Atta Ikede

July 17, 2008


Filed under: San Francisco — attaikede @ 4:52 pm

I caught the flu last week and although I survived most of the symptoms with Tylenol, a stubborn cough and a couple other symptoms have stuck and gotten worse over the past couple days. After my third sleepless night, I woke up this morning and resolved to go to the doctor with one goal in mind: Get codeine. Normal cough medicines had proved useless and after googling my symptoms, it looked like codeine would be an effective way to treat the cough and as a bonus was a pain killer as well.

This was my first time going to a doctor in the US and so I think that’s probably why I put it off so long. Honestly, I should have gone last week cuz I was pretty sick, but I was nervous about the process, the paperwork, and unsure of how much I’d have to shell out. Sure, my plan sounded good in the booklet I read when I signed up for it but maybe there were extra fees and taxes they’d add on at the last minute! Yup. I was pretty worried!


If you’re curious about how health insurance works here then here’s a basic explanation.

There appear to be basically two kinds: HMO (managed care — cheap for a patient) and PPO and its fancy relatives (more patient options — relatively more expensive for a patient).

There are various health companies that offer either or both kinds of health plans. When I started working here, I got a choice of a few different health plans including HMO and PPO options offered by a couple different companies.

Therefore there are two decisions to make: Which company to go with and which type of health plan to choose. These decisions affect your ability to direct your care and affect how much you pay for health care. Unsurprisingly, more flexibility comes with greater patient expense.

The first decision was pretty easy. A couple health companies, such as one called Kaiser Permanente, have a pretty bad reputation for being cheapskates and for treating patients like crap. The bad things I’ve heard about about these bad companies is that you’re “just a number” to them and have no say over your medical care and they just do whatever’s cheapest for them and not harmful to you. Obviously I have no personal experience with any of this so I can’t say whether there’s any truth to those claims. What I do know is that Kaiser has some amazingly cheap plans — it’s $5 copay for pretty much anything — and they have a really convenient campus in San Francisco. Need back surgery? Building A. Hip replacement? Building B. Walkin clinic? Building C. All this on a leafy campus in the heart of the city! Doesn’t sound too bad, does it? Well, I dunno. The bad things I’ve heard about Kaiser did make me nervous, and since the alternative health company I could choose from had a campus that was more convenient for me to get to, I chose the alternative. Better safe than sorry.

The second decision was extremely stressful. Do I trust my HMO to handle all my health needs or do I pay extra to have more flexibility? After fretting over this for a few days and asking my coworkers what choice they had made, I decided to cheap out and go for HMO. The following factors informed my decision: (1) I don’t have any complicated health problems where I have to seek out all kinds of health advice and go for treatments (2) San Francisco has a strong health network and the HMO I chose has a good hospital here. It’s not like i’m signing myself up with some sketchy company in a rural town that only has 2 doctors and no labs — I can reasonably expect competent, professional service from the company I chose and San Francisco hospitals seem to be pretty decent (3) I don’t really know anything about healthcare … is patient choice valuable to me if I don’t have the knowledgeto make an informed decision? What type of choice would I be capable of making? If an emergency happened then I’d be shipped off to the ER anyway, so I figure directing my normal health coverage is a pointless privelege I don’t want to pay extra for.

After those two decisions are made, you fill out the paperwork and pick a primary care doctor within the network you signed up for. I picked a woman who has an office in a hospital/medical center near where I live — just a couple blocks away. Since I picked HMO, I think the deal is that she’ll have to refer me to any other specialists I need to see. (Had I opted for PPO, I am pretty sure would have had more flexibility to make myself appointments for any specialists I thought i needed to see.) Anyway, the doctor I picked is affiliated with the California Pacific Medical Center, which is a decent hospital and so feel like whatever specialist I am referred to, should I need one, will be competent.

That’s it!

The plan you signed up for tells you what copays are for various treatments. Copays are what the patient pays out of pocket. If my copay was $5, I pay $5 and insurance pays the rest regardless of whether it’s $95 or $995. The cheap HMOs, like Kaiser, have a $5 copay on almost every procedure. Surgeries, hospital stays, regular doctor visits. My HMO is not quite as cheap as Kaiser and so has some slightly higher payments on things like hospital visits but it’s still pretty cheap compared to the copays for the PPO option. PPO is way more expensive because their flat rate copay is higher – like say $10 or $20 as opposed to $5 and they sometimes have additional percentage charges too. That’s where things get really dicey because medical bills can end up totalling to obscene amounts! Paying 5% of $100 isnt’ bad, but $1000?
The pharmacy part of the health plan works on the same copay principle as the doctor part. For example, the plan I’m with has me paying $10 copay on most drugs. The insurance company pays the rest.

Anyway, in summary, my first US doctor visit went really well and cost me $40 for the visit and the medicines she prescribed. The charges were exactly what had been quoted in the booklet and there were no surprises anywhere in the process.

I had to shuttle around a bit trying to find my doctor on the campus but the staff were really helpful and I eventually found my way. My doctor’s office doesn’t take drop ins but I was lucky that a nurse who can write prescriptions was able to see me, and since I only had flu like symptoms this seemed ok to me. I got to the office at 1, got an appointment at 3:15, saw the nurse at 4 and was on my way to the pharmacy with 3 prescription slips 15 minutes later.

I was a little shocked that I was prescribed THREE medicines for my symptoms (yes, codeine was one of them) but luckily my copay on medicines is only $10. If they make me feel better then it’s worth it, and if not, it’s only $10 down the drain. Another shocking thing about the medicines is that without a plan, each one of those prescriptions would have cost a couple hundred bucks! I hadn’t realized that the difference between being insured and non insured is so vast.
Hmm .. it’s time for me to go back to the pharmacy and pick up my meds. I can’t wait! I am really looking forward to getting a good night’s sleep tonight!



  1. Thank you, finally I learned about the health system in the US.
    Does the medicine really cost couple hundred bucks?!! Or do they price it that way so people feel better and thinking insurance pays the rest?!

    Comment by picnic buddy — July 18, 2008 @ 5:38 pm

  2. I truly hope you are getting wonderful nights’ sleep and are back to yourself in no time!!

    Comment by Lisa — July 22, 2008 @ 3:55 pm

  3. Hope you’re feeling all better!

    Comment by rabbitdownunder — July 25, 2008 @ 8:19 pm

  4. That’s the really interesting thing about pharmaceuticals. They’re just like any other product and are priced so the company can profit. Prices change depending on the country. For example, drug prices in the states are a lot higher than in Canada .. and this is for exactly the same pill!

    Comment by attaikede — July 27, 2008 @ 11:37 am

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