Category: Insurance

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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?

caduceus

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…

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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??

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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.

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.