This was not our first move to the US, so I was familiar with “in-network” vs. “out-of-network” providers, but if moving is a pain, it’s even worse when you have to find new doctors, dentists and optometrists and navigate a system totally different from what you are used to.
In big cities, you can’t just go based on recommendations of office co-workers because they may live in a different borough. So, we asked neighbours and moms from school for recommendations, called insurance companies to make sure providers were in network, walked around to see if the locations were convenient (last thing you want is an inconvenient pediatrician’s office when you have a sick child, bad weather and no car).
Somehow we lucked out on most providers.
Dentists: Most kids in the neighbourhood go see a pediatric dentist who is really nice and has a double room available so siblings can have appointments at the same time (think two hygienists cleaning teeth simultaneously while each kid watches a video on the ceiling-mounted tv)…genius! And if that weren’t enough, the dentist’s wife is an orthodontist in the practice next door.
Our “adult” dentist was referred by one of the moms at school. His office has rooms overlooking Central Park and the technology he uses is amazing. Digital X-rays, an infrared cavity detector and a drill that emits less heat and vibrates less so you don’t need anaesthetic for most small to medium cavities. I had a cavity under an existing filling that was coming loose and was in and out of the office in literally 20 minutes! No freezing, no soreness, no eating/drinking restrictions. Amazing.
Doctors: Finding a doctor was straightforward by searching the insurance company’s website and we found a nearby practice that has a pediatric clinic, general practice, dermatology and possibly other specialties under the same roof. Obviously there are several differences from seeing a physician in Canada: patients can self-refer to see a specialist; it is common for even healthy kids to see pediatricians; our primary practice clinic is staffed by internists (and yes, we are two healthy 30-somethings); the clinic is beautiful and modern (privatized medicine); we have a co-payment for each visit; we receive a breakdown of services rendered and pricing from the insurance company. Seeing a bunch of specialists is overkill and adds to the cost of healthcare in the US, but what I do like is seeing is the “This is not a bill” statement from the insurance company. I like it for three reasons:
1) An appreciation of the buying power insurance companies have- (e.g., doctor bills insurance $160, the insurance company can slash that to $100 reimbursable – with the balance NOT passed on to the patient, per contract).
2) Gratefulness for my husband’s work-sponsored insurance.
3) A renewed appreciation for Canada’s socialized medicine where anyone, regardless of ability to pay, has access to quality health care without worrying about ability to pay. Being without health insurance in the US could easily bankrupt a person.
Hospitals: Knock on wood we haven’t had to go to the hospital yet, but I did call the insurance company to find out which hospitals are “in network” just in case. Can you imagine trying to figure that out during an emergency? A friend’s child was recently admitted to the children’s hospital which is in our network (child is ok!) and as far as hospitals go it sounds pretty nice…good food, play room, library, sing alongs, music therapists who come to the kid’s rooms to sing songs with them…but (!) their ER is the first one they’ve been to that doesn’t send kids home with a toy! When she told me this I gave a bewhiskered laugh and reminded her that when healthcare fees come from taxpayer dollars there are no toys sent home from the ER!
Eye care: words of advice – make sure your optometrist and optician take your insurance. My husband used a recent eye prescription from Canada at the localoptician and chose some nice new glasses….but upon submitting the receipt found out the provider was out-of-network and we were out-of-luck. Needless to say, we learned from that experience 🙂