[Buckle up…this is a long one!]
For over twenty years, I have loved almost every aspect of having my own business, with one enduring exception — navigating the healthcare “system” and insurance marketplace. Any small business owner knows that it’s extremely challenging to find good coverage at a reasonable price. The challenge multiplies when you don’t have a home base. For a while, we tried to keep our Boston coverage and providers, and we’d schedule routine care (yearly physicals, mammogram for me, colonoscopies, dental and eye checkups) for our holiday visits back to see family. However, the post-COVID health situation eventually made that strategy untenable. Our providers kept retiring, and practices were so backed up that we could not get in for visits. It’s pretty much impossible to cram all of your routine medical stuff AND all your family/friend visits into a single week at Christmas time.
After a lot of research (uncovering some pretty scammy health insurance plans in the process), we chose to go with Blue Cross Blue Shield, a large national brand with strong presence in states we were likely to visit and a better than average reputation for customer service. As RV’ers domiciled in Florida, we could sign up for Florida Blue, and we carefully selected a PPO (Preferred Provider Organization) plan that would give us flexibility to get care nationwide. Theoretically.
In year three, as we found ourselves booking longer stays in favorite locations, we finally decided to make San Diego our medical home base. I found a medical practice in Chula Vista (near San Diego) that was accepting patients and was covered by our insurance. Sadly, scheduling our primary care appointment was the only easy thing about the whole situation. At every step of the way — from trying to catch up on all our vaccines, to scheduling a mammogram, to ordering new contact lenses— some bureaucratic roadblock made it difficult to do what we needed to do to be responsible and proactive about our health.
Here are a couple of snapshots from our Adventures in Healthcare:
Vaccinations:
My memories of vaccines were that you’d get them at your primary care provider’s office, typically during your yearly visit. The doctor or nurse practitioner would wrap up the visit, then a nurse would come in and administer whatever you needed. Fully expecting the same scenario this time around, we were a little surprised to hear that the nurse practitioner would indicate which vaccines we needed, but that we’d then take that little sheet of paper to the pharmacy for administration of the vaccines. Well, ok, we got all of our COVID shots at CVS, so we were comfortable with that idea.
And that’s when the fun began.
The day after our checkups, Andrew found a local CVS and scheduled all of our vaccinations. We received cheery texts confirming the vaccinations, and mentally prepared ourselves to be stuck with a bunch of needles. Then I got a text cancelling one vaccination. Then another. Then I got a text cancelling my entire appointment. Andrew’s were still apparently on, so we decided to go to the pharmacy and figure it all out in person. As we walked through the door of the pharmacy, Andrew received the text cancelling his appointment.
After 45 minutes of looking at screens and tapping on the keyboard (I felt like we were at the airport asking to change our flight), the pharmacist informed us that our vaccines would not be covered by insurance because CVS wasn’t in our network. At that point, we started to question whether we really needed 1. flu shot, 2. DTAP, or 3. shingles vaccination (1. Never got one before, why start now. 2. Looked back and realized I still had 5 years to go on that one 3. Absolutely, given what we’d heard and seen from shingles sufferers).
Back home to call Florida Blue to figure out where, indeed, we could get vaccinated. Turns out that while CVS is not covered, Walgreens, Walmart, and Ralph’s grocery stores are. As New Englanders, CVS was typically our go to pharmacy, but we’d settle for Walgreens. And as RV’ers, we had developed a somewhat surprising new appreciation for Walmart. I did, however, draw the line at getting a shingles shot in the grocery store!
Andrew dutifully scheduled us at a local Walgreens. We arrived, checked in, and were called to the window. At that point, the pharmacist says, somewhat sternly, “I need to talk to you.” She informed us that we were not eligible for the prescribed pneumonia shot, and that none of the vaccines would be covered by insurance. Frustrated, and really just wanting to be covered for shingles at this point, we asked how much we would pay for the shingles shots.
$244.
Per person.
Per shot.
For a two shot vaccination.
Yup, $976 for the shingles vaccination alone. Apparently, all those “get your shingles shot here for free” offers are only for folks who have no insurance at all.
Back to the phone to call Florida Blue. This customer service agent clarifies that we cannot get vaccinated at a CVS or Walgreens pharmacy, but we can do so at a CVS Minute Clinic or Walgreens MedExpress.
Because apparently there is a difference.
We had left San Diego by then, and were settled in LA, where Andrew was determined to find a place that would vaccinate us and take our insurance. We tend to research and schedule everything online, but none of the places he’d found offered online scheduling. Finally, the third urgent care clinic he walked into happily vaccinated him for shingles and the flu, no charge, no copay. Delighted to have solved the puzzle, left arm a little sore, he returned to the RV triumphant (and I immediately raced to the same clinic for my shots!).
Routine Screenings
Dear healthcare system: Please do not make it difficult for me to schedule screenings I really don’t want to do in the first place. Seriously, who actually wants to have a mammogram and colonoscopy? Although, that colonoscopy nap IS pretty sweet.
Much as we love to get all of our healthcare stuff taken care of during our 6 – 8 weeks in San Diego, the calendar and ongoing colonoscopy scheduling crunch made that impossible. Turns out, I had received my last mammogram in January, and insurance is very particular about waiting a full year before getting the next one. Fine… our next stop was Coachella, and it would be easy enough to drive the 2.5 hours to San Diego for a 15 minute mammogram.
At that point, we decided that we would schedule our colonoscopies for the same week (which did mean checking into a hotel for an evening, since of course we cannot have colonoscopies on the same day — who would drive us home?!). Great, all set. Mammogram on Monday, Andrew colonoscopy on Tuesday, Michele colonoscopy on Wed, back to the desert Wed night. We were feeling quite proud of ourselves for our health care tetris, and for being so responsible with all of these preventative care measures. Until…
Call #1 from the gastroenterologist: The doctor is no longer available for Michele’s time, can we move to Monday. Well, ok. I’m sure it’s completely ok to prep for a colonoscopy, have a mammogram, then have a colonoscopy. How bad could it be? Well, I never found out, because…
Call #2 from the gastroenterologist: Your insurance company won’t cover Michele’s procedure in the hospital, we need to schedule in the clinic. OK, fine. We will move the appointment to Thursday.
By the way, in the time between scheduling all of this and actually having the procedures, we managed to buy our new RV. So we also had to spend that week prepping to move! Probably the low point of the entire escapade was transferring all of our worldly possessions from old RV to new, the day before Michele’s colonoscopy — IYKYK! Much electrolyte drink was consumed…
