Jan Gambino Jan Gambino's Blog

Medical Insurance Blues

If you live in the United States, it is likely you have one of the hundreds of insurance plans out there. They all have their own quirky rules, approved medications and lists of contracted physicians. Over the years, my family has been enrolled in several plans. Believe me; we have sampled many of the services: outpatient, inpatient, lab, satellite center, free standing surgery center, durable medical equipment, and pharmacy...I could go on and on.

One thing that really bugs me is the need for a written referral to see a specialist or to authorize a procedure. Yes, I understand that some patients may overuse the medical care system and use the Emergency Room for a hangnail. My kids needed to see many specialists so I was constantly requesting referrals and keeping track of all of the changes in insurance rules. It seemed like an unnecessary burden when my hands were full and my brain was overloaded with the day to day struggles to go through more hoops. Each time one of my kids needed to see a specialist, I had to call the pediatricians office and get authorization. In a day or two, I had to go to the office to pick up the written referral. Most difficult of all, I had to remember to bring the referral with me to the doctor’s appointment!

It seemed kind of ridiculous to get a referral for a test or procedure. Who in their right mind would WANT their kid to have an Upper GI test or ingest a radioactive nucleotide for a milk scan? It seems like parents of sick kids should just get an upgrade-like getting a Gold Card for being a frequent flier. Imagine waving your Gold Card at the patient registration desk or having a special line? You and the doctor’s office staff would have additional hours in the day. I can honestly say there would not be any overuse of the medical system. None of my friends at the playground were jealous that I got to drive an hour to the city to wait another hour for a test and then bring home an exhausted, stressed kid.

I wish the insurance companies realized how much time and energy it takes to comply with the rules and keep up with the changes.


Check with your
doctor first!