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.

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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…

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??

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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.

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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?

Health Insurance is consuming my life.

UnknownI know that many posts lately have been about the failure of Anthem due to the requirements of Obamacare.

I personally think that Obamacare is an utter failure that has imposed yet another layer of un-necessary  bureaucracy on insurers,doctors, hospitals, and the people in general. I hate bureaucracy and running round & round a maze of petty functionaries to get what I’ve paid for.

I’ve always been sensitive to insurance bullshit. I’ve always thought that insurance was the biggest con game on the planet.

UnknownReally? you want me to pay for your service which does nothing for me in my day to day life. The cost of your service will go up every year due to the actions of other people over whom neither of us have any control. The amount that the cost will go up is due to arcane mathematics worked out by some gnome in a basement with a HP-12C and that’s also not under my control.

This is for my own good?

I’d often wondered if I’d have been just as well off handing protection money to the Mafia.

Then I had a major event in my life where I was thankful I had insurance.

I was fortunate beyond words in that the insurance company I’d been dealing with simply PAID. they asked few questions, they just did what they were contracted to do and put the money in my hand.

images-4I’d been fortunate too in that though my work I’d managed to find an insurance company that just PAID. I went to my doctor, I went to a specialist if needed and I didn’t abuse the situation. Like most men, I fucking hate to go to the doctor in the first place.  ALL I had to do was hand the office bitch my insurance card and that was the end of it.

PPOs worked and were good.  I always went to the doctor of my choice and that was the end of it. The shit got paid for!  Now in addition to HMO, PPO, EPO, and god knows what else there are flavors of each plan.

images-2Doctors, are opting out of caring for patients based on the “Flavor” of plan within the broad designations that the patient has. But in general there’s no way for the patient to know if the flavor they have, is in fact a flavor the doctor likes.

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All health care plans are supposed to be Obamacare compliant, that doesn’t make all plans “Obamacare”.

What it does is create confusion. I as a consumer don’t give a flying fuck about the underpinnings and nuances of interaction between the doctors and the insurance company. They EACH have a job to do and I expect them to perform their task. Once again I find myself on the phone calling the representative “Servicer

I’m paying $500 a month for an insurance plan that is all but completely useless because there is no clear way for me as a consumer to know which doctor will take what I have, or for how long.

imagesThe “Servicer” tries to explain that the insurance isn’t useless, but then can’t find a provider within a 100 miles that takes my ‘flavor’ of insurance. That’s even after he added back in all the Doctors for whom English was NOT their primary language.  He did tell me that perhaps I should learn Spanish. I retorted why not Farsi, or Hindi? Then I told him if I was going to learn any language, it would be German, Swedish, Dutch, or Norse.

I’m shopping for other insurance companies but all plans are essentially the same thanks to Obamacare. Technically, there’s no real choice. They all refer to a metallic code, Bronze, Silver, Gold etc.

images-1BEWARE! If you choose one of these insurance levels by metallic code, you’ve essentially consented to an Obamacare plan even if that’s not what you intended.

The insurance providers start throwing around levels of protection with associated deductibles and lumping them into a metal. So you, the consumer say, “Yeah the Silver level sounds about right,” and suddenly your insurance plan is fucking Obamacare.

I compared my old insurance card to the “new” insurance card. Both say PPO but the shitty card says “Pathway PPO” which is somehow different from just the normal PPO that I’ve had for years.

screen-shot-2014-04-20-at-5-42-09-pmThey bait & switched me and I didn’t realize it until I tried to obtain a more specialized service from one of the Jeff Spicolis of the medical world.

So now the problem is can I fix it? The preliminary reports say NO!

So where does that leave me? Well thank god my GP can take care of the dermatology things.

Well, he can for as long as he takes my “Flavor” of PPO. If he decides he doesn’t like my PPO I’m well and truly screwed.

Again with the Anthem BULLSHIT!

UnknownOK, Today I’m starting a search for new insurance carrier.

I had an appointment with a new physcian today. The operative word is HAD. I drive an hour to get to the appointment. I walk in, I’m early, and I’m expecting to fill out the obligatory paperwork.

I hand the little bitch behind the counter my ID and insurance card and she tell me that I have an Obamacare plan and they don’t accept those.

NewImage.pngI tell her my plan is not Obamacare and that given my premiums I expect a little privacy instead of her announcing that I have an Obamacare plan.

I’m LESS than amused. Since I, as a consumer cannot determine if the plan I’m paying through the nose for is Obamacare or not, at least not by looking at the fucking insurance card. However I’m really torqued out of shape about the “Announcement” that I have an Obamacare plan I don’t like the stigma associated with Obamacare.

NewImage.pngThis doctor will not be seeing me. I will not do business with a doctor whose staff is so indiscreet. I felt like she’d just told the full waiting room something like; “OH your lab results came back you have Syphillis!”

Lets be realistic the doctor patient relationships is a BUSINESS relationship akin to Client / Attorney privilege.

So I’ll be back on the phone with the damn insurance idiots this afternoon to determine if this plan is actually OBAMAFUCKINGCARE. If it is, then we’re going to have a conversation that may require a Valium on my part.

As I write this, I’m sitting on a patio at a StarBucks having a treat. Sometimes you just need to have some fun.

If the Arabs would shut the hell up it would be a perfect situation. I’m enjoying the eye candy sitting across from my table and thinking some seriously dirty thoughts.

Another Call to Anthem This time about Express Scripts

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Yesterday, some stuff at the pharmacy was… available, not available, available, not available … Please Call Anthem.

Sigh! 32 minutes on hold with Anthem.

“Hello”

“Hi there, could you please explain why I’m having problems at the pharmacy now?”

“On moment, Ah here it is, you haven’t Opted out of the Express Scripts Mail order service.”

“Ok, Let me explain something to you in no uncertain terms. If you force me to deal with Express Scripts I will cancel this policy.”

“Oh you’re not being forced to use them, you just have to opt out.”

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“In other words you’ve signed me up to use their mail order service without bothering to tell me about it. Otherwise I wouldn’t have to Opt out.”

“Oh no Sir, all our clients have the option to use Express Scripts, you just have to tell us you don’t wish to use this valuable service.”

Briefly, I think about going ‘round the maypole again but obviously the nice lady at Anthem doesn’t understand my meaning about needing to Opt OUT of something versus choosing to Opt IN to something.

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It would be a long conversation that dealt with the English language and fundamental rights, such as the right to privacy. Banking and credit cards spring to mind.

I’d, until the past decade or so, operated from the position that my account information, purchasing habits, or even the fact that I did business with a particular bank or credit card provider was private.  

Then I started receiving bank privacy notifications and forms that needed to be returned to Opt Out of them sharing my data with other companies.

While at the same time a certain bank of note started sending demanding e-mails and text messages once a quarter to Opt IN to their saving programs. Of course I’d like to save 5% on my purchases. Why do I have to re-affirm this every freaking quarter and WHY do they use words like madatory and Action REQUIRED in their quarterly reminders?

Why do they only bug me once a year, in very fine print to opt out of their selling my personal information? It seems backwards to me but then again I’m an old fuck.

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I decide that the Anthem girl probably wouldn’t get it. She sound likes she’s in her 20’s. For her my explanation wouldn’t make any sense.

She’s from an age where its common place for ex-boyfriends to put naked photos of her or movies of them screwing on the internet. 

Privacy means considerably less to her generation than it does to mine. 

I doubt that she’d even understand the subtly of difference between opting out of something versus opting in to something.

“Ok, can I please Opt out of this fine service?”

“Certainly Sir, here’s the phone number to call, Please hold; I’ll try to transfer you to them.”

While I’m on hold listening to Muzak, I’m thinking that If this is what I have to do to deal with the insurance company, then if I were a doctor multiplying that by 100 or 1000 I’d never get any work done.

As it is, just trying to keep the ballon of my personal insurance in the air is stressful and time consuming. I’m wondering, “what are they going to screw up next?”

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I’m also thinking it’s time for me to start shopping around for an insurance company that doesn’t require all this maintenance. Of course I realize that’s probably a pipe dream.

I begin to understand why so many doctors are just tired of the whole damn system.

I think of a childhood doctor, He was in private practice for a few years and I liked him. He’d been a military doctor, when he was just out of med school. After a few years, he gave up his private practice and went back into the military. I assume that’s where he finished out his career, by now he should be happily retired. I remember at the time wishing that he & my mom would start dating. I liked and trusted him.

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“Sir? I’m sorry, but that department at Express Scripts is closed.”

“Fine, thank you for trying. I’ll give them a call myself in the morning.”

I can’t help thinking that this is all far too complex to be in my best interests.

I’ve been on the phone with Anthem at least once a month since November.  They claim all this chaos is due to Obamacare.

I’m sure that at least part of it is, but I’m equally sure that Anthem and other insurance companies are making things more difficult for consumers.

After all what better way to have Obamacare repealed than to inflict pain on the consumers who also happen to be voters.

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I’m sure that the insurance companies aren’t losing any money due to Obamacare.

I keep thinking of the way gas prices go up. The oil companies jack the prices to obscene levels, then keep them there for a month or two. Then they drop the gas prices back to .20 above what they were before the run-up.

We idiot consumers breath a sigh of relief because the prices have dropped but we’re still paying more at the pump than we were.

I wonder if the insurance companies are attempting a similar gambit Obamacare jacks the prices and inflicts a lot of pain for the consumers. Then Obamacare gets repealed and the prices drop some and we think “ahhhh that’s better,” then move on to the latest idiocy of the Kardashians.

This morning bright & early I call the number I’ve been given to Opt-out of Express Scripts ‘wonderful’ service.

While I’m navigating the obligatory voice prompt system; I’m thinking that the local pharmacies have been taking it in the ass because of companies like Express Scripts.

Even the big chains are feeling the pressure and the little independent pharmacies are almost gone. Where is the protest against that? Right, I guess it’s not high profile enough to draw the ire of the Occupy protesters.

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“Hello this is Mark your pharmacy advisor.”

“Hello Mark, I need to opt out of your service.”

“I’m sorry to hear that sir, we do provide a more convenient service providing you with a 90 days supply of your prescriptions via mail. First I’m going to need to know who you are and your date of birth.”

Note to self: Date of birth has become a piece of data that should be protected. This guy is looking me up with my name and date of birth. Come to think of it that’s all the insurance company or medical practices ever ask for.

I provide the requested information.

“Alright sir, could I ask you to hold for a minute or two?”

“Sure,” I reply, wondering why it takes a minute or two for him to click a check box on a computer screen. But then again this IS Express Scripts and I know how royally fucked up they are.

“There you are sir, you’re opted out. I’d like to remind you that we’re here should you change your mind.”

ExpressScripts1“Not going to happen,” I growl.

“Might I ask why?”

“You people screw up all the time. You screwed up my RXs and changed the drug I was taking to another drug claiming it was the same. Look man, if the drug has different chemicals, they’re not the same, they’re different. Here’s an experiment for you, try taking estrogen instead of a testosterone replacement and tell me how that goes for you. They’re both hormones just a little different.  Then there’s the whole question of your being able to keep records. Your RX by mail online history was always wrong and that begs the question about your ability to detect a potential drug interactions. No, I will not deal with you. I’ll continue to go to my local pharmacy and be able to talk to my pharmacist. You might also want to note this, if mail order through your company ever becomes mandatory through this Anthem policy, I will cancel the Anthem Policy just to get away from you!”

“Er, Um… I’m very sorry for the difficulties you’ve had in the past. Please remember we are evolving and our procedures are getting better all the time. So if you ever change your mind we are here.”

I give him props for his recovery.

“Thank you. By the way, it’s nothing personal it’s your company.”

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“Have a nice day sir.”

“Thank you and you do the same,” I hang up. 

Hopefully I won’t have to call Anthem until later in the month, next month.I’ll wait 24 hours then see if all in my insurance world has returned to normal.

I have no need, as far as I know, to call Anthem. I’m penciling them into the calendar just because I KNOW something will go wrong and I’ll spend another 30 minutes to 30 hours dealing with them.