Call an ambulance! Wait, are you sick enough?

(Disclaimer: This blog was written by me and published on another site approximately one year ago. So "today" would not be accurate.)

Today, we had healthcare open enrollment at my place of employment and I must say that I'm overwhelming pleased that in 2008, I will no longer have to make contributions for medical coverage - my employer will fully cover the cost. Bravo!

Our benefits rep and I started to discuss coverage details, deductibles, co-pays and such. We later began to talk about emergency coverage, ambulance usage, etc. In California (I don't know if this applies in other states) but according to the rep, most ambulance factions don't invoice the insurance company directly. They invoice YOU!

"Hmm," I thought. We continued to talk about PPO, HMO, in-network, out-of network, FSA, cost of prescriptions, etc. - but what stuck with me was the fact that my legitimacy in calling an ambulance was now up for debate.

Let me explain.

You will be invoiced if it is determined that an ambulance was used but not needed. In proving this point, someone gave the example of not calling an ambulance if you have a migraine. Well THAT is not a good example for me because I am one of the millions of Americans who suffer from migraines that typically block my vision when active. So how the heck am I suppose to get to the hospital should I feel that my head is about to explode? Oh wait, I guess I could stop mid delirium, try to focus my vision to call someone to pick me up and take me to hospital. Great point. [Insert sarcasm here.]

Who decides what's legitimate or not in calling an ambulance and when did this change? Now in all fairness, I began to think that some limitations had to be implemented to avoid an abuse of the system. Another co-worker mentioned that back in the day if you were picked up by an ambulance the inference was that whatever was going on with you was urgent and therefore you were seen immediately over those waiting in a triage unit. I dont know if the masses are all tired of being stuck in triage and are calling an ambulance for a toe splinter...[insert more sarcasm], but i need to be fair and recognize the potential for again...abuse of the system. Point taken. (I'm slightly off the soap box.)

Today the rep told me that once billed, you have to prove hospital admittance to have ambulance costs paid/covered. (I'm back on my soap box.)

Michael Moore's film "Sicko," examines the frivolous loop holes in our healthcare system as well as some of its harsh ramifications.

Check your healthcare coverage. Changes are happening and some are for the good, while others are just plain silly.