Tuesday, April 15, 2014

Obamacare and Me: Head vs. Wall. Wall Wins.

Episode 1:  From in the pink to on the brink

Once upon a time, in a galaxy far, far away, I had a health plan.  I liked it.  I wanted to keep it.  I had a great doctor, whom I liked, and I wanted to keep him, too.  I was told I could.

I was hosed. 

My dripping-wet hosedhood did not put my name on a particularly exclusive list.  The same thing happened to millions of other Americans.  We all heard the president and other leaders make the same promise.   But they were politicians, and their lips were moving.  That should have told us something.

The story of what happened to me and how I coped with it is an interesting, if not tortured, tale.   And, although I think I may have turned the corner, it’s not over yet.  What follows is Episode One.  There will be other installments.  (And until my paperwork is finally finalized and securely secure, I’m not revealing the name of my new insurance provider).

Until the end of 2013, my wife and I enjoyed our health insurance through an employer-based plan.  But in early November, we received notice that the employer would not be offering insurance going forward.   Part of the problem was that the insurer the employer used was getting out of the business.  The insurance company was a state-sponsored agency, but lawmakers had decided to repeal the authorizing legislation on the grounds that the outfit “would not be able to compete with other health coverage options that will be available in 2014 under health care reform.”  The insurer’s cancellation advisory and the employer letter both referred soon-to-be-former customers to the federal insurance exchange at Healthcare.gov.

When we received the employee notification, the government site had just gone live, if you can use that word to describe the condition in which it found itself right after the launch.  Rather than try to fight my way through all that, I decided to wait a month for the problems to clear up.  On Thursday, December 12, I got on the site without difficulty, and began to compare plans.   My list of finalists included only those health insurance companies that named my primary care physician as an authorized provider.  On Monday, December 16, I created my account, filed my eligibility application, and received approval to apply through the Exchange (and I also learned that we would not be eligible for a subsidy).   The next day, I selected my health and dental providers, and then filed my applications.  A screen on Healthnet.gov reported that my enrollment process had been successful and advised me that the companies I’d selected would contact me for payment of my first premium.  The process had been quick and easy.  I felt good about it.  The same way Captain Ed Smith felt good about his first night at sea aboard Titanic.

Like his, my mood also changed dramatically with the dinging of a bell.  The next morning, my phone rang with one of those calls other schlubs get, but you’re not supposed to.  The previous week, I’d undergone a CT scan to try to track down what had seemed like a minor issue.  But now my doctor was informing me, somewhat apologetically, that the scan had revealed a mass on my left kidney.  A really big one.  Not to put too fine a point on it:  Ding, ding.  Iceberg right ahead.

Quite obviously, the kidney would have to come out.   And God knew what other complications might lie in wait, if it were to turn out that cancer was involved, which it almost certainly had to be.  And my existing health insurance would end in just 13 days.  You gotta love that number, 13.  As I said:  ding, ding.

Right away, I hit the phone to schedule the next medical steps.  In doing so, I asked my doctor to find me a urologist who was authorized both under my old plan and my new one.  Shortly, I had the name of a qualified internationally renowned urologist in hand and had made an appointment for Christmas Eve.

Well, here we go with bells again, as in, Jingle Effing Bells.  And slay bells.  And hell’s—well, you get the idea.  I was in a mood.

In fact, during the process of working the phone to secure treatment, I began to feel a bit paranoid.   I really was covered for whatever I needed, right?  Despite the cancer?  I logged onto Healthcare.gov to double check my enrollment status.  It still read “complete.”  But it also warned that my coverage would not start until after I’d paid my first premium, which I had not done.   Remember, I’d been told to wait.  Now, I began to fidget.  Was this a done deal, or not?  They can’t turn you down by trying to claim your kidney issue is a pre-existing condition, I told myself.  After all, that’s one of the joys of the Affordable Care Act:  walking revenue-depleting profit-sucking insurance stockholder nightmares like me get to sign up with impunity.   Damn the company’s bottom line, and full speed ahead!  I then double checked to make sure my primary care physician was an authorized provider.   His name popped up again.  I was good.  Cancer would not eat me without a fight.  Nor would any cancelled insurance policy defeat me.  Praise the Lord, and pass the Obamacare.

But as the saying goes, just because you’re paranoid, it doesn’t mean they’re not out to get you.  Imagine my reaction when, at mid-afternoon, I open an email from Healthcare.gov and beheld the following:  "You’ve taken the first steps toward getting health coverage at HealthCare.gov, but you still need to complete your enrollment."  

I was speechless.   I was horrified.   My heart stopped.   Beads of sweat popped out on my brow.   My hands shook.  My bad kidney hurt.  I may have spotted.  My imagination ran wild.  Visions of untreated, pulsating, cancerous tumors and ugly, slowly creeping lesions began dancing in my head.  I was starting to feel like a character in the zombie novel I’d just published, wandering around a barren, desolate landscape looking for a place to collapse and dissolve into a green, bubbling puddle of goo.

Making a mighty effort to control my rising panic, I examined the unnerving, contradictory email more carefully.  There was no explanation of what steps I had missed in failing to complete the enrollment, but the email did contain a link to a web page where the advisory said I could finish up.  Guiding the computer mouse across the pad with both hands, I clicked on the link.  It led back to the same page I'd just checked, the one that had listed my enrollment status as "complete.”  The screen was still listing my enrollment status as "complete."  There was no reference on any of my account pages to the alarming email I'd just received, no information suggesting that I needed to take any additional steps, and no buttons offering me the opportunity to do so had I wanted.  And I really, really wanted. 

Atop the page, in huge black letters, was a question reading, "Forrest, what would you like to do?" 
“Not die” would do nicely for starters, I thought.

At the bottom right hand corner of the page was a button reading "live chat."  I clicked it.  What followed next was—well, the metaphor of a plague-ridden survivor of the apocalypse stumbling around a bleak, blasted, barren landscape still works pretty well here.

In chat session #1, I patiently typed out my problem.  The agent assured me that the scary email was probably a glitch, to ignore it, and that I needed to “wait for the insurance company to call you and set up the payment.”  This sounded about right to me, since it’s the same info I’d seen upon enrolling.  But I remained concerned that there might be some hidden glitch lurking in the shadows, just waiting for the opportunity to jump out at the last possible moment and bite me on the you-know-what.  Would it confuse things further if I were to take the proactive step of initiating contact with the insurance company myself?  If I were to call, would they have my file on hand and know who I was and what I was calling about?  Or would the call simply create even more confusion, possibly even leading to the establishment of a duplicate account that would ultimately require even more delay to sort out?  I typed the questions.  At which point the agent simply disconnected me.

Fine.  This led to session #2, with a different agent.  Thinking the length of time it was taking to type out my tale of woe might be an issue, I cut and pasted the explanation I’d previously written out.  At which point the agent simply disconnected me.

Session #3, with a third agent.   I went through the entire process of explaining my situation yet again.  This agent waited patiently to hear it all, and then gave me completely different advice.  She assured me that since I’d already chosen a plan, I now needed to “contact that plan and set up how, and when to pay your premium.”  Now really confused, I pointed out that the previous agent had told me just the opposite.   Agent #3 was polite and apologetic, but insistent.  She repeated numerous times her advice to contact the company, but finally added that I could probably take either course of action—initiate contact or don’t—and it would work out okay.  Given the timetable, the stakes, and the dramatically different potential outcome scenarios (croak, don’t croak) I was not inclined to wait to see what would happen.   I noted that if there were any kind of link on Healthcare.gov leading to payment or contact information for my new provider, I had hadn’t seen it.  She provided me one, and then we ended the session.

First thing the next morning, with credit card in hand and my heart beating with eager anticipation, I followed the payment link she’d given me.  It led to a company 1-sheet that stated the following: "The Health Insurance Marketplace will let [us] know that you have enrolled. This may take up to a few weeks. Then, we will send you a 'Notice of Acceptance' in the mail.... Please wait for the Notice of Acceptance to come in the mail before you make your payment [bolding is in the original.]

What?!?!?!  Oh, my God.   My stomach flipped, my ears roared, and the blood drained from my face.  A weeks-long delay was so not going to do. With me needing immediate surgery, any lapse in coverage would leave me in a world of hurt, as I had patiently explained to three agents.  Time, tide, and spreading cancer wait for no one.

Trying not to panic, and ignoring the 1-sheet’s firmly stated instruction to wait, I called the phone number listed on it, and reached an insurance company rep.   I gave him a summary of the odyssey listed above.  He told me that I had not called the correct number (which, let me say again, I had gotten from his company’s 1-sheet), and then added, somewhat phlegmatically, “You’ve gotten a lot of bad information.”  No kidding!  But his words were reassuring just the same, because his was the first demonstrably true statement I’d heard yet.  He then gave me the correct company number to call.  And within an hour I had made arrangements to pay my first premium by credit card.  (The plan, plus dental, cost us about $35 more than the coverage we had before, and provided slightly better benefits.)

The process of getting there would have left me with a few more gray hairs if it weren't for the fact that I'm bald, but when all was said and done, I had received coverage, and the surgery could now proceed (or so I thought, and please consider that a teaser for our next installment).  No harm, no foul, right?  I was sure that Obamacare defenders would be quick to say that the inconvenience, the minor panic I’d experienced, and the episode of the Walking Dead that had played out in my mind as a result were a small personal sacrifice to make, given that millions of Americans who didn't have health insurance would now be able to get it.  Indeed, when I posted a version of this story on my Facebook page, that is exactly the response I got.  Fine.  I agree that we should have found a good way to take care of uninsured Americans long ago.  But the confused, conflicting, maddeningly glitchy mess I encountered in my dealings with HealthCare.gov does not inspire a great deal of confidence that the government knows what it's doing with our health care—control of which it has largely wrested from us.  Based on what I've seen in the media, I knew my experience was not unique, or even the worst.  My thoughts as the week closed were that if the government is going to compel our participation in ACA under the authority of law and threat of penalty—which it has certainly done—then it damned well ought to get it right.  And it seemed to me that telling us the stone cold truth, giving us accurate instructions, and showing a little customer service would be a really good place to start.  Strike that:  it would have been a welcome change.  The option of starting with those things had passed.

But as I was about to see, confusion and conflicting advice at the hands of Healthcare.gov would turn out to be only the beginning of my problems.


You can find the entire series of blog posts on my medical journey on this page:  My Medical Travails:  Adventures in the Toilet Zone.  And of course, I invite you to check out my author's page, where you can learn about my novels, see critic and reader reviews, download sample chapters, and find purchase links:  www.forrestcarr.com.

© 2014 by Forrest Carr.  All rights reserved.

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