Category: Obamacare

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End of year Bullshit!

I hate CoveredCa and their demands where they seem to think I work for them. When they’re sending me a paycheck, I’ll get right on giving them all kinds of detailed information about my life. Until then I’m going to be sending my fucking money to the damn insurance company. I resent like HELL the State of California demanding shit from me instantaneously.

Tell me State of California Would you rather I spend 10 days collecting bullshit information that you’ll be automatically privy to come January, OR look for a job so that I can continue paying obscene taxes to provide services to others that I can’t access? I know the answer, you’d prefer I wasted the time. I was asking a rhetorical question.

I got message from DAN (Diver’s Alert Network) that my credit card on record is out of date. Uhhh DAN, the renewal isn’t for 6 months! I’ll worry about the issue in 6 fucking months!

Nerri.jpgADT Oh hi. Gee you’re JUST now getting around to sending me a letter telling me that the Credit card you had was expired? WOW, it’s ONLY two months after you sent me double billing and a nastygram. At the time we had a lovely telephone conversation wherein I gave you updated information and you billed me a past due month AND two months in advance. Gee Thanks!

I’m stressed enough right now without SERVICERS forgetting that They fucking work for ME, not the other way around.

Yeah, I’ve gone all Nebari again!

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Insurance!

As all of us in Amerika know. It’s open enrollment for our mandated healthcare plans.

I’m not overly fond of ACA, but it did actually do some good.

According to a friend who is an actuarial, there was a net gain in the number of people who previously couldn’t get health insurance now being insured.

I don’t know if that is still the case. It was true in 2013 – 2014. However it looks like the young people that ACA is dependent on, are staying away in droves in 2015.

Anyhow, I absolutely dread open enrollment. I hate having to revisit all the plans and really do miss the days when I just paid the bill and had insurance with an 80/20% split. I paid 20% the insurance company paid 80% and it was easy to figure out what was what.

Due to changes in the other half’s employment picture and my less than stellar year freelancing, this open enrollment has been particularly stressful.

We decided that we needed help. Changes in what is being phased in and what is being phased out confused the situation so that we weren’t sure if what we were doing was actually in our best interest.

SO we went to an insurance specialist who came highly recommended. Bottom line…

WE SHOULD HAVE DONE THIS SOONER!

Part of my insurance nightmare was that there were too many cooks in the soup. This guy called all the parties on the phone and declared HE is my agent and he had the ball.

Suddenly, Covered California, and Blue Shield were working together smooth as silk. Suddenly, I was paying a bit less for the same quality plan. Now instead of having to call one person, then another, and another, and get transferred to yet someone else, I call my agent. He takes care of everything.

The other half… is suddenly paying less than half what they were paying for much better coverage.

I’m still suspicious of something being too good, too easy, or too simple. We’ll see come January if our insurance is really straightened out and everything is on track for the year.

Based on the paperwork I have in hand… It looks like it really pays to have someone who knows how Obamacare works in your pocket.

That in itself speaks volumes about Obamacare and it’s complexity.

If the Republicans succeed in gutting ACA I fear we’re all going to be horrifically screwed. The insurance system is not capable of absorbing another significant disruption. Much as I hate to say it, Obamacare is here to stay. Congress should be forced to concentrate on fixing the parts that are broken.

 

 

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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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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??

MickeyObama

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.

CoveredCA

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?

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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.

Nerri.jpgENTER BUREAUCRACY!

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.