If I was Queen for a Day

Everyone knows that the healthcare system in the US has issues. I'll be the first to agree with that. I am not, however, on the side of "Let's just put Uncle Sam in charge of it all!" We did military medicine the first four years of our marriage and honestly, anyone who wants socialized medicine should have to do that for a couple of years (particularly years wherein they aren't super healthy) just to see how awful it is. We were basically healthy and it was still a PITA.

So.

Today's "Queen for the Day" solutions are medical in nature. And I probably couldn't fix it all in one day, although my overall plan is simple: Hospitals and Doctors can charge 20% over cost (or thereabout). Hourly pay for a doctor can't exceed $200 and needs to be commensurate with experience and training. Insurance companies pay what they're charged (since charges are now realistic) which means that sans insurance, self-pay if necessary isn't hideous. And you can't sue a hospital or doctor for "pain and suffering." Malpractice needs to be clearly proven and frivolous lawsuits result in huge fines for those bringing them. The only time there is a payout for malpractice is if willful bad treatment is proven. Accidents and unfortunate circumstances are not open to litigation. You went into care with the assumption of risk and best effort. They provided it under these circumstances. Medicine isn't a promise and sometimes life sucks.

BUT, more specifically today, my QFTD dictate is that therapy is covered as preventative care under insurance. All kinds (physical, occupational, mental) and thus is subject to a copay. Period. No caveats. If a doctor says "You need x kind of therapy." then you are entitled to receive said therapy regardless of presence or absence of whatever diagnosis may or not be "typical" for said therapy.

Yes, super specific. Because youngest has had two psychiatrists recommend ABA. But insurance says, "Oh hey, cool. We cover that, but only with an Autism diagnosis." Well, we don't have one of those. And the psychs say, "We could always do another evaluation and see if it gets diagnosed now." And the insurance company says, "Cool, cool. Just remember we don't cover evaluations either. So that six grand is on you." 

And I'm like, "So...can I self-pay the ABA? Because 6K for something that may not give us the diagnosis we "need" for the therapy seems dumb."

And they're like, "Yeah, of course. It's $250/hour per therapist and there's usually two. Plus we recommend two hours a week."

And insurance is like, "But it'd be a $40 copay if we covered it. Which we do. But just not for you."

And I'm like...FML.

Getting your kid the help they need should be based on my kids need help, they can give it to him, let's coordinate. It should NOT be based on, "Do I get my kid help or afford groceries?"