Obamacare Update 2

by Leslie Sholly | May 6, 2014 | family, health | 11 comments

As promised, I will continue to update you on our family’s journey out of the ranks of the uninsured thanks to the Affordable Care Act. Here’s where we are now: John, Emily, Jake, and I are fully insured through BCBST. Lorelei and William remain on TennCare which seems to be in a kind of limbo status–we haven’t heard anything from them in months. Teddy remains uninsured but I have been contacted regarding my appeal, so we’ll see. I really think it’s a glitch of some kind.
If you did not purchase a policy on the Marketplace because you were afraid the outlay for the monthly premium would outstrip the value of the health care received, let me tell you a few less obvious benefits of having insurance, some of which I did not know until I had it.
1. When you visit any doctor, even the Walgreens clinic, YOU DON’T HAVE TO PAY UP FRONT. That’s right, they send you a bill. So you don’t have to forgo medical care if you are short on cash on a particular day. Yay!
2. You reap the benefits of something called the “negotiated rate.” That means everything is cheaper for you, even before your deductible is met, than it would be for an uninsured person. Medicines cost less. Doctor visits cost less. That above-mentioned trip to the Walgreens clinic costs an uninsured person $90. It cost us $60.
3. You have access to more doctors. When we had TennCare, it was easy to pick a doctor because there just weren’t that many who accepted it. And many of the ones who did accept it would not have been my first (or second, or third) choice. And get this: at our former practitioner’s office, TennCare patients HAD to see the nurse practitioner instead of the doctor. We happened to like the NP, but it still felt like we were being told we weren’t worthy of the actual doctor.
John is having his first visit with the doctor today. Jake and Emily have checkups scheduled for next month. Jake has been to the Walgreens clinic and another specialist already. We have purchased MANY prescriptions. And I have had FIVE visits with health care providers since March. That’s more visits than I normally have in five years, and I’m not exaggerating. John has met his deductible, and I believe the family one was met as of yesterday.
Now on a more personal level, how is this benefiting us? Well, I went to the emergency room a couple of years ago because I was worried about the possibility of a blood clot in my chronically sore and swollen leg. Why the emergency room? Because that is where people with no insurance go for health care. I tried to go to the doctor I occasionally saw only to be told that I was no longer considered their patient because I had not been there in two or three years. Anyway, there was no blood clot; I was told to follow up with my (non-existent) regular doctor; and I’ve continued to suffer.
At my first check up with my new doctor, she prescribed a mild diuretic. It was like a miracle. The swelling is greatly reduced, my blood pressure went down, my energy doubled. If I’d had health insurance, I would have gotten this little pill years ago.
I used to lie awake in bed at night worrying that when I went to the doctor (I was counting down the months and days until the ACA went into effect) that there was going to be something really wrong with me. I had strange feelings (attributable to high blood pressure, and GONE thanks to that little pill) that caused me anxiety. When you don’t have insurance you are afraid to see a doctor even if you can afford one because what if they find something wrong which becomes a pre-existing condition and makes you uninsurable down the road? But I don’t have to worry about that any more. NO ONE DOES. Because there is no punishment for pre-existing conditions under the ACA. And there’s no more uninsurable either. I also don’t have to worry about it because I got it checked out. I had an EKG and now I know I am okay.
As I mentioned in the last update, I had my first check up (check ups are free under my plan, by the way) in mid-March. That’s when I got the little pill. I also had blood drawn. I came back two weeks later for the EKG, and to discuss the results of the blood work. I was low on Vitamin D so I got another pill (a much bigger pill!). My glucose, cholesterol, triglycerides, and blood pressure all need to come down. Did my doctor throw more pills at me? No, instead she set up an appointment with the wellness nurse (for exercise) and the nutrition nurse. I’ve seen the wellness nurse twice (that’s $20 each time) and the nutritionist once (six visits per year are included in my plan). I’ve learned about a new way to eat (I will write on that separately later) and I am walking regularly (as you might have surmised). I won’t know if my levels have gone down (and I’ve been warned that sometimes they go up before they go down) until my next check up toward the end of June. But I do know that I feel great and that I’ve lost 15 lbs.
I know that this story is only a personal anecdote, but remember, so are the Obamacare horror stories that you see in your newsfeed. That’s why I’m speaking out on this very personal topic.
John is at the doctor as I write. If he will allow it, I will include some of his story next time I update. I promise to keep you posted.
If you want to read this story from the beginning, see below:
Who Are the Uninsured?
Uninsured No More
Obamacare Update

See More Posts Like This One

11 Comments

Mary Cooke on May 6, 2014 at 10:27 am

Leslie this is awesome thank you for sharing.
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- lesliesholly on May 6, 2014 at 10:31 am
  
  Thank YOU for reading and commenting!
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Kristi Birchfield on May 6, 2014 at 1:01 pm

So glad you wrote an update about this. My brother signed up for the ACA and he, too, has had great success while on it. Being able to go to the dr. when necessary has been a great thing for him as well. And I note you’re down SIX MORE POUNDS since we last spoke! You are an inspiration. Get it, girl! 🙂
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- lesliesholly on May 6, 2014 at 1:50 pm
  
  I’m so happy to hear that about your brother! It’s amazing to be able to go to the doctor whenever you need to!
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Clisby on May 6, 2014 at 1:40 pm

This sounds great. Is John getting better advice for his diabetes also? A good nutrition plan can work wonders for that even if you do have to take medication.
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- lesliesholly on May 6, 2014 at 1:52 pm
  
  The doctor said today that she will be adjusting all his medications after the blood work comes back, and she set him up with the nutritionist in a couple of weeks. So I’d say that’s definitely in the cards. He’ll have to learn, though, that he can’t just take medicine and eat whatever he wants.
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Maggie May on May 6, 2014 at 2:07 pm

I really love reading this in such detail. It is so encouraging!
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- lesliesholly on May 6, 2014 at 2:56 pm
  
  Thanks, Maggie!!
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Cathy Mathes on May 6, 2014 at 10:14 pm

I am really trying to tell my uninsured patients to sign up on the Marketplace. There are so many misconceptions and prejudices out there that are keeping people from doing it. The first problem is that most people don’t understand how much decent insurance costs. The mandates for coverage under Obamacare are similar to my private insurance. I am self employed and pay all my premium but get the discount of being part of Summit Medical Group. I pay $514 a month with a $1000 deductible/ $35 copayment /20% of charges as a single person. Our premium for couples is double that,$2000 deduct and family coverage is about $1400 a month. THAT IS WHAT INSURANCE COSTS! Most people have no idea because either their employer pays much of that cost or they are on a subsidized plan through Medicare /TNCare and now Obamacare. That being said,the vast majority of my patients that I have polled,IF they are telling me the truth,are getting deals on the Marketplace for a fraction of those costs,yet many balk at paying $300 a month for coverage that essentially guarantees that they will get treatment and will not have to pay more than $6000 out of pocket even if they end up in ICU for a year. Obamacare guarantees that most people should never go bankrupt over medical bills. People don’t get it. They have no problem paying that for their phone, internet and cable but not for peace of mind for health. It will be interesting to see what happens in the next few years because most employers can ‘t continue to subsidize those rates, those of us who can pay them are becoming fewer, and it is predicted that 50% of Americans in less than 7 years will be on either Medicare, Medicaid (TNCare) or Obamacare. I’m telling my patients that now is as good as it’s going to be so take advantage.
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Cathy Mathes on May 6, 2014 at 10:27 pm

And Leslie your family sounds like exactly the folks that are intended to be a part of the new plan and I ‘m so glad that it is working out!
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- lesliesholly on May 7, 2014 at 9:49 am
  
  Thanks, Cathy. And I really appreciate getting thoughtful comments on this issue from a medical professional. Please feel free to share this post because that’s why I’m writing–to combat some of the misinformation. The upfront costs of premiums were scary for us too (even though we are benefiting GREATLY from the subsidies) because it was an additional expense, and that’s why I wanted to share in this post some of the great effects of having insurance that we had not anticipated and make the initial outlay even more worth it. I believe one of the greatest achievements of the ACA is getting rid of pre-existing conditions. Years ago, we could have purchased a policy to cover all of us for about $500/month. That seemed like a lot (it still seemed like a lot), but more than the monthly cost, what stopped us from purchasing it was that for an entire year none of John’s pre-existing conditions would have been covered. And then the deductible was $2500, so it would have covered nothing routine for anyone else. So we would have had to pay an entire year of premiums, then into the second year continuing to pay the premiums plus meet that deductible before any of John’s medicines or appointments would have been covered at all, all the while paying for the medicines and doctor visits out of pocket as we had been doing all along! So having everything covered immediately (plus the low deductible) made all the difference for us.
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