the visit, I could be covered for the full cost or I might have to pay $100. Sorry, I might have to pay $100 plus a $50 deductible. I then brought up the recommended appointment with an orthopedic surgeon - which elicited a no-go response. If I wanted to see a specialist, I'd be paying out of my own pocket.
With that, I tried calling my parents' insurance company. They told me that my initial ski clinic visit would probably be covered - but I shouldn't have any doubts since it was an emergency and I needed the treatment. They'd get back to me. So far so good. But if I wanted to see an orthopedic surgeon, that would not be covered since I'm no longer in an emergency situation. Oh well.
Next, I tried calling the orthopedic center, but using a different method. In August, I went to my family doctor to see if I could get my nose cauterized to stop my nose-bleeding problem. When the receptionist tried scheduling an appointment with a specialist, they were able to book an appointment for the following week. Since I needed similar (i.e. fast) results, I did a little role-playing. Again, I was routed to a bunch of different people, leaving one voice mail message along the way. Once I was finally put through to an office, I tried to schedule an appointment for myself as the receptionist of the ski clinic. It worked - I was scheduled to see a doctor the next morning! One hiccup though - I didn't have a primary care doctor recommendation to back my case. The appointment was cancelled, bursting my brief moment of happiness.
I called my parents next and asked them to book an appointment with my family doctor for me (since I'll be flying home for Christmas), as well as inquire whether I might be able to book an appointment with an orthopedic surgeon in Canada. I figured I might as well see if the Canadian health care system was any better since I wasn't having much luck in the States.
Later in the day, I heard back from my dad. Basically, I was advised to seek treatment in the US since it would take at least a year to schedule an appointment with an orthopedic surgeon in Canada. I didn't know what to do. I couldn't very well wait a whole year - what if my knee got worse?
Then, I got a message from the orthopedic center (since I'd left that one voice mail earlier) telling me that they received my call and could I please give them a ring back? Well, not without insurance I couldn't.
As a last resort, I talked to my company's administrative assistant. She was horrified at the thought of me waiting a whole year to seek medical advice, and baffled by my no-coverage situation in the US. Her next moves were to send emails to the company's co-op coordinators (to see if they had any advice) and to call the orthopedic center. There was no sense in delaying an appointment just because of insurance - my health was more important.
By the end of the day, nothing was resolved. The co-op coordinators said I should be covered (ha!), and no one picked up the phone at the orthopedic center.
On Tuesday, I took a break from phone calls and instead, left the task to the administrative assistant. I'm not sure if she was able to get in touch with the co-op insurance company, but I didn't hear any new information regarding that matter. She did receive a call back from the orthopedic center - and managed to schedule an appointment for the next day in the afternoon. If I wasn't covered by insurance, the visit would cost me $100, and each subsequent visit (if needed) would only cost me 50% of the actual bill. Better than nothing, I guess.
That brings me to today - Wednesday. This morning, I tried calling my parents' insurance company again because they hadn't gotten back to me yesterday. It turns out that they had the wrong phone number, but they had good news - I would be covered 100% for my emergency visit at the ski clinic! Well, with such a good omen, I couldn't help but ask again about coverage for my appointment with the specialist. At first, they told me I wasn't covered, but then a "follow-up visit" was brought into the discussion. I explained my situation again - I injured myself and sought emergency treatment, following which I was requested to seek further diagnosis from a specialist; if I waited until I returned to Canada, I would have to wait a year. This seemed to spark a bit of sympathy and I was promised a call back to see if they had missed anything in my policy.
I debated calling the co-op insurance company again, but in the end, decided against it since I wasn't in the mood to deal with another "no".
I went for my appointment in the afternoon and was examined by a PA. I was surprised at how efficient the clinic was - despite the fact that I arrived 15 minutes early, I was helped into an examination room before I'd even finished filling out the necessary paperwork. The doctor was very attentive as I explained how I injured my knee, after which he tried bending my knee and applying pressure at various angles to see what caused me pain. When he finished, he recommended an MRI scan, but understood if I wished to dismiss his recommendation since that procedure would cost at least $1000 to $1200. Since he didn't want to shoulder me with that debt, he suggested a diagnosis based on his examination of me and his experience with similar cases - I had torn my ACL (anterior cruciate ligament) and possibly torn some cartilage as well.
Because ligaments will not regenerate, nor can they be further damaged once they're torn, I ultimately have two options. The first is surgery, which would involve taking tissue from elsewhere in my body and grafting it to my ACL to reconstruct the ligament. Successful surgery would ensure almost full function of my knee after rehabilitation - it would never be the same again, but it would be as close as medically possible. The second is physical therapy, focused on strengthening my other muscles to support the damaged knee. In time, I should be able to function normally, but may not be able to overstress my knee.
I decided to go with physical therapy - so the doctor gave me a prescription for a one-time treatment (since I'll be going back to Canada soon). I scheduled an appointment for the upcoming Monday and that was that.
Upon returning to the office, I found a message from my parents' insurance company. I called them back and received more good news - today's visit would be fully covered! When I asked about physical therapy, they explained that they wouldn't be able to cover that since it was classified as ongoing treatment, which I could easily do in Canada. Completely understandable.
With no other alternatives - I had to call the co-op insurance company. When I asked them about the physical therapy, they said they wouldn't be able to help me. Why? Because I hadn't undergone surgery, nor had I been admitted into a hospital. I then confirmed that they would perhaps have been able to pay for my ski clinic visit and today's visit, but only if my parents' insurance company hadn't been able to foot the bill. Even then, they would only have been able to pay for 80% of the cost. I guess that's okay - but that means they haven't done anything for me through this entire process. I explained that I saved them money by not being admitted into a hospital, incurring hospital fees. I also saved them money by not having surgery. That being said - because I saved them money, I'm suffering? Does that mean, I should put myself through surgery in order to get the treatment I need?
Their reasoning was based on affordable health care. Since students don't have a lot of money, they provide an affordable insurance. But what good is affordable insurance if you can't use it? Why spend that money if there's no chance of getting what you need when you need it? It doesn't save students money if they can't use the insurance and have to pay for everything themselves! Instead, students could spend a bit more and get health insurance that would actually provide health care!
Anyway, I just needed to get everything off my mind. I'll be contacting my university co-op coordinator about this as well, to make sure he knows how difficult it's been for me to get medical treatment. Thank goodness I had my parents' insurance.
On Saturday, when I skied into the first aid office on the mountain, I was able to get medical treatment without paying a cent up front. However, I was given paperwork to fill out with my insurance information in order to cover the bills, as expected.
When I got home that night, I tried to call the local hospital to see if I could schedule an appointment with a specialist. After a few more calls, I ran into a dead end - the orthopedic center was, understandably, closed on weekends and I would have to wait until Monday to speak to anyone. I then tried to contact my visa sponsor to discuss insurance coverage, but they weren't open on weekends either. I should have stopped there, but I gave the insurance company a call too - to no avail.
On Sunday, I made zero phone calls. Instead, I mulled over my two insurance options - my parents' insurance and my co-op insurance. I knew I was covered for emergencies under my parents' plan, but I wasn't sure how extended the coverage was. For the co-op insurance, I was provided with very vague details by my visa sponsor, through which the insurance was obtained. This insurance seemed to cover most of the services I required, as long as I was not treated in an ER - which I didn't think I was.
Oh wait, I actually did make one phone call - to the ski clinic. I asked them if they could possibly recommend a surgeon since I probably wouldn't be able to get an appointment otherwise. That was my prediction anyway. They replied in the negative - patients were expected to know what was best for them and thus, find an appropriate surgeon themselves. Sounded pretty ridiculous to me, but there was nothing further I could do.
On Monday, as soon as I got into the office, I tried calling my co-op insurance company. I was told that I would probably be covered for my initial visit, but that wasn't for sure because the ski clinic may be considered as an ER. Apparently, depending on the write-up of the visit, I could be covered for the full cost or I might have to pay $100. Sorry, I might have to pay $100 plus a $50 deductible. I then brought up the recommended appointment with an orthopedic surgeon - which elicited a no-go response. If I wanted to see a specialist, I'd be paying out of my own pocket.
With that, I tried calling my parents' insurance company. They told me that my initial ski clinic visit would probably be covered - but I shouldn't have any doubts since it was an emergency and I needed the treatment. They'd get back to me. So far so good. But if I wanted to see an orthopedic surgeon, that would not be covered since I'm no longer in an emergency situation. Oh well.
Next, I tried calling the orthopedic center, but using a different method. In August, I went to my family doctor to see if I could get my nose cauterized to stop my nose-bleeding problem. When the receptionist tried scheduling an appointment with a specialist, they were able to book an appointment for the following week. Since I needed similar (i.e. fast) results, I did a little role-playing. Again, I was routed to a bunch of different people, leaving one voice mail message along the way. Once I was finally put through to an office, I tried to schedule an appointment for myself as the receptionist of the ski clinic. It worked - I was scheduled to see a doctor the next morning! One hiccup though - I didn't have a primary care doctor recommendation to back my case. The appointment was cancelled, bursting my brief moment of happiness.
I called my parents next and asked them to book an appointment with my family doctor for me (since I'll be flying home for Christmas), as well as inquire whether I might be able to book an appointment with an orthopedic surgeon in Canada. I figured I might as well see if the Canadian health care system was any better since I wasn't having much luck in the States.
Later in the day, I heard back from my dad. Basically, I was advised to seek treatment in the US since it would take at least a year to schedule an appointment with an orthopedic surgeon in Canada. I didn't know what to do. I couldn't very well wait a whole year - what if my knee got worse?
Then, I got a message from the orthopedic center (since I'd left that one voice mail earlier) telling me that they received my call and could I please give them a ring back? Well, not without insurance I couldn't.
As a last resort, I talked to my company's administrative assistant. She was horrified at the thought of me waiting a whole year to seek medical advice, and baffled by my no-coverage situation in the US. Her next moves were to send emails to the company's co-op coordinators (to see if they had any advice) and to call the orthopedic center. There was no sense in delaying an appointment just because of insurance - my health was more important.
By the end of the day, nothing was resolved. The co-op coordinators said I should be covered (ha!), and no one picked up the phone at the orthopedic center.
On Tuesday, I took a break from phone calls and instead, left the task to the administrative assistant. I'm not sure if she was able to get in touch with the co-op insurance company, but I didn't hear any new information regarding that matter. She did receive a call back from the orthopedic center - and managed to schedule an appointment for the next day in the afternoon. If I wasn't covered by insurance, the visit would cost me $100, and each subsequent visit (if needed) would only cost me 50% of the actual bill. Better than nothing, I guess.
That brings me to today - Wednesday. This morning, I tried calling my parents' insurance company again because they hadn't gotten back to me yesterday. It turns out that they had the wrong phone number, but they had good news - I would be covered 100% for my emergency visit at the ski clinic! Well, with such a good omen, I couldn't help but ask again about coverage for my appointment with the specialist. At first, they told me I wasn't covered, but then a "follow-up visit" was brought into the discussion. I explained my situation again - I injured myself and sought emergency treatment, following which I was requested to seek further diagnosis from a specialist; if I waited until I returned to Canada, I would have to wait a year. This seemed to spark a bit of sympathy and I was promised a call back to see if they had missed anything in my policy.
I debated calling the co-op insurance company again, but in the end, decided against it since I wasn't in the mood to deal with another "no".
I went for my appointment in the afternoon and was examined by a PA. I was surprised at how efficient the clinic was - despite the fact that I arrived 15 minutes early, I was helped into an examination room before I'd even finished filling out the necessary paperwork. The doctor was very attentive as I explained how I injured my knee, after which he tried bending my knee and applying pressure at various angles to see what caused me pain. When he finished, he recommended an MRI scan, but understood if I wished to dismiss his recommendation since that procedure would cost at least $1000 to $1200. Since he didn't want to shoulder me with that debt, he suggested a diagnosis based on his examination of me and his experience with similar cases - I had torn my ACL (anterior cruciate ligament) and possibly torn some cartilage as well.
Because ligaments will not regenerate, nor can they be further damaged once they're torn, I ultimately have two options. The first is surgery, which would involve taking tissue from elsewhere in my body and grafting it to my ACL to reconstruct the ligament. Successful surgery would ensure almost full function of my knee after rehabilitation - it would never be the same again, but it would be as close as medically possible. The second is physical therapy, focused on strengthening my other muscles to support the damaged knee. In time, I should be able to function normally, but may not be able to overstress my knee.
I decided to go with physical therapy - so the doctor gave me a prescription for a one-time treatment (since I'll be going back to Canada soon). I scheduled an appointment for the upcoming Monday and that was that.
Upon returning to the office, I found a message from my parents' insurance company. I called them back and received more good news - today's visit would be fully covered! When I asked about physical therapy, they explained that they wouldn't be able to cover that since it was classified as ongoing treatment, which I could easily do in Canada. Completely understandable.
With no other alternatives - I had to call the co-op insurance company. When I asked them about the physical therapy, they said they wouldn't be able to help me. Why? Because I hadn't undergone surgery, nor had I been admitted into a hospital. I then confirmed that they would perhaps have been able to pay for my ski clinic visit and today's visit, but only if my parents' insurance company hadn't been able to foot the bill. Even then, they would only have been able to pay for 80% of the cost. I guess that's okay - but that means they haven't done anything for me through this entire process. I explained that I saved them money by not being admitted into a hospital, incurring hospital fees. I also saved them money by not having surgery. That being said - because I saved them money, I'm suffering? Does that mean, I should put myself through surgery in order to get the treatment I need?
Their reasoning was based on affordable health care. Since students don't have a lot of money, they provide an affordable insurance. But what good is affordable insurance if you can't use it? Why spend that money if there's no chance of getting what you need when you need it? It doesn't save students money if they can't use the insurance and have to pay for everything themselves! Instead, students could spend a bit more and get health insurance that would actually provide health care!
Anyway, I just needed to get everything off my mind. I'll be contacting my university co-op coordinator about this as well, to make sure he knows how difficult it's been for me to get medical treatment. Thank goodness I had my parents' insurance.
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