Navigating the US medical system

By Karina Rook

We have private health insurance in California through a salary package, so already I knew we would be ‘taken care of’. I learned this through watching years of Grey’s Anatomy on TV, where the poor un-insured people get slow medical help, if any. Before moving to the Silicon Valley I was very concerned about getting decent specialists, affordable prescriptions and timely doctor’s appointments. I guess I expected the worst?

The reality has been very different. We ended up joining Kaiser Permanente, a HMO (Health Maintenance Organisation) that manages all our health care needs through a large network. They have a good reputation and I liked the fact that our medical records were centralized, and we could still choose our own doctors and specialists. They are re-furbishing their hospitals and medical suites, and they have good coverage over the Peninsula – I only have to drive 4 miles to get to our appointments. This may seem a long way to Aussies, as we’re more used to seeing a neighborhood doctor, but you have to drive everywhere in California, so I’m used to it now.

A huge advantage for me is that I can do so much online, such as:

  • Make appointments
  • Order refills for prescriptions (which are then mailed to me! Woo Hoo)
  • See a record of every visit I have made, including the doctor’s notes on my file
  • Email my doctor with questions

Another difference is that it is so easy to get referrals to specialists, for example our daughter needed her tonsils out and her pediatrician made the specialist appointment on the spot! No printed referral letters, no need to update the specialist with medical history, etc as it’s all in the system. The specialist even updated the pediatrician after the operation, so everyone is kept in the loop. Brilliant.

I think our HMO is very into preventative care too, so because I turned 40 this year they sent me off for a mammogram. The kids and I also had a full check up soon after we joined including blood tests and everything. They are very thorough – I think it’s just financially better for them to know your medical state and prevent problems, rather than fix bigger problems later.

Similar to Australian private health insurance where you can choose Excess payments, we too could choose which services to have for free, and which we could contribute a ‘co-payment’ for to cover some of the cost. So the tonsillectomy cost us $36 total, blood tests and immunizations are free, and general appointments cost us $10-$20. I think that’s fair given that I was often paying a gap over the scheduled fee for services in Australia anyway.

So we have had a great experience medically-speaking here. Quite a pleasant surprise.