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Letter from a friend in Maine

Friday, December 01, 2017

We recently received this letter from our friend in Maine:

The perfect storm.  I was transitioning from commercial health insurance—a generous and well-respected health plan in Massachusetts—to Medicare in another State.  My coverage was to extend a month after I left my position and then Medicare would pick up in Maine, but meanwhile I moved. 

Moving, leaving a fast-paced high stress job that I loved and was good at, and searching for balance in my life and work in semi-retirement proved stressful.  More stressful than I anticipated.  I finally succumbed to a cold and the cold quickly became more serious.  I suffer from asthma, so I know to take symptoms seriously and I was pretty sure pretty fast that I was heading for pneumonia. 

And there I was.  Living in Maine with Massachusetts insurance. I called my insurer. No, they would not pay for me to see a new PCP in Maine.  My “old” practice was three and half hours away and though I am sure they would have seen me, and taken care of me as they always had, driving seven hours for a twenty-minute visit while my head was pounding, my chest tightening, and my nose running like a faucet just wasn’t an option.  So instead I waited.  I took over the counter meds to ease the discomfort and waited for a bad cold to blossom into pneumonia.  Once I was really, really sick I could go to an ER or an Urgent Care clinic and get help. 

The PA on call in a nearby Walk-In Clinic and I talked about what had happened while she confirmed the pneumonia diagnosis and wrote the prescription for antibiotics and a steroid taper.  “Yeah” she said we see this all the time here.” The transitions of care make for tricky medicine. People go to Florida for the winter and then come back to Maine for the summer months.  The insurance coverage is a mess and people get caught in the wrong place at the wrong time with health issues that need to be dealt with immediately. 

Ideally, I would have been able to have my illness dealt with in a primary care practice. Happily, I could go to an urgent care clinic rather than an ER, even though it meant waiting for a bad cold to develop into full-blown pneumonia. I am fortunate to have had healthcare coverage through my employer. But how would the outcomes have varied if my options were more limited? I would have likely gone to the local ER, where caring but overworked physicians would have put my case way down low on the priority list.  I might have wound up with a hospital admittance. What a waste of precious medical resources that would have been.