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I am going to lose my mind with health insurance...

Proprioceptive

Proprioceptive

Golden Member
So it took about 4 months to manage getting through the Health Insurance Marketplace system, but I finally got covered. I even got a decent plan even though Emily's still sucks royally. I'm covered. Great! But no... then I find out that only a handful of facilities accept the plan because it's part of the Obamacare system. It's Blue Cross Blue Shield... but it's considered a "Pathway X" plan which is severely limited. I continue to roll with the punches and figure, "hey, I'm covered... stop complaining" until I find out that half of the physicians listed on the websites list of approved providers DON'T actually provide for the Pathway X. I have to call every single provider ahead of time and basically walk them through the process of finding out if they actually provide for my plan. Okay... still rolling with the punches...

Things get REALLY frustrating now. I go to providers that are verified to be in network only to receive claims information afterwards stating that they're out of network. I can't get ANY clear answers from anyone at customer support. Then I notice that appointments on under one provider are being billed out of network and then seeing that other appointments with that SAME PROVIDER are being billed IN network! At this point I'm getting furious. There is no way for me to keep track of what I can afford with this crap going on.

Yes, it gets worse. I start going through my claims history and notice some math errors... now I'm seeing that when claim is processed for an in-network provider, sometimes the deductibles are being applied to my out of network limit and vice versa. I now have an IN network out of pocket amount higher than my IN network deductible amount which is IMPOSSIBLE. I just called customer service today to find out why my latest appointments with an IN network provider are being billed IN network but the amounts are being applied to my OUT of network deductibles which means even though I should owe $0, I will now owe the full amount! AAAAGGGGGHHHHHH!!!!!!!!!! Between this and dealing with the idiocy at FedLoan Servicing for Emily's loans (I could write another few paragraphs about that insanity), I'm about to lose my mind. I'm sure you're probably just as confused by the above ranting as I am....


TL;DR - Obamacare sucks... the plans offered through Obamacare suck... the health insurance companies through Obamacare suck... I hate health insurance.
 
Simple solution. Do away with insurance altogether and go to single payer. Take Medicare, scale it up, problem solved.
 
Mxylplyx said:
Simple solution. Do away with insurance altogether and go to single payer. Take Medicare, scale it up, problem solved.
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Somehow I don't think he can do this himself.

OP, you fell for BCBS's ruse. Sorry. That sucks. When I went through the marketplace, I noticed that my offerings were approximately 80 plans, 75 of which BCBS, all of which sucked fat donkey shit. I don't know whose cock they sucked to be allowed to flood the system with their bullshit, making people think that they are the only option...but it sure seems to have worked.

Of the other 5 or so plans, there were like three absurdly-priced Cigna plans and two Humana. I went with Humana, as they were the one single offering for a plan that was not 'high deducticle' (i.e. I get to go to the doctor and make a $25 copay, rather than having to fulfill deductibles) that had a real network. I almost fell for BCBS's shit (they had one or two plans...of the 70+...with copays) before realizing that they were essentially HMO's that would pick your doctor for you.

Don't get me wrong- I'm paying $270 a month for insurance, and it still blows. Just not as bad as it could have.
 
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so you go to anthem.com, and do a provider search filtered by your area and exact health plan, correct? And the listings are inaccurate?

Who do you suspect is doing their job wrong? (A) The insurer has bad listings or (B) the people handling insurance in the doc's office are a bunch of idiots? My (fairly extensive) experience with this sort of thing tends towards (B)...but (A) wouldn't surprise me either since the whole thing has been such a clusterfuck.
 
Gooberlx2 said:
so you go to anthem.com, and do a provider search filtered by your area and exact health plan, correct? And the listings are inaccurate?

Who do you suspect is doing their job wrong? (A) The insurer has bad listings or (B) the people handling insurance in the doc's office are a bunch of idiots? My (fairly extensive) experience with this sort of thing tends towards (B)...but (A) wouldn't surprise me either since the whole thing has been such a clusterfuck.
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Yep. They're very inaccurate. I would agree with you on who's to blame but it doesn't change the fact that the whole system is horribly screwed up.
 
Funnily enough, your experience mirrors that of mine, and I have United Health Care PPO HSA option (everything except for the in-out of network doctors and facilities, but I don't think that matters). I think this whole health insurance scam, eh, I meant system is out of whack.
 
Proprioceptive said:
Yep. They're very inaccurate. I would agree with you on who's to blame but it doesn't change the fact that the whole system is horribly screwed up.
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Yikes. My best suggestion, if you don't do this already, is to fax or email your insurance card to the office ahead of time to verify (and re-verify) with them that they're actually in-network on the plan.

In addition to the natural complication of navigating the insurance maze, and insurers lagging in updating their own plans and databases, I've found admins in doc offices to be incredibly lazy at their job, eager to take short cuts and make assumptions.
 
Gooberlx2 said:
Yikes. My best suggestion, if you don't do this already, is to fax or email your insurance card to the office ahead of time to verify (and re-verify) with them that they're actually in-network on the plan.

In addition to the natural complication of navigating the insurance maze, and insurers lagging in updating their own plans and databases, I've found admins in doc offices to be incredibly lazy at their job, eager to take short cuts and make assumptions.
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Sadly, I find providers that do not accept my insurance listed as accepting my insurance and vice versa. It's become a total crapshoot lately. I've communicated all of the errors with customer service but all they can tell me is they can resubmit the claims which will take 45 days... totally frustrating
 
I'm not too happy with my new plan either. I have Humana's cheapest Bronze plan, and received a letter the other day. They said my plan doesn't meet the new tax law requirements. I bought this plan through an agent / company website rather than the gov site.

I spoke with my agent, and it has to do with this particular plan, which is about $70 cheaper than competing companies. I can however get the next higher plan. The only difference is the co-pay is 0$ instead of $30 for doctor visit. But you cannot buy a new plan until November 15th. It was October 15th, but was moved to just after the elections.

So now I'm screwed for this tax year, and will have to pay a 1% penalty (tax). I'll just have to pay the increase, because the penalty is going to periodically go up each year.
 
Bcbs automatically placed all the physicians who were taking their regular commercial insurance onto the obamacare plans so it seemed like they had a large network. once the physicians found out that the obamacare plans paid them $9/hr, they started dropping out.
 
I am sorry for your frustration and struggles. But it is a racket that corporate America has been playing for awhile. Except now they are discovering that health care cannot be delivered like McDonald's burgers. It's a lot less expensive to actually pay for regular health care and have a cheap policy that covers hospitalizations.

The reason for the chaos is the attempt at centralizing a fundamentally decentralized transaction. And if you think scaling up Medicare will solve the problem, just ask any veteran who goes to a VA Hospital. That is single payer in this nation. The 'management' and administrative jobs in health care are finding ways to expand themselves because it is easy and low risk work.

Legal risk is the other devil that drives expenses in this nation.

Still, corporate CEOs pull in 8 figure salaries. The Dean of the non-profit state medical school here (UMASS) pulls in 2 million while the governor of Massachusetts only pulls in 150K.

We Need to
1) limit the number of patients per physician to less than 2000
2) make all health care jobs that do not involve direct patient contact pay less than those that do.
3) eliminate the power of the hospital and the pharma lobby in Washingtom. Corporations are not people and should not be allowed to have a voice in politics-an activity that was born to empower people.
 
Slew Foot said:
Bcbs automatically placed all the physicians who were taking their regular commercial insurance onto the obamacare plans so it seemed like they had a large network. once the physicians found out that the obamacare plans paid them $9/hr, they started dropping out.
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Web link to news story to verify?
 
It sounds like you should document your experiences with BCBS and send a long letter to your state's Insurance Commissioner or equivalent.
 
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