Feeds:
Posts
Comments

Posts Tagged ‘insurance’

Dear Facebook Friends:

Next time you are tempted to gleefully post about how happy you are to see ObamaCare repealed, I want you to think about the people whose lives are going to be affected dramatically when that happens.  I want you to think about people who are terrified of losing their coverage, who went years uninsured,  who saw doctors only when in dire need, who went bankrupt due to medical bills, who visited the emergency room for care because they didn’t have the money a clinic would have demanded up front, who spent hours researching online and filling out forms and chasing down doctors for signatures to get prescription medication payment assistance, who figured out which of their medications they could forgo in a given month, who held their breath in the pharmacy drive-through line while they waited to hear the terrible total.

You are entitled to your opinion and the ACA isn’t perfect, but it’s sure better than the nothing many people had before it was passed.  You can suggest changes and discuss drawbacks and talk policy without appearing to be enthusiastic about the fact that millions of Americans stand to lose their care and that some of them are going to die.

Consider, please, how it makes me (and others) feel when I see people who are supposed to be my friends celebrating the fact that my family may soon be without health insurance and thus effectively without care.  In my posts on this topic in the past I have always been careful to affirm my friends who told me that the implementation of the ACA had caused them difficulties like higher premiums and changes in doctors.  I was always sympathetic and willing to concede the imperfections in the ACA, as evidenced by my many honest posts  (which I will link at the end).  I agreed that improvement–although not repeal–was needed.

Remember that there are suffering people who see your Facebook posts, people who are frightened, for whom this isn’t about politics or partisanship or finances but about staying alive.  Remember that, and if you care about those people, watch the tone of your posts.

Your friend,

A Once and Possibly Future Uninsured American

My previous posts on ObamaCare:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

Obamacare in Practice:  An Update

Read Full Post »

We were a little late getting signed up for Obamacare when it launched, so this month marks our one year anniversary–one full year of being insured!

I know that “anecdotes don’t equal data.”  I also know that UNBIASED data I’ve read on the success of Obamacare has been largely positive.  But right or wrong, anecdotes are what people listen to and remember.  That’s why I’ve been sharing my family’s experiences–both negative and positive–with my readers.

Obamacare has been a success for my family.  Here are the 2014 stats:

Premiums paid:  $3,796.75

Physician Charges:  $41,191.17

Prescriptions:  $9,581.96

Our portion after insurance:  $5,454.47

Total health care costs: $9,251.22

That’s a lot of money, but it’s $41,521.91 less than we would have paid if we DIDN’T have insurance.  Actually, what would have happened is we would have gone without care.  We wouldn’t have had the tools to improve our health the way we have this year (more on this in my next update post).  Jake would have been left with a non-functioning finger after his accident.  We would have tried to do without medications that were less essential.

If you’ve always had insurance you may not realize another huge plus:  ACCESS.  If you don’t have insurance, you are expected to pay for services up front, except in the emergency room (which is why the uninsured–and I’ve been there–head for the emergency room for primary care).  With my magic BCBST card, I can go to the doctor and pay later.  We still owe money for Jake’s surgery.  But he GOT THE SURGERY.  The only thing we had to pay in advance was about $150 to the surgery center.  Furthermore, you will pay MORE for those services because without insurance you lose the special negotiated rate, which basically halves the out-of-pocket costs.

I’ve been honest in my reporting so you already know that our experience has not been completely positive.  To recap, part of the family was not originally covered.  Although that was rectified in August, I still have not gotten a satisfactory response on the appeal I filed, which was your basic bureaucratic comedy of errors.  At this point I am probably letting it go, as the benefits really don’t outweigh the PITA factor.  The website itself is just terrible and while it may not crash as often as it did in the beginning, there are still plenty of problems with it.  On the bright side, the customer service is excellent.  They will do whatever you need right on the phone, and they are kind, pleasant, knowledgeable, understanding, and efficient.  As someone who has spent literally hours at a time on the phone with TennCare representatives, I appreciate that.

Finally, as seems to be true for many people, our premium went up at the beginning of the year.  WAY up.  It’s $200 more this year, and while it is way less than what we would pay (and couldn’t!) without the subsidy, it is still a stretch.  Many blame the rise in premiums on the ACA; I blame it on the greed of the insurance companies and think the solution is a single-payer plan, which I hope we finally get some day.

You have until February 15, 2015 to apply for your own plan!  It can’t hurt to take a look.  Maybe you will get lucky–and healthy–like we did.

And here’s the rest of our ObamaCare story:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

Read Full Post »

It’s been a couple of months since my last update, and things have been happening (and also some things have not been happening, as you will see!).

When I updated you last, I was complaining about the bureaucratic elements (mess) involved in Obamacare, AKA The Affordable Care Act, despite my overall satisfaction.  We were waiting to get a letter notifying us of our official hearing on the appeal I filed to try to get Teddy, William, and Lorelei covered.  Well, I am still waiting.  I have never received a letter or a call or ANYTHING.

However, I also told you that I was going to have to submit another huge batch of financial information, and proof of citizenship, and I don’t know what all else.  So I got that all together and went to upload it to the (still very user unfriendly and prone to crash) website, and could not for the life of me figure out where to upload the documents.  Last time I think I just mailed them.  So I called the help line.

This is the first bright spot of Healthcare.gov, and I want to reiterate it:  The people who staff the help line are efficient, courteous, and knowledgeable, and there are no ridiculous hold times such I have experienced with, for example, TennCare (40 minutes or more).  This guy was quickly able to tell me how to upload the documents, and also said that he thought from looking at my account that it was a mistake anyway.  I wasn’t taking any chances, of course, so I did upload them, and thought I would also take a moment to ask him is he knew anything about my appeal.

Naturally, another department handles that, but he told me if I wanted we could reapply right then for the rest of the family, and that if we were successful, they could be covered by the first of the next month, and that the deductible we’d already met would apply for them as well.  He did it for me while I stayed on the line and supplied the information, and lo and behold, one hour later, everyone in our family was on the way to being insured!

He also put in a request to make it all retroactive to my original application date.  They’ve since denied that and I am getting ready to file yet another appeal.

Our premium did go up as a result of the addition of three people.  We are now paying $411/month, which I am quite sure is still pretty darn low.

What have we been doing with all this awesome health insurance?

Emily, William, Lorelei, and Teddy have all gotten checkups now and have been pronounced in good health.  William and Lorelei both got some immunizations, and Lorelei had several icky warts frozen off (she was very brave!).  John and I both saw the dermatologist.  Y’all, I have been dreading that checkup for years.  Skin cancer runs in my family and I was sure I would hear some awful news.  Instead, the doctor told me I have relatively light sun damage and she doesn’t think I have anything to worry about! (I celebrated by coming home and laying out in the sun.  Just kidding.  Sort of.)  Teddy and I visited the chiropractor yesterday.  Now if you know anything about chiropractic you know it usually takes at least a couple of visits to straighten out whatever brings you there (sciatica, in my case).  So in the past, as a self-paying patient, I would usually try to get by with one visit.  But with a co-pay of $8, I think I’m going back Monday.

Now you know that as a result of all this care and support, John and I have both made some significant dietary changes.  John has now lost 20 lbs., and I’ve lost approximately 40.  He had his blood drawn last week and will find out on Monday whether his numbers have improved along with his weight.  I won’t have another checkup till October some time, but I can tell you that I feel great, have lots of energy, and can walk four miles up and down hills on a summer day without dropping dead.

John and I smiling and feeling healthy!

John and I smiling and feeling healthy!

I wrote a post on my five favorite low carb things to eat a couple of weeks ago and y’all, the page views on that post went out the roof!  So I expect people might be interested in hearing in a little more detail about some of the dietary changes I’ve made, and I’m planning a post on that next week probably.  But for now let me just share one amazing change that I am incredibly proud of:  I now drink my coffee with NO SUGAR AT ALL.  Only cream.  And anyone who ever saw me drink coffee before will know how huge that is!

If you would like to read all about our healthcare triumphs and travails, please see below:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

Read Full Post »

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 http://www.healthcare.gov and apply before February 15 to be covered by March 1!

Read Full Post »

So the other day I was looking at this sort of small boil thing on my leg (I know, I know, TMI but necessary to the story).  “Do you think this could be a staph infection?” I asked Teddy, figuring he would be the expert since things like that tend to lurk in locker rooms.  “Could be,” he answered.  “Well, if I start to see some necrotizing flesh I guess I will go see a doctor,” I said, and I was only kidding a little bit.

I went with John to his doctor yesterday.  There was no more putting it off.  He hadn’t seen a doctor for any sort of follow up since being diagnosed with diabetes in February.  They called him over the phone to let him know.  They didn’t tell him how to check his blood sugar, or what he should be eating, or anything.  And now he was out of his medicine.  He’d been out of five or so other medications for several months, but knowing so little about diabetes we didn’t know what would happen if he stopped taking that one.  So off we went.

We left $150 poorer, with a lab bill to follow, with a handful or prescriptions that will cost us over $500 every month IF we fill them all every month, and that’s after prescription club card discounts.

The last time I wanted to see the doctor, earlier this year, because my leg was swollen and I was worried about a blood clot, I went to the emergency room.  Yes, I am one of those people.  Why?  Because when I called the doctor’s office where I go when I am sick (which is thankfully never) they said I hadn’t been there in over three years, so I would be a new patient, and they would have to charge me for a check up first, and they wouldn’t be able to see me right away.  And I would have had to pay the whole bill right then.  This also happened to me the last time I got sick enough to need a doctor.  That time (I had walking pneumonia) I ended up at the Walgreens walk-in clinic (I recommend them, by the way.). See, healthy uninsured people don’t get annual physicals.  So they don’t have a relationship with a doctor.  When they get sick, they wait a few days.  Tough it out.  See if it won’t get better on its own.

Emily has student insurance because Spring Hill requires it.  She graduates in May and will enter the ranks of the uninsured unless she finds a job that provides insurance.  Luckily for her she is astonishingly healthy–no antibiotics or doctor visits for illness since the age of two.  The other kids are on TennCare but I’m pretty sure Jake gets kicked to the curb at 19–bad news, since he does take medications that it fully covers.  Teddy will have coverage in college, I suppose, and even if we lose TennCare for the little ones as we have fewer dependents, there is a program called CoverKids for them.

I could write several columns about the failures of TennCare but I won’t because despite all of them I am grateful that my kids have had insurance of any sort.  There were years when they didn’t, when I sucked it up and asked for a bill at the doctor’s office while staring at the sign stating that all accounts needed to be paid in full at the time of service, when we waited a day or two longer than other people might to see the doctor, hoping things would improve on their own, when we paid $100 for eyedrops for a corneal abrasion and used them on pinkeye outbreaks for years in order to get our money’s worth.

So how did we end up here?  Where did we go wrong?  Aren’t those uninsured people, those people who think they are entitled to healthcare, people who don’t work, or who are deadbeats, or who just don’t bother to purchase insurance?

Well no, they are people just like us, which is why I am writing about this very personal topic.  Because I think people ought to know that.

I’m not going to go through the last twenty-plus years and tell the whole sorry saga of our health insurance blues, because it would take too long and probably be boring.  I’ll just hit the high (the low?) points.

Growing up, I never thought about health insurance, and I’m sure you didn’t either.  I went straight from my father’s plan to my husband’s–I got married less than three months after I graduated from college.  I remember how fun it was reading about the plans and deciding which one we should pick.  That was right at the beginning of HMOs, and the Federal Government (where John worked then) offered Kaiser Permanente, which was free but kind of sucked, actually.  But it was a lot better than nothing.

The only problem was that when we moved to Knoxville, Cobra notwithstanding, we were screwed, because there was no Kaiser here.  So with a baby on the way, we entered the ranks of the uninsured.  I got a job at UT that had great benefits, but not for pre-existing conditions!  So Emily was an out-of-pocket purchase, paid off over many long years, as were two of our other babies.

Image

I was also writing for the Tennessee Register then, and I wrote a long article about the burgeoning health care crisis in this country–something I had never heard of at that time.  All the experts I interviewed said it was only going to get worse.  When I was seeking a position with the East Tennessee Catholic, I showed that article to the then-editor, and he wanted to know what it had to do with Catholicism.  Ah, hindsight.

That was my last full-time job, so I never was offered insurance again.  John was, at his first post-law-school position, but the family plan was so expensive that we couldn’t afford it, plus I was pregnant already and it wouldn’t cover that pre-existing condition–that didn’t stop TennCare from kicking me off though–because I was OFFERED insurance, even though we DIDN’T get it and it wouldn’t have covered me if we had!

Several years later, after John began practicing law on his own (that means no group coverage, people), he found a nice insurance agent who said he could get us affordable private-pay coverage.  He came out to the house and we picked a plan.  A few weeks later, we got the bad news:  because of his pre-existing health conditions, and the medications he was already taking, John had been declared officially uninsurable.

That’s right, folks:  that’s how insurance companies hold their costs down.  They weed out the people who need the coverage most.

After awhile, we did the math.  Paying monthly premiums, the deductible, and the co-pays for people who rarely if ever got sick made it impossible for us to afford the care and medications for the one person in the house who needed it.  We had to drop that insurance and it’s only become less affordable since.

In the ensuing years, there have been times (pregnancies, extended illnesses, excessive medical bills) that we’ve been able to qualify for TennCare in one form or another.  I was able to get my gall bladder removed during one of those times, happily.  In between, John only goes to the doctor for medication refills and we look for patient assistance programs and samples to cover the costs of his medications, or else he goes without “less important” medications.

Something has to be done about the state of health care in this country.  My European friends laugh at our resistance to “socialized medicine.”  They can’t understand why we wouldn’t want what they have.  The Affordable Health Care Act is not perfect, but it’s a start.  I trust the pro-life Democrats’ assurances that they are satisfied with the concessions that were made to them before they voted for the bill.  I may yet read the whole thing (900+ pages) to see what all it includes for myself.   My feelings about the HHS mandate are already on the record but I am still hopeful that it will be overturned or modified.

Reform has to come, one way or another, sooner or later.  It’s coming too late for some people.

Read Full Post »

%d bloggers like this: