At first, thanks to NJ FamilyCare, he was able to receive basic tests and prescriptions. But the problem arose when more detailed tests were needed. The insurance company required a 'prior authorization.'

Prior authorization is a procedure where a doctor must obtain permission from the insurance company before performing certain treatments or tests, originally intended to reduce unnecessary procedures.

But do you know how complicated and lengthy this process can be? Submitting records, waiting for reviews, receiving additional requests... weeks went by without any response. In the meantime, the church member's husband's condition worsened. One day, his eyes and skin turned severely yellow, and he couldn't speak properly, so they hurriedly called 911 and went straight to the emergency room.

As soon as he entered the emergency room, the situation changed. Tests and treatments were conducted within hours, and the necessary medications were administered immediately. What would take weeks in outpatient care was resolved in just one day in the emergency room.

However, the bitter truth is that the emergency room is the most expensive medical service. Patients are forced to choose the emergency room for quick treatment, but ultimately, they end up paying much more in insurance premiums and out-of-pocket costs, which also raises the overall healthcare costs in the system. Still, from the patient's perspective, they had no choice but to take that path to survive.

Why does this happen? Ultimately, it is due to the way insurance companies operate. They make the prior authorization process complicated to save costs, delaying or outright denying treatment approvals. When patients end up in the emergency room after letting their conditions worsen, they are billed at a higher cost, and that burden eventually falls back on the patients and society as a whole.

In the end, patients are caught between "getting treated cheaply when they are less sick" and "getting treated expensively when they are more sick."

The church member's husband felt the same way. "After weeks of back-and-forth with the insurance company, it's better to go to the emergency room and pay the high cost for immediate treatment." This statement reveals the contradictions of the American healthcare system. Insurance is supposed to protect patients, yet it ironically pushes them towards more expensive options.

Thus, the emergency room has become a functioning medical system in a very urgent situation within the American healthcare system.

Originally meant for patients in life-threatening situations, it is now filled with patients whose conditions have worsened due to insurance approvals. As a result, patients pay more and face increased healthcare costs, while the medical system fails to adequately protect them, leading to a continuous cycle. Writing about such a difficult topic for a blog is incredibly stressful. I respect those who write...

Anyway, I hope the American healthcare insurance system changes for the better soon.