Am I a Bad Mother … Or Just A Lucky Survivor in the Game of Healthcare Roulette?

This year, for the first time, we’ve done something that would have previously been unfathomable for my family. We’ve had to choose who to take to the doctor when everyone needed to go.

I can’t tell you what that feels like to watch your children playing in the living room and debate in your head who should go to the doctor and who shouldn’t. It’s practically un-American, at least culturally, for the near 90 percent of us who have health insurance or Medicare, and most of the rest of us, many of whom qualify for Medicaid.

Do I take the child who has had diarrhea for two weeks, knowing he has lost some weight, or do we just continue to give him Pedialyte, keep him hydrated and hope it finally goes away? Or do I take the child who had tubes put in her ears who is now almost daily holding her hand to her head and complaining that her ear hurts? Do we send my husband, who might have strep? Or do I go to the prenatal appointment I’m due for?

With a typical insurance plan with a $30 co-pay, the answer is simple. We all go and the insurance company picks up the costs, whatever they are. No one stops to consider what the final bill will come to, because we don’t have to pay it.

But my family no longer has a typical insurance plan, so we are no longer typical health care consumers.

This fall, when I was pregnant, I went to about half of the standard, required prenatal appointments moms usually are scheduled for. (My son was born Valentine’s Day.) At one point, I went nine weeks without seeing a doctor, praying every day that my baby was healthy. (I should have seen her twice during that period.)

The doctor’s office would call, reminding me that I was overdue for an appointment. You haven’t been in here in six weeks, the nurse would say disapprovingly, in a voice you could tell she usually reserved for deadbeat, slacker moms, the kind she normally would track down in an alley somewhere.

“Which appointments are important?” I’d ask her.

“All of them,” she snipped back. Then I explained to her that my insurance policy through work comes with a $2,000 deductible for each member of my family. Not a total $2,000 deductible, but $2,000 on each person. Each Jan. 1, it rolls back to zero. What that means is that we end up paying for each appointment out of pocket, because we never reach the deductible. And since we started on this insurance plan in the fall, we were forced to make all of our decisions with the knowledge that rollover would come in January.

We are a solid middle class family, but we simply can’t afford that, I explained to the nurse who called. Between the four of us and with me pregnant, we go to the doctor about three times a month. Without insurance picking up the tab, that costs $300-$400 a pop including medicine, or $900 to $1,200 total for the month. The nurse didn’t have a response for that, but when pushed, she did eventually reluctantly divulge that in fact, some obstetrics appointments were a lot more important than others and helped me pick which appointments to attend.

At the doctor’s office, I’d see other pregnant moms with their Medicaid cards at check-in, moms who weren’t missing their appointments thanks to the taxes I pay, and I’d have to work to banish my unkind thoughts. At least we had health insurance. If something catastrophic happened, we were covered.

So what does a rational consumer do in this situation? Normally you price shop, you bargain and you make difficult decisions. With modern medicine, my husband and I quickly learned, that’s impossible. Doctor’s office staff literally can’t answer a simple question every other business owner knows the answer to off the top of their head: What does your service cost?

“That depends on your insurance company,” they’d tell me, or “We don’t know what we get paid until we file, so you’ll have to call them.”

So I did. The insurance company rep told me I’d have to call the doctor for the price, because they couldn’t say either until I went to the appointment. Are you freaking kidding me?

“OK, what if I’m paying out of pocket, what would it cost then?” I’d ask the people who worked at the doctors’ offices. They all essentially said the same thing.

“Well that would depend on how long the doctor spent with you,” they’d say. “OK, then surely you can tell me how much a block of his time costs,” I’d say. That way we could plan out a quick, to-the-point appointment.

“No. That depends on what he does,” they’d say.

“Well what are the options for what he might do?” I’d ask. “Can you give me a price range?”

“We can’t say until we see you,” they’d say. It annoyed these people that I would even inquire about price. You could hear the exasperation in their voices.

Without exception, at every office I called in town, the person I ended up talking to in billing eventually got snippy with me. When I asked for at least a best and worst case scenario price range, two of the offices I called refused to give me one at all. Two others gave me ranges that were ridiculous. Maybe $189 to $400, but no guarantees, one told me. The other office put it at $175 to $400.

Excuse me, but who the hell runs a business this way in America? The consumer can’t know the price and comparison shop? Heck, even the plumber I use in Charlotte will quote me a specific price before he starts digging in my front yard, even though he doesn’t know exactly what he will find.

Not in modern medicine, where I’ve found that the actual price of goods and services is virtually unknowable before they are purchased by the consumer. (After the appointment, miraculously, they seem to be able to figure that all out and bill you.)

There are a few things you can do to save money. I learned to drive a hard deal by doing another thing that was unfathomable to me a year ago – defy the doctor and pull the customer card. When the whole family was laid out on our bed, barely able to move from a nasty bout of stomach virus this fall, I called my OBGYN, the only doctor I have. (A primary care doctor is a luxury I can’t afford.) She wanted me to come in. I insisted that I had been a good customer and she needed to call in my anti-nausea medication this one time without an appointment.

After some back and forth with the nurse, she did. Then I split it with my husband, which allowed us both to recover just enough to stand up without vomiting and take care of the kids.

We’ve discovered other promising shortcuts. The minute clinic at CVS, unlike the doctor’s office, will quote you an actual firm price on a visit and can tell you the additional cost for a strep test. The CVS clinic tends to come in around $75 to $100 cheaper than the doctor, so we often go there. I call ahead to grill the nurse practicioner on whether she can treat whatever my kids appear to have. A lot of the time she can. So we pay cash.

At one point, due to my copious internet research in order to avoid the doctor’s office, I discovered that the oral ear infection medications doctors had been prescribing for my daughter are only effective in about 10 percent of cases, but that doctors write prescriptions for them anyway to make parents feel better (Thank you Wall Street Journal). So no more oral ear infection medication. We just stick to ear drops. And we’ve gotten good at pressuring the doctor to call in another drops prescription without a visit if we need one. You’ve just got to be willing to play hardball on the phone, explain your insurance situation and use the long-time customer card.

Am I a terrible mother for living this way, for taking the risks — although minimal — that I’ve taken? We could, after all, have gone thousands of dollars into debt to take everyone to every appointment that we would have gone to had we still had a $30 copay and the ability to sashay into the doctor’s office at the drop of a hat like we used to. It’s what our in-laws felt we should do. Their reaction at every sniffle was to guilt trip us for not taking our children straight to the doctor.

That’s how, last month, I came to be driving round and round the traffic island on the highway that runs in front of my doctors’ office. My son had had a 103 fever, just below the 104 threshold that freaks out doctors in kids. We’d kept him home, and by the end of the day he was acting loopy, almost drunk, in that febrile way kids do when they could be in the danger zone. As you know if you are a parent, 103 really isn’t the danger zone, but it is awful close to 104, which is. So I made an emergency appointment and drove almost all the way there when he perked up, seeming to be just fine. I called my husband, who said to ditch the appointment, which we’d just made 30 minutes before. So I turned the car around.

Then I called my mom, the nurse, who insisted I go to the appointment. She always pushes for the better-safe-than-sorry route, no matter what the cost, but we were already at $477 in medical costs for the month. I turned the car around again, circling the island, headed back to the doctor.

My husband was going to be annoyed the way he always is when I insist on an appointment and it turns out, $170 later, to be a cold. I turned the car around again, driving once again around the traffic island.

I did this for 10 minutes until I looked at the sweet, angelic face of my toddler back there and decided to heck with it and took him in. He had a low grade fever — and strep. I’d guessed right this time.

After seven months of this, and hours spent doing our own medical research on the internet, we’re all still healthy. It now seems incredible that for over a decade I’ve taken the ability to see a doctor for granted, going again and again at the first sign of a sniffle without once ever inquiring about the cost of his services. I can’t help but wonder, if the whole country went on this type of plan, if, instead of medical costs rising by double digits each year, they wouldn’t begin to plunge by double digits.

I can assure you that consumers forced to choose which child to take to the doctor would rapidly become remarkably shrewd customers. They would begin to question everything their doctors did — and charged. Doctors would immediately be forced to compete on the basis of cost and quality, like other business people do and would be able to tell you exactly what their prices were when you called. And they’d have to become fast and efficient to keep the lengths of their appointments — and thus consumer costs — down.

I can even envision a future health care system in which colds, the flu and strep are treated at drugstore clinics — which are quite good — freeing up doctors to deal with more serious matters. And I can see alternatives to doctors’ offices and expensive health insurance subsidized prescriptions, like the kind Walmart has begun to develop, flourishing.

Maybe the market, if allowed to, could drive the actual cost of an appointment down to $50 without insurance subsidy, the level at which my family would again likely be willing to go to an appointment for every sniffle and fever.

Or maybe if we did things this way parents like me would eventually bet wrong and a child or parent would be damaged or killed by skipping an appointment and missing something serious. There’s no telling.