71) Medical scare... so grateful to our medical care- how do insurance coverages compare?

It's been quite a week.  On Wednesday afternoon, Sasha had a sudden loss of his vision in which his vision became very blurred for about ten minutes then cleared a bit but stayed blurry.  Sasha already has visual impairment from the optic nerve atrophy caused by his tumor and surgery back in 2011.  He is able to correct his right eye to 20/100 (with glasses) but his left eye is uncorrectable at 20/360.  Without his glasses, he is considered legally blind (right eye is 20/200 uncorrected) and with his glasses, he is considered "low vision."  In any case, the sudden change in his vision was alarming and led us to bring him to the emergency department at the hospital.  There, he had a CT scan to check for any large mass (his tumor has a tendency to regrow) or large brain bleed.  Fortunately, the CT scan was reassuring and ruled out these problems but he still needed an MRI and an ophthalmological exam for more a more detailed view of what might be causing his vision changes.  The very next day (yesterday), Sasha was offered a MRI followed by an appointment with the ophthalmologist.  To our relief, the MRI and eye exam were also negative (NO news is GOOD news in the medical world).  Although his vision has remained blurry and we still have no explanation for his vision changes, we are relieved to know that they are not caused by the scary problems my overly active imagination were conjuring up.  Due to his atrophied optic nerve, we were told that sometimes there are changes to vision and that all we can do is "wait and see" if the vision changes back to its former state.  We will also have his eyes checked by an optometrist in case his vision problems are refractory in nature and might be helped by corrective lenses.

In the last 6 years since Sasha's tumor diagnosis and surgery,  I have felt so fortunate for the amazing medical care we have with our medical insurance and provider, Kaiser Permanente.  In this recent situation, Sasha was treated in the emergency department, had a CT scan, MRI scan, ophthalmology exam, and was informed of the reassuring results- all in less than 24 hours!

Kaiser (the largest HMO in the US) is a major medical provider in California where we live and provides "one stop shopping" by offering comprehensive medical care all under one roof.  In Northern California alone, there are 20 hospitals and 54 outpatient clinics totaling 8000 physicians in the region. All medical providers in all departments are connected under one system and use the same electronic medical records (for ease of referrals, communications, etc).  As a Kaiser provider myself (psychologist), I find it very patient-friendly since my job is to focus solely on treating my patients.  Unlike other medical providers who work in other types of clinics, I have absolutely no responsibilities to bill or collect fees or hassle with insurance matters.

As a very high maintenance patient, Sasha has truly reaped the many benefits from Kaiser- all of his physicians work in the same system and he has seen A LOT of them!  Besides his regular pediatrician, he has had treatment by providers from the following specialities: emergency medicine, radiology, endocrinology, neurosurgery, neurology, physical therapy, speech therapy, occupational therapy, dermatology, nutrition, genetics, ophthalmology, psychiatry, pharmacy, otolaryngology, and sleep medicine/pulmonology.  We have never had any problems whatsoever fighting for his care because whatever has been needed (referrals, medicines, treatments, equipment, etc.) for him has been granted swiftly and easily.  When Kaiser has not been able to offer the care with its own providers, Kaiser has paid outside contractors (such as with his speech therapy, psychotherapy, overnight sleep studies). The only exception to this (ironically) has been oxytocin but that is because it is considered too experimental a drug to prescribe and is not in the Kaiser drug formulary. Besides the excellent care, I am an employee of Kaiser and I have the option for bargain-priced coverage: $70 comes out of my paycheck each month which covers myself and family for medical coverage.  This includes NO cost for hospitalization, surgery, MRI, etc.  (big ticket items) and other routine items like laboratory tests; $25 for emergency room visits; $10 for prescription drugs; $10 for all other outpatient appointments.  There is never any deductible.  After talking to a friend this morning who has had to fight tooth and nail for her medical care from the insurance company while still dealing with a high deductible AND high co-pays, there is just no comparison between her experience and ours.  She even shared an absurd story with me about bringing her son into the emergency department because he cut himself on his thumb by accident- he didn't need stitches as they feared he would- he needed only a butterfly bandage.  Cost of visit= $2,000! She will probably end up having to pay for 40% of that visit, $800 for a bandage, ugh!!

I am VERY grateful to Kaiser (both as my employer and my health insurance provider) for the excellent care Sasha has received. I know that others are not as fortunate with health coverage and I think this is WRONG.  In our current political climate, there is much talk now about repealing/replacing the Affordable Care Act (Obamacare).  Irrespective of one's political opinion about what is best to do in regards to our country's health care, most would agree that having excellent and affordable health care is a MUST especially if one has serious and chronic medical conditions such as Sasha.

If you care to share about your satisfaction with your medical care, medical insurance coverage, and costs, I would be very interested in learning about it.  Please write your comments below, thank you!