Obamacare: My Latest Update

I went to Walgreens yesterday to pick up some prescription refills that I had called in.  I drove up to the window and gave my name and the guy said, “It looks like there are ten of them.”  He rang them all up and I held my breath and he said, “That will be $36.20.”
Y’all, when I got home I looked at where the info sheet for each prescription says, “Your insurance saved you . . . ” and I got out my calculator and do you know how much those ten prescriptions would have cost me last year?  $590.30.
That’s a WIN for Obamacare, folks.  Those were maintenance prescriptions (and there are six more that didn’t need filling) for two members of our family who were uninsured this time last year.  One of them had in fact been declared uninsurable.  We got medicine through mail order programs; we filled out numerous Patient Assistance Forms and took them to doctor’s offices to get help from the drug manufacturers; sometimes we just went without the medicines that I (as the family health expert) decided were non-essential.
I’m used to getting soul-crushing news from the Walgreens clerk, but now our most expensive prescription is about $70.  (That’s the one we used to go without.) More usually, I now pay five or ten dollars.
John has now had his first doctor’s appointment and a visit with the nutritionist.  If you’ll recall, he was diagnosed with diabetes a couple of years back.  As a self-paying patient, he didn’t get much attention from his doctor when this happened.  He was told of this enormously life-changing diagnosis over the phone, and they called in a prescription for him.  He wasn’t offered any education or told to change his diet.  And although I was pretty sure he needed to do something different, I didn’t know enough about it to help him.  (Nor did any recommendations I attempted to make carry the same authority as a doctor’s orders would have.) So he continued to eat the same way as before–which was pretty much a “Hey, let’s get diabetes!” kind of diet.  And after some improvement due to the medication, he started getting worse again.
But our new doctor’s office is all about prevention and treating underlying causes, not just slapping medicine on an illness like a band-aid.  “Food will be your medicine,” the nutritionist told him.  And so John finally committed to going on the low-carb regime I’ve been following for the last couple of months.  It’s been very hard for him for a variety of reasons, but he’s been doing it for almost two weeks and last time he weighed he was already down 12 pounds!  (And he feels better, too.)  That’s giving him the motivation to keep going.
I convinced Jake that even though he is not sick he should get a check up (it’s free, after all!) and become established as a patient in advance of future need.  So he had his first visit with our new doctor yesterday.  When his TennCare was about to expire, just a little over a year ago, I took him for a last minute check up.  What he really wanted was a prescription for an asthma inhaler, something he needs infrequently, but does need when he needs it!  The TennCare doctor could not prescribe this without giving him some kind of test which was not available at her office and had to be scheduled at the hospital.  By the time it was approved and then scheduled, his TennCare had expired.  I am happy to say that his new doctor called in an inhaler prescription for him that was ready by yesterday afternoon.
There shouldn’t be a set of assumptions about people who are on TennCare which influences the care they receive.  There shouldn’t be different levels of care for people who have insurance and those who don’t.  But that was our reality, and Obamacare has changed that for our family.
For more on our journey from being uninsured to becoming healthy, and on my views on Obamacare in general, see the links below.
The $64,000 Question, Answered
Who Are the Uninsured?
Uninsured No More
ObamaCare Update
ObamaCare Update 2

Obamacare Update 2

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

Obamacare Update

I promised several people to continue to share my family’s experiences with being insured at long last via the Affordable Care Act, AKA Obamacare.  We are coming up on two months of being insured and so far it is an unqualified success.
There was a little sticker shock for us regarding some of the medications we’ve had to purchase, as we have to pay full price until we reach the deductible, and while some of the negotiated prices were better than what we’d been getting with the various discount cards we’d been using, a couple have been quite a bit more.  However, thanks to that, John has now met his $300 deductible and I told him to start making appointments for every kind of doctor he’s ever wanted to see!
Emily, typically, has not used the plan yet, since she has literally not had to visit a doctor for illness since she was two years old.  But I’m encouraging her to get a check up at least.  Jake has visited two doctors and purchased prescriptions.  Here’s a perk:  even though his deductible has not been met, because we HAVE insurance, the doctors file it and then send a bill–they don’t expect us to pay up front.  Maybe that’s not news to the rest of you, but it was a happy surprise to us!  Another happy surprise was seeing our first Explanation of Benefits statement and discovering that because of negotiated rates we will pay less for doctor visits even before we meet our deductible!
As for me, I have now been to the doctor twice and haven’t had to shell out one dime as yet.  The first task was finding a practice, and I couldn’t be more thrilled with where I’ve ended up.  We have a Blue Cross plan, and of course it’s super easy to look for doctors online.  I’m used to looking for TennCare doctors and not finding any, so I was overwhelmed by the choices that were available!  I ended up with Trinity Medical Associates, which is a Christian practice, about five minutes from my house, that focuses on wellness.   I love my doctor, I love her nurse, in fact everybody there is super friendly and helpful.  John, Emily, and Jake are all going to start going there.
My plan covers one free check up and one free gynecological check up per year–no charge.  This practice can do both of those, so I will not pay anything for either of the two visits I’ve had so far.  I went two weeks ago, did the gyno thing, got my tetanus booster, and had blood drawn.  I went back today to go over the results of the bloodwork and to have an EKG.
I’m fat and I haven’t had a check up in six (I think) years.  I was really scared there might be something wrong with my heart, or that I might have to take medicines.  Besides the cost, I’ve avoided having these things checked out for fear of being saddled with a pre-existing condition that would have made me uninsurable too.  But I don’t have to worry about that anymore.  Nobody does.  Because that’s one of the things Obamacare has accomplished.
My doctor recommended a mild diuretic for the swelling in my leg (caused by an unfortunate encounter with my own car ten years ago).  She wants me to take a Vitamin D supplement and a Fish Oil capsule.  My sugar, triglycerides, and cholesterol need watching, but she prefers we try diet and exercise changes first.  To that end, I’ve got a nutritional counseling appointment (covered by insurance) and an exercise counseling appointment (not covered, but only $20).  I’m to go back to the doctor in three months to check my numbers again.
After so many years without insurance, I’m almost giddy about this, y’all.  I highly recommend that you take a look at healthcare.gov and see if Obamacare can help you too.  You’ve only got until the end of this month before open enrollment is.  It wouldn’t hurt you just to take a look, would it?
 
 

Uninsured No More

Since I’ve come out supporting the Affordable Care Act, with reservations, both here and on Facebook, and have publicly stated that my family would be applying for coverage, I thought I should let you know that as of February 1st I have joined the ranks of the insured at last!
You will see and probably have already see “Obamacare” horror and success stories in the media.  I am going to share my family’s story, and I hope you know you can trust me to be honest.  There will be no slant here, just anecdotal evidence of how this has worked out for one family.
I was excited to sign up for health care as soon as the website opened.  And that website was just as much of a mess as you may have heard.  The dysfunction could hardly be exaggerated.  I finally managed to get registered but even after days of trying could not log back in.  I figured I had plenty of time to sign up so I decided to come back and try again after the glitches were fixed.
Well, you can imagine what happened, given that the deadline for January 1st coverage was December 23, right in the middle of Christmas preparations.  I waited too long, didn’t realize how much there was to the application process, and had to settle for getting covered in February instead.
That said, the log in problem was solved with a phone call.  The process still had some glitches, definitely, but I was able to get help for all of them from customer service, and the wait times were short.  If you plan to apply, be aware that they are going to need all kinds of detailed financial information about everyone in your family who makes money.  One of the problems I had with the application was that it seemed to be impossible to leave it and come back where you left off.  The info was saved, but you had to click through all the screens again, not exactly a tragedy but a pain.
Once through the screening process, our results were mixed.  John, me, Emily, and Jake are all covered together.  William and Lorelei are supposed to be able to stay on TennCare.  Teddy was deemed ineligible.  I’m afraid he might be falling in that Medicaid hole caused by Tennessee’s refusal to fully participate.  I called a counselor, who said the results did not make sense to her, and I am appealing that part of it.
But in the meantime, four people in my family, four people who were completely without health coverage, are now insured.  About 15 monthly prescriptions are now covered.  A person declared “uninsurable” 13 years ago now has insurance.  All the pre-existing conditions don’t matter.  I can stop being afraid to go to the doctor for fear that they will find something wrong that will disqualify me from being insured down the road.
We did not choose the cheapest plan.  With subsidies we could have gotten one for about $85/month.  You can decide what level of coverage you want, what doctors you want on the plan, what your premium would be, what your deductible will be.  There are many, many plans to choose from.
We picked a plan with a $600 deductible per FAMILY.  With a $4,000 out-of-pocket limit for the year.  With free yearly check-ups, and pretty much 80% coverage of everything once the deductible is met.  Every doctor we care about accepts our plan.  We will pay $272/month.
Even with all the glitches, that’s a success story for us.  I’m going to be shopping for a primary care physician and I’m going to make appointments for the four of us with every kind of doctor we have ever wanted to see.
If you haven’t applied yet, it’s not too late to see what kind of deal YOU can get.  Go to www.healthcare.gov and apply before February 15 to be covered by March 1!