Been Head Down working

Healthcare reform

Tuesday I got a call from my normal doctor. I was expecting it…

The office staff called to tell me that the Doc wants to see me again. I look at the calendar and it’s been over a year. In truth I was expecting this call, the Doc is good about making sure he’s not just renewing prescriptions without seeing his patients.

While I’m on the phone with the staff, I remember that the insurance card I’ve been carrying around has proven to be completely useless and before I set up an appointment I ask them if they can verify that the insurance card will be honored.

Affordable Care

The staff says sure, and I give them my card number. About an hour later, they call back and tell me that they can’t accept this flavor of insurance. Yes, it’s a PPO but it acts more like an EPO and they’re not part of that network. They also told me to contact one of the attorney’s involved in the class action lawsuits against Anthem and to contact the Insurance Commissioner. Can you say this is a problem they’ve gotten tired of dealing with??


I make the appointment anyway, By December I’ll have either come up with a real insurance carrier or I’ll not have insurance at all. Either way I’m going to see my doctor.

After a decade of him taking care of me I have no desire to have that relationship destroyed. There are damn few people I trust with my life outside my family. My Doctor is one of those people.

After getting off the phone with the Doctors office, I call Anthem and ask them what the hell is going on? Once again I’m assured that I have a PPO plan, once again I ask “If this is a PPO plan then why can’t I simply go to any physician that takes Anthem insurance?”

That’s when I get a lot of dancing around about how PPO plans have changed and that there are no PPO plans available in California because of ACA. I’m told that Cedars Sinai is now taking the PPO plan that I have and that Anthem negotiated with Cedar’s to make sure patients weren’t being excluded.

In other words, let’s put some more lipstick on this pig.


After much discussion the Anthem representative tells me that I can’t make changes to my plan until open enrollment. I comment that since I’ve been unable to get any medical care under this plan I’ve been wondering if I wouldn’t be better off with a simple catastrophic injury plan.

The representative begins to tell me that if I had a catastrophic plan I might not be covered for hospitalization or emergency room visits. I retort that the definition of a catastrophic plan is a plan to provide those services. The representative does finally concede that perhaps, given my difficulties with their PPO plan I might consider a catastrophic plan during open enrollment which begins November 15th.

I spend the rest of the day researching my options…

Sigh, why can’t we just get the goods and services we pay for?