Impressions of Obamacare

I recently had the opportunity to work through signing up for Obamacare, though it was not for me.  A family member recently took on a new position, and since their employer does not offer health insurance, she needed to sign up for insurance using Obamacare.  She asked for my help.

I won’t walk step by step through the process, since there are already a million articles out there about that, but wanted to share some of our shared impressions.

  • It’s pretty cleanly designed – I was pretty impressed by the user interface.  It was colorful and simple enough to be welcoming, but not distracting.  It also split much of the form entry into multiple pages so as not to be overwhelming.
  • There’s a lot to enter – Most of the information you need is pretty straightforward but there is a lot more information than you probably think going in.  We had estimated it’d probably take around an hour but in reality, it took closer to two hours.
  • Figuring out income is tricky – Many people likely know how much they make, but if you are hourly, or if you aren’t really sure, you’re likely taking a guess.  In our case, we struggled because of the hourly component, and also didn’t really the implications of only being at this job for part of the year, which will greatly affect the total income that will go on the tax return.
  • All of the options lead to second-guessing – We had a rough idea of the needs, and also had a rough idea of the expected costs, but when we got to the lists, it was quite a bit to take in.  The variation in pricing and such made it pretty confusing, and you found yourself just scrolling through.  Also, when you found what appeared to have the same offerings, but for price variations of up to 100%, it made you start second-guessing whether you were really making the right choice.
  • The providers have some work to do – When we found the plan we wanted, it gave a link so that it could be paid to ensure that coverage started on the 1st of the month.  The only problem is that the link didn’t work.  It likely went out to the providers site for payment, so there is some problem somewhere along the way.   We also noticed during the sign up process that the details about each plan took you to the website of the provider, which was fine, but that led to confusion as each provider structured their information to their own design.  Since you’re comparing multiple plans along multiple providers, I think that providers should be encouraged to put the information together in a more common template format.
  • Some stuff needs to be re-arranged – We needed to sign up for health and dental.  It wasn’t really clear whether they are done completely independent (they are) or not, so before we submitted ‘OK’ on the health side, we were nervous that we were locking out of the dental options (we weren’t).  I think this could be solved by having the participant select the coverage that they need up front before signing up for anything, and the system could build your sign-up plan accordingly, making sure that you go directly to dental sign-up.

Overall, it wasn’t a horrible experience but it wasn’t great.  I’d say it was OK, though we were expecting worse.  The biggest takeaway is that health insurance is still full of a lot of unknowns, and that can lead to nervousness and such.  I can see where they tried to take a lot of that out away with their design, but some additional re-work could make even more improvements.   We finished up and I could tell that my family member was nervous.  Taking away that ‘What did I just do?’ element is something that could help consumers a long way.

Readers, have you or someone you know signed up for Obamacare?  What was the experience and what suggestions would you make?  Note: This isn’t a place to debate whether Obamacare should be in place or not.  It’s here and the purpose of this article was to discuss our experiences with that framework in place.  I’d appreciate if discussions could be handled along the same lines.  Thanks.

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Do Everything By The Book And Still Get Screwed By Health Insurance

Every time we think that we have health insurance figured out, we are proven that we are and will always be wrong.

You can do it all.  Every step.  Check it off.  Verify it.  Dot every i and cross every t.

Doesn’t matter.

The insurance companies will still manage to get you.

Actually, it’s not always the insurance companies.  It’s more the laws and the medical profession as a whole.

In Network But, Oh, Just Kidding

The latest example I saw that just floored me was in a New York Times article last week where unsuspecting people need immediate medical care.  They do the right thing.  They head to their emergency room that they already know is in network and get the care that they need.

It all sounds fine and good, until the bills come, and they realize that while they went to an in-network emergency room, the physician that treated them may not have been in-network.

Meaning, you’re stuck paying through the nose.

Apparently, many hospitals can’t (or won’t) fill all positions with employed doctors, so they contract out some of the staff that they need.  This is becoming more and more common.  It reduces fixed costs for the hospitals, but it means that you really have no idea what you’re going to end up being billed for.

Sometimes, it’s a crap shoot.  The hospital may have some doctors employed by the hospital, and some brought in as contractors.  The one that you get to see?  You can’t really pick.

Granted, patients can find out if the doctors are in network or not, and if the doctor that comes to see them is not, they could always refuse service or ask for someone else, but honestly, if you’re in a situation where you or a loved one needs emergency care, how often do you think this will happen?   If you’re hurt or having a heart attack, or your child has a broken bone, are you really going to wait around in hopes that a doctor is available that can save you money?

Sadly, that’s what our health system in America is coming to, and you may be asked to make this choice.

The hospitals themselves are covered.  In the sheaf of paperwork that you sign when you first arrive, you’re likely signing something that indicates that there is no guarantee of the network participation of anybody that treats you.

Since most hospital visits incur separate charges for the hospital and the doctor(s), many unsuspecting patients are falling into this trap, and when they call to protest the bill, the hospital can point to the fact that they signed the paperwork.

And, the sad thing, this is all legal.

What’s The Better Way?

The bottom line is that the system is broken.  I’m generally conservative, but I’m not staunch enough to think that Obamacare is an unmitigated disaster.  Many conservative people argue that it should be repealed, and many politicians build their platform on trying to do just that.

I’m not so sure, and the main reason is more of a fear as to what would happen if it was repealed.

Think about that for a second.  There are people out there whose goal in life seems to be to get rid of our current arrangement, and they will talk for hours at end about why it is so awful for our country and our citizens.  If anybody started that conversation to me, I would politely stop them and ask them how they would propose to make it better.  What would they put in it’s place that would stop the stupid nonsense and loopholes that screw the average consumer?

My guess, based on the fact that I’ve never heard one good proposal, is that nobody really knows.

On the flip side, Obamacare has not and will not prove to be a big fix.  We’ve already seen that.  It made a lot of promises, and even lived up to some of those as to problems that it was able to solve.

The main  issue I have is that for every problem it solved, it often created another issue.  You have many paying higher than they used to for insurance.  The second problem is that it did not truly reform the system in that there were way too many problems and loopholes left open that didn’t get addressed.

Like going to the in-network Emergency Room and getting billed thousands for the out-of-network doctor that took care of you.

Sorry, until stuff like that gets fixed, you can slap any label you want on the health care system, but the one I would slap on it would read:

Out of Order

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Back When I Knew Virtually Nothing About Health Care Or Hernias

Way back in 1999 and 2001, I went under the knife, both times for hernia repair operations.  Going in for surgery is never fun, but looking back, I’m amazed at how little I thought of the cost of health care in terms of what was a priority and everything else.

The First One: I Didn’t Even Know What Was Wrong

When I had my first hernia, I didn’t even know what I had.  For those who aren’t sure of the exact problem, it’s essentially a tear in your inner lining that typically keeps your intestines in place.  I had a ballpark idea of what a hernia was and I knew how the doctor tested us guys (yes, we do turn our heads and cough), but I didn’t know why I had this big lump that appeared at the bottom of my stomach, and why I could push it in and have it pop out.  It didn’t really hurt, it was just…weird.

So, I scheduled a visit with my doctor and just by looking at it, he was able to tell me that I had a hernia, and referred me to a specialist.

The specialist confirmed the diagnosis and said that I would need surgery.  They’d have to cut me open at the spot of the hernia and patch the hole.  This was done via a type of mesh.  In the old days they would actually sew you up on the inside, which I guess hurt a lot and it also wasn’t very reliable.  The mesh solution allowed for more flexibility and movement which would reduce the future chance of tearing.

At that point, all that came out with health care was providing my insurance card to make sure that the hospital and specialist (who was the surgeon) would cover it.  I had no idea what it would cost total or what my out of pocket was.

Even the day of the surgery, I really had no clue.  I filled out the paperwork, got ready for the surgery, and went in for the fix.  It was a little daunting because it was at a hospital and the surgery area was huge, and there was just a lot of hustle and bustle.  The surgery was the type where they had to do a full incision, and for any ladies who have had a c-section, you can relate that cutting through your abdomen is painful.

Really painful.  It hurt a LOT to walk and move around, even with the pain medication.  I had arranged to spend a couple of days at my parents for recovery time.  The healing was slow, and after a couple of days I did go home, and a couple of days after that I went back to work, though on a very light schedule.  As it turns out, I probably should have stayed out for longer than I did, as I went through a lot of pain in those first few days.

Eventually, things got a lot better and after a couple of weeks was largely pain free.

Until the bills started coming.

I have no idea what the costs were, except that my final cost was around $700 out of pocket.  Before that, I had no idea what to expect.

Still, I remember looking in awe at what the hospital billed the insurance company, and was also shocked about how much of a lower rate they actually received.  The $700 hurt, but I was enlightened by my first real exposure regarding an ‘Explanation of Benefits’

Round Two, When Everything…I Mean Everything….Was Easier

The hernia I had above had happened on my right side.  The surgeon had warned me that in cases like this, it was fairly common that whatever the conditions were that led to the hernia on one side likely existed on the opposite side of my body, and that another hernia would be possible.  Sure enough, I felt the familiar feeling of my intestines not being exactly where they should be.

I once again called my doctor, and he didn’t even want to see me!  He knew that someone who had a hernia once would recognize the symptoms, and since my insurance didn’t require a referral, he just advised that I go right to a surgeon.

This was a couple of years later, and I decided to do a little checking.  Research told me that there was now a laparoscopic method of hernia repair that was much less invasive and would therefore be less painful.  Instead of doing a full incision at the point of the hernia, they would do several tiny incisions at a couple of different points.  One of them would allow for a small camera to be placed in, and others would be for the instruments to go in and the mesh to be fed in.  At that point, the surgeon could do the work by looking at the camera.

It sounded really good to me.  I did some research to find a surgeon in the area that participated in my plan, and went to see him. I actually spent a great deal of time talking with him, learning about the procedure, and understanding his background since it was a relatively new process in hernia repair at the time (it’s now the routine method).  He said that the biggest risk was that if the hernia was bigger than originally thought or in a location where the instruments couldn’t go through, they would have to do a full incision anyways, in which case you actually have more pain because you have the full incision plus the other little ones.  Still, he felt that with what he found with mine, that the risk of this would be less than 10%.  Those were odds I was willing to take.

So, I was on the track for less pain, which I loved.  I also found that he scheduled it at a surgery center versus a hospital.  A surgery center is a standalone building that is dedicated just for surgery.  It was so much easier to handle. It was lower key.  You went in and it was barely a few steps until you were where you needed to go for prep (versus the maze of getting through a hospital to the surgical area).  Same with getting out.  From the recovery area to the door where my parents car was waiting was literally less than 100 feet.  Try managing that at any hospital.

The first day when I got to my parents house, I was awaiting a lot less pain.  And, it didn’t happen.  That first day, it hurt just as much as the first day it did for the original surgery.  I was mad and cussing the doctor out quite something.  On the second day, when I woke, though, is when I felt the difference.  I practically hopped out of bed. It was at that point that I knew the laporoscopic method really did result in less pain.

So far an easier surgical experience and an easier recovery.  It couldn’t get any better, right?

Except in this case it did.  I had set aside a similar amount of money anticipating the bills to come where I would need to pay the $700 or maybe more.

The bills never came.

In fact, the explanation of benefits came and showed that I owed exactly nothing.

This was amazing to me and I even called the insurance company, and they confirmed it.

I found out years later that I was the benefit of an office manager that had kind of taken advantage of his position and used it to help his personal situation.  He had a large family, I think six or seven kids, and thus there were a lot of doctor visits and such. He was also in charge of working to set up our insurance plan, and somehow managed to negotiate a plan that lowered out of pocket costs to virtually nothing (or in many cases, as I found out, exactly nothing).  It must not have been noticeable up front to the owner, because it took a couple of years until the owner had to tighten costs, so he let the office manager go, and started reviewing all of the costs.  He quickly reverted to the plan that was less costly for him and would put co-pays back in line.

(Note: This is all the story I was told by a co-worker who remained there.  I had left the company by the time this discovery was made.  So, things could have and probably did transpire differently.  I’m just relating what I was told.

I was lucky enough to be the recipient of that year or two window where the office manager may have…taken some liberties, but it introduced something else I really knew about health coverage (but have since really learned), which is that some of it is really good and some of it really sucks.

Since then, a lot has changed. Thankfully, I have had no further problems with any hernias and I’ve not had to go under the knife for anything else.  I have had a lot more interaction with the ins and outs associated with health care, and I’m sure that’s going to be the case for the rest of my natural life.  I did learn that pays to be educated…both about health care and about hernias, of course!

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Who Paid For The Flu Shot?

A few weeks ago, I was talking to my wife while I was at work, and she mentioned that she had gone to Target, and had decided to get a flu shot.  We’d never done this before so I was a little curious about how everything went down.

Typically, we get our flu shots in one of two ways:

  • Doctors Office – As part of a checkup, they will usually offer a flu shot during the season.  Our insurance coverage provides 100% payment for routine checkups and immunizations, as long as it’s done through a participating provider, so we have never had any out of pocket costs.
  • Work – The employer I work for actually brings in a couple of nurses for a day, and you can get your flu shot for free.  I’ve done this before, though if I happen to have a checkup scheduled, I’ll usually have it done there to avoid lines and such.

The plan by my wife raised a few red flags, specifically with regards to the cost and payment.  She told me that Target had taken her insurance card, and said they accepted that coverage, and didn’t charge her anything.  On top of it, my wife got 2 pharmacy rewards points, which is a program that if you fill prescriptions at a Target pharmacy, you get a 5% off shopping pass good for one day only after you have accumulated 5 points.  Since we already get 5% by using our Red Card, this stacks, and you get 10% off.  Not bad.

The issue is that I know that our insurance plan likely doesn’t accept Target.  I have no idea why, but they do not consider anything outside of a doctor’s office or hospital as an in-network provider.  This means that we cannot go to any urgent care facility or any ‘in pharmacy’ wellness clinic.  This has always struck me as backwards, because if it’s off hours and I have a non-emergency need to see a doctor, I’d be happy with going to an urgent care facility, but instead they either say that you should wait or you should go to an emergency room, which is going to have a much higher billed rate.

In any case, I called my provider and asked if the flu shot would be covered at Target, and they confirmed that it wouldn’t be.  I called Target back and asked about our account, expecting to have a balance.  They pulled it up, and said…it was paid.  We had no balance.

So, I logged into our insurance plans website, where you manage all claims and information about your coverage.  You can see backward two years.  There was nothing there pertaining to my wife getting a flu shot.

I figured that maybe it had somehow gotten billed to the prescription plan.  We have one insurance card that provides information on both, so I logged into our prescription plan’s website.  There was nothing there either.

Those are the only two places that would have possibly received a claim for this, and neither is showing a claim filed.  It’s been over a month, so I know it would have processed by now.  Yet somehow Target is satisfied that they’ve been reimbursed for the shot.

If it were to somehow show up, I think the cost would be $28 to us, so it wouldn’t be a huge amount.  I’d of course be mildly annoyed that we had to pay for something out of pocket that could have been covered elsewhere, but at this point, since no one will fess up as to who actually pays for it, I’m not going to say anything.  Shhhhhh……

Who do you think paid for my wife’s flu shot?  Have you ever had someone report payment in full though you weren’t sure it was paid?

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