As I bounce between San Francisco and Los Angeles, one of the unexpected obstacles to a hassle-free two-city life has turned out to be something medical. It’s not about exhaustion from all that traveling up and down I-5, nor immunological breakdowns, especially respiratory ills, due to the frequent change of climate from maritime to desert and back. Those are issues you have to be ready to address if you choose this come-and-go path, and I grapple with them on occasion. But the problems are more logistical and bureaucratic than physical in nature, even if they are exacerbated by any illness that might strike. The main concern is access to health care when you’re in one city and your doctor and dentist are in another one that’s hundreds of miles away.
A few years back, I had individual health coverage — a little on the pricey side — that allowed me the freedom to have a doctor and any kind of medical procedure, as needed, in each city for the same fee. While in L.A., I could have an eye exam at UCLA’s renowned Stein Eye Clinic or have orthopedic surgery done by one of the most respected doctors in the field at Cedar-Sinai — both of which happened. I could see my longtime primary care physician in San Francisco’s Sunset district for my annual check-up or to address a serious case of the flu. And I could get a colonoscopy, and whether I was north or south, the cost would be the same with my old insurance. Reasonably-priced medical treatment wherever I happened to be: Not quite as wild as the idea of a sailor with a girl in every port, but gratifying — and lower on the toxic-masculinity scale.
HMO, PPO, E-I-E-I-O
Times change, and so do insurance carriers. Even with the twin boons of Covered California and the Affordable Care Act (presuming the ongoing attempts by vile and greedy power-mongers in Congress don’t thoroughly destroy it), I decided to trim back my expenses by opting for an HMO, rather than a PPO. Now, your guess is as good as mine regarding what those letters really mean. Just kidding. HMO stands for Health Maintenance Organization, and PPO means Preferred Provider Organization, with the latter being much more flexible, thus costlier. As such, I pay a smaller premium as part of an HMO . . . only there’s a catch: It locks me into a geographical region in exchange for that less high-priced coverage. Because my official home address is in San Francisco, my G.P. and specialists must be located in the same corner of the state, or I pay much more.
In other words, the cost of a doctor’s visit at my HMO-approved network in San Francisco is minimal — when I can actually get an appointment (which is a whole ’nother issue). I assume the same would go for a walk-in if I’m afflicted with something that allows me to get to the accepted office or clinic. Yet if I am in L.A. and suddenly struck with some vile gastro-intestinal disorder, the choices are urgent care or an emergency room — or who knows what might transpire. And it’s considerably more expensive for treatment when out of network, and anything that ain’t in the Bay Area is O-U-T out.
Even a simple consultation for a head cold needs to be at an urgent care facility when not in San Francisco, since no L.A. doctors in private practice are approved by my HMO — and the Southland prices can be startling when compared to what I pay to see my current official M.D. on Nob Hill. Even if I’d like to cough up (sorry) the extra cash to shift to a PPO, I can only do it during a specific re-enrollment period that’s currently months away.
BUYING THE PREMIUM WITH HIGH MILEAGE
Then, there’s this counter-intuitive aspect of the situation: While the amount of cash required for everything from rents and espresso to gasoline and Grubhub in San Francisco continues to escalate, my out-of-pocket for health care is more manageable as long as I get the work done in the 415 area code. Thus, my primary care physician, dentist, and eye doctor are all up north, which requires that I schedule appointments in S.F. far enough in advance that I can avoid conflicts with my L.A. business responsibilities — potentially a procedural nightmare when unexpected meetings come up.
So when it comes to my wellness, I’m being penalized for my not-so-extravagant lifestyle. If I’m in L.A., where I want and need to be half the time for personal and professional reasons, and I need medical assistance while affiliated with an HMO, it’ll hit me in the wallet. And if I decide I should be in a PPO since I’m in L.A. so much, I’ll also be burning beaucoup bucks. It’s enough to make you sick.
The real answer is to stay healthy, particularly when I’m in L.A. where one can all too easily succumb to dissolute activities. At least the Vitamin D blasts from Old Sol are seldom blocked by fog or cloud cover in Los Angeles, and fresh produce is bountiful and cheaper there than in our beloved City by the Bay.
Now, if you’ll excuse me, I need to scour OK Cupid for Canadian women seeking American husbands. It’s either that or write my congressperson (that would be a Northern Cali rep) and lobby for universal health care, although I think that’s an even longer shot than finding love and free colonoscopies among the Canucks.
Michael Snyder is a print and broadcast journalist who covers pop culture on “Michael Snyder’s Culture Blast,” via GABnet.net, Roku, Spotify, and YouTube. You can follow Michael on Twitter: @cultureblaster