Blue Cross blues
I was a naive Canuck lost in the wilderness of American health care, Sylvia Mulholland writes
Facts & Arguments is a daily personal piece submitted by readers. Have a story to tell? See our guidelines at tgam.ca/essayguide.
When I moved from Toronto to Los Angeles in my 40s, health-care coverage was not a huge concern. I arrived in the summer of 2001, after giving up a law partnership in a big Canadian firm to study screenwriting (please, stop laughing).
I was in the United States on a student visa and I figured I could always head back up north if anything really bad happened, health-wise. But being a die-hard Canuck, I was still anxious. What if I had an emergency of such catastrophic nature that there wouldn't be time to airlift me home to Toronto?
I signed up for what's known as "Hit by a Bus" emergency coverage from Blue Cross, for $450 (U.S.) a month. And got on with my screenwriting program.
Six months later, I awoke with abdominal pains so intense I could barely stand, let alone arrange an airlift home. I had a friend rush me to the nearest hospital – Cedars Sinai in Beverly Hills, where all the movie stars go to have their babies. I was not concerned that the place looked more like a four-star hotel than a hospital.
Fast forward 12 hours and I was on a morphine drip (no complaints there) and had been visited by a parade of specialists, a gaggle of interns and residents and presented with an array of delectable options rarely seen under my government-funded health-care plan in Canada. Would I like a CT scan? An ultrasound? How about an MRI?
I began to get uneasy. "You're the doctors," I (nervously) joked, "aren't you supposed to tell me what I need?" (Ah, a simple Canuck, lost in the wilderness of American health care.)
By midnight, the pain had dwindled to a vague cramp, with no diagnosis having been made. "Would you like to stay overnight?" one of the doctors asked.
I wasn't sure I'd heard properly. In Canada, only a year before, I'd been dropkicked to the curb in a wheelchair with my head still in a vomit bag, a couple of hours post surgery.
But here I was at Cedars, being offered a bed – presumably whether I needed one or not. Panicking, I yanked the tube out of my arm and pronounced myself ready to go home.
A month later, I got a bill for (drum roll, please) $14,000. It came with a whack of paperwork to back it up. I almost laughed out loud (it was either that or cry). It had to be a mistake.
I called Blue Cross and reminded the representative that I had emergency coverage, so the bill was clearly in error by several zeros.
"It wasn't an emergency," the representative replied drily.
"How to do you know?" I demanded, "Were you there?"
"Did you have any surgery?" he asked. "Stitches?"
I had to admit that I had not, since "surgery" was not one of the choices offered on the à la carte menu presented to me at Cedars. Was the key to getting an insurance company to pay up to beg an ER doctor to cut or stitch something – anything! – so you wouldn't have to file for bankruptcy when the hospital bills arrived?
I made many more whining phone calls to Blue Cross and they sent me a revised bill for $5,000. As a student living off the tatters my RRSP, I was as likely to cough up $5,000 as $50,000. I dusted off my legal hat, pulled out my policy and started highlighting paragraphs that supported my claim to having, indeed, needed emergency care. Then I found out about the Superintendent of Insurance for California. Though I never met this person, he (or she) seemed sympathetic to my cause. After receiving copies of my bills, my highlighted policy and lengthy explanatory letters, I eventually received a final bill from Cedars for $1,400, about the cost of a lunch for four at the Ivy, where celebrities like to lunch. I paid this off with a grudging $100 a month, which likely wiped out my nascent credit score.
In the United States today, with all this Trump talk about open markets and health-care choices that Americans demand, need and want, I really do have to laugh out loud. The average American, heck, the average person anywhere, doesn't know what they need by way of a health-care policy. They want damn coverage! That's it.
Canada is regularly bad-mouthed in the United States as either a country that has messed up on health care (long waits are the favoured bugaboo) or touted as a country that has its act together, depending on which politician is talking on which cable network.
In Canada, I had no choice: I got what I got, and I liked it. In the States, most people (me, certainly) don't have the mental machete needed to hack though all the bumpf about premiums, deductibles, co-pays, out-of-pocket limits, in network, out of network and so on, to choose a health-care plan.
Fortunately, I am covered now under my husband's work policy. We pay $500 a month, our annual deductible is $3,000 and the out-of-pocket ceiling is $6,000, meaning that after we have paid our deductible for the year and then another $3,000 in our share of "co-payments" for medical care, the remainder (apart from the monthly fee) would be "no charge." But all those numbers click back to zero at the start of his employer's fiscal year, which in our case happens to be July. "Honey," my husband likes to joke, "if you're going to get really sick this year, could you please do it before July?" I smile ruefully every time. We are among the extremely lucky ones.
Sylvia Mulholland lives in Long Beach, Calif.