So this morning, first thing I do when I wake up is call the doctor's office to get an appointment.  They have no appointments available so they have a nurse call me.  The nurse says I should go to the emergency room.  Now, keep in mind that though my shoulder looks wonky, it's only mildly wonky, and I'm not in a lot of pain (2 advil every 6 hrs or so is doing just fine). 

So I called my insurance and they told me that if it was an actual emergency I'd just have to pay a $50 copay but that if it wasn't, they wouldn't cover anything.  Of course they can say nothing beyond that because they aren't doctors.  So if I went to the emergency room it would depend on how they coded it whether it was actually paid for or not.  That seemed a risky proposition given that I'm not in serious pain and I'm not bleeding or anything. 

So I pressed them a bit and they ended up calling my doctor's office.  Apparently their normal procedure for such things is to refer people to an orthopedist or an ER.  Doesn't sound like there was much consideration of how serious my situation really is.  But after talking to them, the end result is that they are trying to find me an appointment with an orthopedist somewhere in Chicago this afternoon.  Waiting to get confirmation, but sounds like I have an appointment this afternoon.  Currently waiting to get confirmation.

This, incidentally, is one of my biggest problems with the way our insurance system works in this country.  If you have an obvious emergency (bleeding from both eyes, etc), then you go to the emergency room and it's all fine (presuming you have insurance in the first place).  If it's an obviously non-emergency situation, then you make a doctor's appointment and go that route.  But if it's anything in between, what do you do?  Because if you make the wrong decision the difference in cost can be staggering.

The thing is that I do not have the information to make that decision.  What I know is that my shoulder hurts and that it LOOKS wonky.  How that will ultimately be coded is a total mystery to me.  I can only know that by having it treated and at that point if it turns out to not be deemed an emergency procedure, then it's my problem.  I don't know what codes my insurance company will accept as an emergency treatment, and I don't know how the hospital would code it.  Hell, I'm relatively in the know that I have some clue what the codes even are.