Category: ACA

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My Schrödinger’s Insurance policy

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Seems to be my lot in life, my insurance is always a pain in the butt.

I switched to a provider that supposedly has a real PPO instead of the Bullshit PPO that was really an EPO my previous insurance provider was selling.

I’m not getting a good feeling. The policy was supposed to have taken effect on Jan 1 but as of Jan 19th I still had no insurance cards, and no paper communication from them. 

Do I have a policy at all? They took my money.

I called them and found out BIG SURPRISE I apparently have Schrödinger’s insurance policy.

I’m not surprised at all. The universe seems to like to play with me and insurance policies. Normally this wouldn’t be a problem except that I was trying to have a prescription filled.

I think I’m playing the part of THE CAT in this experiment! 

After an hour on the phone, many assurances, apologies, and stressing my jinglish translation capabilities… I think it’s straightened out. Either that or I’ve initiated 3 additional policies and purchased 4 cats.

I was able to pick up the prescription so that represents at least a little progress.

In the Misrepresentation Category 

There is still the matter of the previous Insurance and policy that has declined to pay for anything except routine prescriptions. This is the policy that was sold as a PPO but it’s actually an EPO, or perhaps an HMO. I call it a NOMO (No Medical Organization). 

This policy was supposed to include a once a year physical at no cost to me. They’re refusing to pay any part of that routine physical and FYI the cost of my annual physical this year is well under $1000  

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The funny thing about it is this. The cost of the physical and labs is $100 LESS than a single monthly payment which I faithfully paid them throughout the year.

It turns out I can mathematically I can prove that for at least last year, I would have been better off without insurance at all.

I saw my doctor exactly once. I’m guessing that the Insurance company made about $300 profit from me each month.

I’m hoping that the folks associated with this rip off plan burn for a while in the fires of hell. Not because of me, per se.  

It’s all those little old folks that purchased this bullshit policy in good faith and then ended up screwed because their medical costs quickly spiraled out of control. I’m lucky in that I’m pretty healthy, but what about those other folks that aren’t?

I know that the legal system can’t punish these executives I can hope that a higher power does.

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Insurance AGAIN…

Shopping

I swear I have other things that I’d rather be doing. You know, living my life, taking a huge dump, jerking off, drilling my own teeth, (although Dr. F would probably be pissed off if I did that.) In short, I’d rather be doing ANYTHING and I mean any fucking thing aside from dealing with trying to sort out the insurance bullshit again.

Yet here I am, dealing with web sites Cigna (for example) that has incorrect information published about which providers currently take their insurance. Yep, they say my Doctor is accepting the Cigna plans, but turns out Cigna only offers HMO policies in Orange County and my Doctor doesn’t actually take any HMO patients from Cigna.

So who do I believe?

You know who I believe? I believe the lady that handles the billing and money.

Which leads me back to the bullshit of shopping policies. Anthem Blue Cross is right the fuck out. They’ve already screwed me for a year.

As it turns out Blue Shield actually offers a real PPO to people like me, and that PPO has no regional limits. However THEY demand a bunch of information before you even get a chance to ask them IF they sell private policies at all. 

They wanted to know how much money I was making BEFORE they would even let me talk to an agent. I pulled a number out of my ass. Then I’m talking to an agent that tells me I should go to Covered California, get a number of some kind, and then we’ll talk because I’m eligible for a subsidy based on the number I just pulled out of my ass.

This agent was all excited to tell me that I was eligible for a subsidy and something inside me twisted. That subsidy money is taxpayer money and honestly the unsubsidized premium wasn’t all that bad.  She was all excited about my getting money from other taxpayers to pay for my insurance.

Is it me??? Am I the only person that has a problem with this?

Pragmatically, she’s right in telling me not to leave money on the table that can effectively halve my premiums. But there is something so inherently wrong with this that I can’t wrap my head around it.

This is SOCIALISM, plain & simple. I’m greedy, I’d love to have someone pay my premiums for me, but I can’t help but think this is wrong. 

SO what to do? Follow my ethics and pay full pop even thought I can’t really afford it, or sign up on the exchange and get a subsidy even though I fundamentally disagree with the whole system. 

If I go for the subsidy, does that make me a sell out?

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You know, I’m beginning to think this is all a SCAM

Healthcare Insurance Logos

Welcome to Open Enrollment! Your ACA plan is serving you… UP!

As I’ve chronicled over the past year I’ve been involved with a nightmare called Anthem Blue Cross of California.

A month or two ago I was told that I’d have to wait for open enrollment to change my health care, I’m still not even sure how that works, or how they think that is going to work. I can change my health care any time I want to, ALL I have to do is not pay the bill!

And speaking of bills… I understood having open enrollment periods when I was working for a corporation. That makes sense, it tends to allow the company to budget their expenses and keeps the employees from jumping healthcare providers each time they don’t like something.

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However, since I’m paying the bill, I’m the one buying the goods or in this case services, why do I have to screw around with open enrollment at all?

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Technically, as a consumer of the insurance service, I am the Insurance company’s employer. As such, I ultimately have the capacity (Or I would in a non-socialist country…)  to hire and fire a poor provider at will. Oh yeah, but NOT under Obamacare.

Anyway, I’m shopping.

I can’t see myself putting up with more of the same from Anthem and not being able to see my primary care physician, (Even though they said I could. Then when I found that I couldn’t, they told me he must have dropped out of their network. But I have a PPO plan, networks are irrelevant… Well apparently it’s not really a PPO and My Doctor was NEVER in the plan they sold me). Or not being able to find a dermatologist. (And neither could they within 90 miles of my location.) 

Assurant

You see, I’ve been paying through the nose for a policy that was at best only a catastrophic plan with prescription coverage because none of the doctors I wanted to see were in fact accepting the Anthem Pseudo- PPO. I could have saved about 1/2 of my medical costs per month by just having a catastrophic care plan, and paying for everything else out of pocket which is essentially what I’m doing anyway.  By the way, a catastrophic plan is one of the options I’m looking into.

Under the “Won’t get fooled again” premise I’m trying to compare companies based on how they’re rated by consumers. As I’ve been sorting through the data I’ve discovered a couple of interesting things. 

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1) Of five companies I’ve checked on thus far, only two will allow me to purchase their policies based on my zip code.

All of these companies appear to service California but apparently they don’t all service the county in which I live.  

Sorry folks I’m an all or nothing kind of guy. If you’re selectively insuring counties that means that technically I can’t move from one county to another until the next open enrollment period. Doesn’t that also mean that when I drive across county lines, I’m out of network? Either you sell in all of California or don’t sell at all. 

I recall speaking to some insurance agent last year. That person said that even though I could purchase their insurance policy, AND that my Doctor was in their network, AND that the policy and my doctor were compatible, I still would be unable to see my doctor. Their explanation for this was that since my doctor and I were in different counties, he would be considered “Out of Network”. I seem to recall not purchasing that particular policy.

2) I can’t narrow down if my county theory is correct without requesting a quote from each possible provider — this is significantly slowing down the shopping process.

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The upshot of all of this is that insurance shopping, which was always painful, has now become 100 fold more painful because there is no simple way to sort through the data to compare stuff. I have noticed that every policy seems to have an ACA metallic moniker;

Bronze, Silver, Tin, Rusted Iron, Busted Galvanized Pipe, Copper, Pyrite…

All of which mean the same damn thing…

I’m beginning to think we have no choice in policies, just a choice in the company administering them. 

In dealing with all of this bullcrap, I think that I’d rather pound my own testicles with a sledgehammer, (1000 FemNazis just came in their jeans) than shop for health insurance!

I just don’t think I have medical coverage for that…