Paper Weight
So, this happened. (This will be my fifty-first explanation, but that's okay!) Seth was riding our one-wheel on Friday. He was admittedly going too fast (the machine was actually beeping at him!) and he fell off, wrecking himself on the asphalt. Besides the mean road rash you see in the picture, he also sprained his left wrist and broke his collar bone on the right side. Broke. His. Clavicle.
"What's a one-wheel; is that like a unicycle?" is our most commonly asked question. And since a picture is worth a thousand words, this is a one-wheel:
We are so thankful Seth was wearing his helmet, that I was out for a walk on the same street with him at the time it happened, and that it was not worse.
What I am having a harder time being thankful for is insurance. Since when does an insurance company get to tell me that we can or cannot be seen by a doctor? Let me back up.
We went to the ER shortly after the accident. X-rays happened. The x-ray report for his upper torso reads this way: "Right mid clavicle fracture with shortening and greater than a shaft width displacement." Again, since a picture is worth way more than words, his collar bone xray looked very similar to this:
At 8:24 on Monday morning, I phoned the number they had given me for Nemours Orthopedics. I waited 22 minutes on hold to speak with someone, only to finally reach... a switchboard operator. Yes, folks, I'm here to tell you in 2025 we still have switchboard operators, I kid you not. I explained that I needed to make an appointment for my son and she said, "Which location?"
"Ooh," I thought, "Maybe they have a new location nearer to me and I won't have to drive downtown and navigate the parking garage." I asked what my options were, and she said, "Are you in Delaware, Pennsylvania, Florida...." Okay. So the number I had been given wasn't even for the Nemours in my state!!" I sighed, resolved to brave the parking garage after all, and said "Jacksonville, Florida." She said, "One minute while I connect you."
18 minutes later....
I finally got someone at the Nemours in Jacksonville, Florida. Now we were getting somewhere! I explained the broken collar bone situation we were in, and that the ER doctor had recommended we call Monday morning for an appointment this week. I opened my planner and got my pencil poised to write down our appointment. Only she didn't give me one.
"What type of insurance do you have?" she asked. I told her. She clarified, "Is that the 'MyBlue' plan, by any chance?" I suddenly wasn't sure and had to fumble around in my purse, grab my wallet, and fish out the card, which stubbornly refused to come out of its slot. "Yes!" I announced, a little too triumphantly.
"That kind of insurance requires a referral and prior authorization before you can be seen by a specialist." She said "That kind of insurance" as if it smelled like rotten potatoes. "I can't make you an appointment until you've seen his Primary Care Physician and gotten an authorization," she said, bored already that I was still on the phone wasting her time with my pretend insurance.
My mind reeled as the full meaning of her words sank in. Broken clavicle. Doesn't matter.
In vain, I appealed to her common sense. "We just got this insurance in January, and we haven't even seen the primary care physician that was assigned to us," I explained. "We were seen by a doctor in the ER. She gave us a referral to call you." Confident that this would be sufficient. She repeated her refusal to make me an appointment, with a thin, "I'm sorry."
Hanging up, bewildered, I remembered that we had gotten a letter assigning us a PCP, so I dug through the pile on my desk until I found it and called that number. The ten minutes I was on hold crept by. "I"m sorry, we're not taking new patients," said this receptionist, a little too cheerfully. I shut my eyes and bit my lip as she calmly explained that I now needed to call my insurance company to let them know that I needed to be reassigned to a different PCP, so that Seth could be seen hopefully soon, and get my referral to the specialist.
Let me take a break for a second as we digest this. It is possible, here in the United States in the year 2025, to BREAK YOUR COLLAR BONE and have an insurance company hold you hostage in needless paperwork run-around and reassigning of doctors and charging of copays and waiting for authorizations from their approved doctors before you can see someone who can determine if you will need surgery or not. Make it make sense.
After another hour on the phone with someone deep in the heart of Mexico, whom I could barely understand, we had an appointment with a new Primary Care Physician for Tuesday at 11. That appointment lasted all of 4 minutes, in which they charged me $90, took Seth's vitals, reviewed the xray, and confirmed that they would be writing him a referral to see an orthopedic doctor. Poor Seth, who thought he was there to actually find out if he was getting surgery or not, exclaimed, "That was it? What did they need me here for? I was like a paper weight at that appointment!"
That's funny, Seth. That's exactly how I feel about insurance companies at this point!
It is currently Wednesday, five days after his accident, and we are still waiting for the insurance company to approve the referral.
The hope I have and the truth that I must keep resting on is that God is in control of it all. Isaiah 51:12-15 says,
"I, I am He who comforts you; who are you that you are afraid of man who dies, of the son of man who is made like grass, and have forgotten the LORD, your Maker, who stretched out the heavens and laid the foundation of the earth, and you fear continually all the day because of the wrath of the oppressor, when he sets himself to destroy? And where is the wrath of the oppressor? I am the LORD your God, who stirs up the sea so that its waves roar--the LORD of hosts is His name."
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