Now I Have Insurance. But I Can’t Use It. What Am I...

Now I Have Insurance. But I Can’t Use It. What Am I Supposed to Do?

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A THCB Reader in New York City writes in to say —

“I am a self employed psychotherapist in New York City. I had health insurance through December 31st when my policy was canceled.

I bought an ACA policy in mid-November and had to fight to obtain my insurance identification number the entire first week of January. I did not receive my id number until January 9th.

Now, I still can’t use the insurance — even though I have an id number — because none of the doctors that I know who are actually taking the insurance have been placed on Blue Cross’s website as being in the ACA plan network.

Thus, I can’t change my primary care and I can’t get a referral for my pain management specialist (I have nerve damage in my spine due to a surgical complication). So, I have an insurance policy but I can’t see my doctors who have decided to take the ACA insurance. I essentially have purchased insurance that I cannot use at the present time and I don’t know when I will be able to use it unless I go to the few doctors they have put into their system.

I have been talking to the New York State Department of Health and so far, their aid if you will call it that, has been useless. I am still left with having to pay out of pocket to see my pain management doctor onJanuary 15, 2014.

This is something no one is talking about — that those of us who were insured, who have tried to keep some doctors, who have inquired and found doctors who say they are taking the insurance — that utilizing these new policies due to referral requirements is next to impossible.
Many of the doctors listed on their networks do not exist. I have called many of them. My guess is this will be talked about in two to three months when more people find they can’t use their policies. BUT NO ONE IS TALKING ABOUT IT NOW and it’s driving me crazy because it is happening now.

The government representatives I have contacted and asked for help are of no help. They have no plan in place to deal with these problems and they don’t appear to think the problem of not being able to see your doctor is important enough to deal with. Since it’s not happening to them, well, you know….”
If you have questions about the Affordable Care Act or your buying insurance on the federal state exchanges, drop us a a note. We’ll publish the good submissions.

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92 Comments on "Now I Have Insurance. But I Can’t Use It. What Am I Supposed to Do?"


Guest
Mary
Apr 20, 2015

I am in California and I am having the exact problem you are having with my Doctors office. I got into a argument with his office personal and have been denied an appt with my Dr that I see monthly under the guise that it’s an insurance problem. My insurrance allows me to go out of network and I even found a wonderful ins rep that called my Dr’s office and informed them that I would just have to continue as a cash patient and they have still refused to allow me to obtain an appointment with my Doctor. Check with patiences rights groups , and good luck . I am enlisting the help of an attorney to resolve my issue.

Guest
Alison
Mar 28, 2015

I think mass elder poverty is part of the reason my friend died. He didn’t want to call an ambulance because of the cost. I am terrified of living well into my 90s. What for? To have a horrible quality of life? To be impoverished? To be alone at the mercy of healthcare providers?

I don’t think so. I’ve got another plan here!

Guest
Mar 28, 2015

Thanks John. I appreciate your appreciation!

The Medicaid estate recovery nightmares are rarely for hospital bills. Most hospitals forgive their enormous bills when the patient has no ability to pay. This is done quietly, one patient at a time, so the word does not get out.

Instead the asset recoveries are for nursing home costs. What is going on here is that people are living longer, but the amount of money they earn and save is not keeping up with life expectancy. As you suggest, the scope of this problem is quite enormous. It will take another New Deal of some kind to prevent mass elder poverty.

One way to characterize

Guest
Mar 28, 2015

Thanks for sharing, Alison. I feel bad for what you have gone through.

Seems to me that narrow networks are a secret strategy of the insurers to cope with guaranteed issue.
Before 2010, insurers in the individual market could turn away sick people, and they did so in large numbers. And/or they drove off sick people tjhrough relentless premium increases.

All they can do now is to make their plans very unattractive to sick people, and to drive off sick persons with awful service.

Expanding Medicare down to age 55 would have been far better than the ACA in this regard.

Guest
Alison
Mar 28, 2015

Thank you, John. They’re making it as difficult as possible and our representatives are not helping at all. You go to the government and you just get more red tape.

A friend of mine in his early 60s who went YEARS without healthcare in the middle of New York City, who worked as a psychotherapist with the poor (who were fully covered by Medicaid) died last Wednesday.

He never got an Obamacare policy. He was so sick, in so much pain and struggling with so many bills that he couldn’t even imagine getting a policy. Knowing this man, he would not have known how to navigate this system. He could barely manage email let alone the internet. Can you imagine finding providers when you’re not internet-knowledgable?

He’d spent 10 years in his 40s working on his PhD. He told me it was like being in the military. By the time he got his PhD, he was in his 50s. He was worked like a dog by the nonprofits here who provide services to Medicaid patients and don’t even care enough about their clinicians to provide them with ANY benefits.

I felt like a cab driver when I had that job. I didn’t get paid if the patients didn’t show and they had better benefits than I did.

My friend didn’t survive this situation. Obamacare was too little too late. Or let’s just say it was a whole bunch of nothin’ too late!

So you can imagine how I’m feeling this week.

It only gets worse.

If this man had gotten the care he deserved, he’d be alive today. Considering the kindness he showed the population he was working with, it’s downright shameful.

Guest
Mar 28, 2015

Spot on, Bob Hertz. Even with Medicare there is a difference between the supplemental private policies and Medicare Advantage. Last year was the first time I left original Medicare for a MA plan, but my wife remained with Medicare. We learned about four years ago that people with more expenses are better off (financially) with Medicare, but MA is a better deal for healthy people. For starters, where we live the premium is zero, I presume because they are working to increase enrollment. It’s more about money than medicine, it seems.

You’ve been at this for some time. Have you any sense of where the politics is headed? Clearly the notion of “repeal and replace” is nothing more than a slogan. There are too many positive features that will never go away. And as the president said, they can’t repeal it mostly because it was a Republican plan to begin with.

The assessments at your site are excellent, by the way. I just love this:

Medicare has been an enormous success, but it is not self-financing. A senior who gets a hip replacement does not go out and earn more money and increase tax collections. Saving lives is expensive twice — first when we do it, and then with higher Social Security and Medicare costs in the decade of extra life. I have often thought that doctors should be taxed for saving elder lives, not paid to do so.
http://healthcarecrusade.com/Center/How%20to%20Control%20Medicare%20Spending.pdf

Are you aware whether enough Congressional policy makers are paying attention to make correctives? Better yet, do you have anyone’s ear (even if you are not at liberty to say who)? I sure hope so. Every time I listen to stump speeches and talk radio it makes me sick. Surely they know better, but they keep on with the same tired soundbites.

Aloson’s case is a nightmare, but the financial impact of medical bills is totally catastrophic for many whose entire net worth gets wiped out. When they can no longer work they are at the mercy of whatever Medicaid services are available where they live — and lately I’m seeing reports of states going after estates post-mortem with those five- or ten-year lookbacks, taking what little might have been deeded over too late to the next generation — who will face even worse prospects if changes are not made.

Guest
Alison
Mar 22, 2015

Gotcha, John. You have clarified yourself completely here.

I am happy that the working poor have coverage and I supported the ACA for that reason. My complaint is that there is little discussion amongst Democrats of the real problems with the ACA and little focus on improving things. It’s about fighting the Republicans to keep the ACA. So, in the midst of this, those of us forced onto it are part of an experiment. To say that it was poorly implemented is an understatement.

Here and there you see an article with a horror story but this issue of the insurance companies not contracting with enough providers — or any at all in the beginning — is very problematic and it was very distressing to me to be in the middle of recovery from a serious nerve injury and to face not only NO care even though I was paying for insurance, but a drastic cut in my income as well. And then when I was as Little Red Riding Hood might say “lost and alone,” my Liberal comrades were downright mean.

I am still without a neurologist! Having a serious NERVE injury, I have no neurologist. Working on it. It takes time to replace eight doctors. And we all know the insurance companies know that. Think of how much money they’ve saved just with me by taking away my doctors and making those visits impossible.

I was a Democrat but I experienced a side of my party that was incredibly nasty, indifferent, and downright mean. And I was just a person having problems. I wasn’t even making a political statement in the beginning. I have been a supporter of the ACA in theory. I was very frightened and I couldn’t rely on my local Democratic representatives to help me, those who advocated and fought for this legislation, those who weren’t even interested in the people who were getting hurt by it and weren’t lifting a finger to help. It was quite disillusioning.

They should be ashamed. I left the party as a result. I am now independent, and the party has lost what most of the time could be counted on as a vote.

A single sole proprietor in her 50s gets fucked by Obamacare. Who cares?

There’s nothing anyone can say to make me feel better. If you could wave a magic wand and make my nerve better and let me run again (I can’t), that would make me feel better. That’s the only thing. I just want my health back. And I’m having to fight every step of the way, every single little thing. You have no idea what this is like (or perhaps you do if you’ve struggled with illness). I am alone with this. It is the most difficult thing I have ever faced.

So now, when I do get to a doctor, particularly at the hospital centers the Obamacare folks want everyone to go, you know these centers for care where they’ll take of everything, well, the hospitals incorrectly charge ALL THE TIME and of course, they’re always over-charging. The insurance companies don’t even process claims properly. For example, my copay for routine labs is $0. I was billed $35. This happens all the time. Now, that happened occasionally with my prior insurance, but it’s happening much with every single visit to a hospital clinic for my primary care. I am not getting the one free preventive visit, and my low copays are not happening. It’s a big fat lie.

I think the hospitals are making these small errors in their favor and hoping that people will just pay as it’s not worth their time to fight. Of course, for me, it’s the principle; I’m not going to pay what I don’t owe, and so it’s a hell of a lot of correspondence and in terms of my time, I’m essentially losing more money.

So, I pay more for less, I’m nickle and dimed to death, I can only generic medications (nothing else!), and I’m terrified of becoming seriously ill because my options here in NYC will be very limited and there will be a fight for everything. When I’m sick and alone, that’s what I’ll be facing. Already I can’t get my medications at various pharmacies due to the government “protecting” me from myself.

I know these things happened before. But they didn’t happen to THIS extent and that’s what no one’s getting. Talk to anyone on one of these plans and they’ll tell the same thing. It’s a fucking mess and we’re the guinea pigs and it’s our lives at stake, our retirements, our peace of mind. It is absolutely terrifying.

If I could leave this country and go back to Canada and work there, I’d do it in a heartbeat. But I can’t as I”m a licensed professional and stuck in New York. Another example of government “helping” with licensing. Now, I can’t work anywhere but New York. I feel so incredibly hampered by government interference in my life that I fear I’m going to become, oh no, a Republican!

And get this — I could go to any number of hospitals in this city with my prior plan. My roommate had leukemia and went to Sloan Kettering and lived. They send me requests for donations but now, with my ACA policy, they won’t let me in their door if I had cancer. I’m shaking my head as I write this. The audacity.

Thank you for your thoughtfulness. There’s nothing anyone can do. I’m basically fucked for a while. I hope it’s okay to swear on this thing. Life is miserable enough as it is recovering from a serious nerve injury (unless you’ve had one, you just have no idea, it’s not even possible). Let me put it this way — I would have preferred my leg broken in a couple of places and staples and metal put in to the nerve injury (where there’s nothing they can do apparently).

I just didn’t need another form of hell in the form of Obamacare. I already have one that is bad enough.

Oh my. I’ve become a bitter person. I never thought it would come to this.

Guest
Alison
Mar 20, 2015

This all occurred with the ACA so I’m not sure this is simply an “insurance” issue versus “governence.” It’s the law that caused insurance costs to go up for MOST (even my corporate patients have high deductibles now and higher costs) and this is because ACA demands that MORE be covered.

The result is MORE is covered by LESS doctors.

Look, I don’t know what the answer is, I really don’t, but what’s disturbing to me is that I see almost no newspaper coverage of the fact that none of us can find quality doctors and someone with a brain tumor can’t get care.

Good job, good job, Obama. What a big fat liar.

Health care providers who take the ACA plans — and I’m one of them — take at least a 20% cut if not more to provide services to members. I do it myself as I’m one of the victims of the ACA but my guess is that other providers might not be so inclined to take such a cut.

John Ballard, keeping us “health care providers” in line? Would you take a 20% pay cut to fund the ACA? I have. Do you have any skin in the game? I’m really just curious, not trying to be rude here but I’d like to know your thoughts on taking a 20% pay cut to fund ACA. Would you do it? Do you believe in it that much? That’s the cut I took, and my health insurance costs rose while I was in the midst of a terrifying health crisis (and I got little sympathy from ACA supporters).

Would you personally go for that at over 50 years of age and when you have to save for retirement? What do you think this has done to my potential to save for retirement?

This is a matter of some people paying for ACA and others not at all. It has to be paid for somehow, and perhaps the public option would have been the fairest of them all.

I hear from other providers who take Medicare that Medicare is often six months behind in paying them. Providers are people who get paychecks that they then take home to pay their rent, their grocery bills, etc., etc. “Providers” is another word for a group of people who are being expected to foot this bill.

Guest
Mar 20, 2015

Alison, I doubt anything I write will make you feel better. But for the record I neither said nor inferred that ACA was aimed at keeping health care providers in line. In fact, I said almost the opposite,..

It’s too bad no public option… was allowed among the exchange choices. It would be a Medicare/Medicaid hybrid, and the existence of such an option would be a powerful incentive to keep both insurers and the health care providers in line.

Believe me when I say I’m totally sympathetic with the problems and challenges you have faced and still do. It’s no comfort to say this, but lots of people face deep income cuts, up to and including the complete loss of their job. I have reached retirement, but in the course of my career I once took an income cut so deep our children qualified for reduced price lunches at school. Fortunately I recovered and eventually paid the max into Social Security over twenty years. But careers that never have any setbacks are few and far between.

As for skin in the game, I did, in fact, work in a health care system after taking an early retirement from food service. I saw up close and personal the stark difference between the private sector and a so-called “not-for-profit” health health care system which was awash in money — marble floors, live plants, flat-screen TVs, concierge food service, industrial-sized laundry and landscaping departments and employee benefits I never imagined. I never knew what PTO was and sure didn’t have both 401(k) AND a defined-benefit pension plan. I realized THAT revenue stream comes from one main source — medical bills. I’m sure there are endowments, charitable contributions and tax considerations, but the serious money comes from seriously big bills. It’s no mystery that America has the world’s most costly medical care in the world.

As for ACA, unless SCOTUS and/or the GOP succeed in destroying it, there are now some ten to fifteen million people who have health insurance that were previously not insured at all (leaving that many more and then some STILL uninsured). I worked all my life with the working poor — people for whom “medical care” means enduring sickness, pain and injury as long as possible then going to the ED when it gets unendurable. As far as I’m concerned there is much to be done before America’s health care system becomes the world-class system it should be.

Let me repeat what I said at first — I did not say ACA was intended to keep health care providers in line. And I have plenty of complaints about how it was crafted and continues to be having problems. But the mess we call health care in America was a mess before ACA and will continue to be a mess even if it is destroyed. For example, even as we speak the “Doc Fix” (which Congress has neglected to correct since 1997) is an ongoing embarrassment which last time I checked meant 29% reduction in your income — and that preceded ACA by a decade.

I really hope your health care issues are resolving and your practice flourishes enough to generate enough for your retirement. At times like this I wish I were wealthy enough to just write a check and make it all better. But all I can do is wish you the best.

Guest
Rebecca
Mar 17, 2015

I am going through this right now. I was diagnosed with a brain tumor at the end of the year before my insurance was canceled. (Turned 26) I got a new plan thanks to the ACA but now, I have no doctor I can use. I do agree that this is an insurance issue and not governance issue…but I just want to express my deepest sympathy to you. I know exactly what you are going through.

Guest
Mar 2, 2015

This must be the shortest post at THCB ever to receive so many words in the comments thread. If nothing else it underscores the fact that insurance and health care are not the same. Health care providers and insurance companies are both involved with risk management, but while doctors manage health risks, insurance companies manage cost risks. It’s a toxic mixture to be sure.

It’s too bad no public option (eliminating the insurance industry) was allowed among the exchange choices. It would be a Medicare/Medicaid hybrid, and the existence of such an option would be a powerful incentive to keep both insurers and the health care providers in line.

Guest
Jenn
Feb 4, 2015

My problem is that I have a Blue Cross Blue Shield of Texas HMO self-paid plan. Most Drs. within the network do not accept patients within the HMO plan. I have a general Dr. within the network, but none of the OB/GYN’s accept the HMO plan. Need a well woman physical or pregnancy check up? Sure, it’s covered under my plan, but there are no doctors who accept my plan within my network. It’s B.S.

Guest
Vince H
Feb 2, 2015

Hi, unfortunately I had to sign up for state assisted health insurance as I was loosing mine due to work. I went to the Health.Gov website, very nice people there 24/7. For the most part very knowledgeable. I had about 10 plans to choose between 3 companies. Long story short, I picked a plan that I thought suitable. The fine tiny print I didnt research, my bad. The fine print is an EPO, “Exclusive Provider Organization” plan., they say they pay 94%. There list of Dr’s like everyone keeps stating is there are none to be found on their preferred list.
I went to an orthopedic surgeon on their list, He does not do the kind of surgery I immediately need. He explained to me that I HAVE NO out of pocket benefits. The Healthcare.Gov and Amerihealth networks could have cared less that I need this surgery immediately. My only option I see is it is all out of my pocket, its a 34,000 surgery. Can anyone help who may be reading. Honest to god I need this neck cervical spine fusion immediately.

Thank you, God Bless.

Vincent H
[email protected]

Guest
Alison
Feb 4, 2015

Vince, you have NO out of NETWORK benefits. Now, the health insurance companies have to have, in theory, a sufficient number of providers on their panels. This is in New York overseen by the Department of Health. So, in Texas, you have to find the government body that will assist you. You need a neurosurgeon most likely and they have to have some neurosurgeons on their panel; if not, they have to pay somebody to do it — or they have to have an orthopedic surgeon who does back surgery. But you do not have any of network benefits with an HMO.

This is the dirty little secret of Obamacare that its supporters — and I included myself as one of them at one point and in theory I would be in support of everyone having insurance — don’t want anyone to know OR they don’t even know this at all and are extremely ignorant. We have all had to deal with panels and not having enough providers. What Obamacare supporters don’t seem to get is that it is a sham because it’s not a matter of having to call around a lot and maybe finally getting a doctor, it’s that the contracts were not even in place and the networks barely created for these particular policies. When I bought BCBS in 2014, they had not even contracted with many doctors AT ALL.

So you have insurance with no doctors available. Wonderful. Great. Thank you, Mr. Obama.

You have to fight even harder for what you need and you have to get the state to help you. Good luck with that. But the insurance company is OBLIGATED to have a provider who can perform the surgery you need and if they don’t have one, they are capable of making special deals with out of network providers. But I wouldn’t try an out of network provider first. You can’t. You have to try their network.

When I had spinal fusion, a plastic surgeon had to sew me up after the second surgery to repair the “equipment failure.” He was not in network but because of the circumstances, my health insurance did pay (this was an Oxford plan and Oxford is generally a better company than Blue Cross, generally, depends on where you are).

So, you have to make a lot of phone calls to prove that the network does not have the doctor you need. They will also try to find you a doctor that will perform the surgery and you will have to see the doctors that they recommend.

If I had crappy insurance, I wouldn’t be inclined to have a serious back surgery by just any doctor.

Aren’t you able to change plans at this time? I thought we are still in a period where you can. Have you considered looking for a better plan? I’m not familiar with Texas but in general, in New York, the better insurers are BCBS, Oxford, United Health, Aetna, and Cigna. Most doctors take these insurers however they will not necessarily take the Obamacare plans. BCBS has gotten its act together to some extent.

Obamacare shoved individuals onto the marketplace, the people who could least afford it, rather than corporations and small businesses. They were exempted the first year. So, we got experimented on. It was even worse in 2014.

Look at some of the responses to me on this blog. People accused me of lying, of not being a real person, and they were very blase — “we all have problems with insurance networks.” They had and have no clue what it is like to deal with these Obamacare policies.

You have to fight and fight a lot because no one in politics will help you. The Democrats are too invested to admit there’s anything wrong and the Republicans are so against Obamacare that we are lost. And of course, if you had to get one of those plans, you’re inherently irresponsible.

It’s not pretty is it? I finally found a decent primary care after four tries and he and I both talked about how scared we are due to the dismantling of our healthcare system.

And I am a provider as well.

Guest
Nov 15, 2014

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Guest
Alison
Sep 20, 2014

Kelly, I’d be happy to help you with this but this forum can be hostile at times and I’d rather just help you out directly. Please feel free to email me at [email protected] and we can talk.

It may be true that Blue Cross is forcing their providers on the plan. At least, new providers HAVE to take us (I know because I’m one of those new providers). Note that Blue Cross is paying 20% less to any provider who takes a patient who is in the exchange network.

I was someone who initially bought Blue Cross only to find out that I lost all of my doctors and there were almost no doctors in the network — they hadn’t bothered to contract with anyone for this insurance. It should have been highly illegal — what they did — but no one seems to care as we are a minority of people suffering. Look at some of the hostile responses to my initial plight. To be honest, I found it quite hurtful. Here I was in physical distress, illness, and my confusion and anger was met with hostility and distrust.

My guess is when everyone else starts going through this, they’ll do something about it. In the meantime, we are on our own.

Feel free to email me and we’ll exchange numbers and we can talk on the phone.

Guest
Kelly Giles
Sep 18, 2014

I too feel so frustrated with my Empire Blue Cross insurance ( pathway). I have the Silver Guided Access which I pay almost $500.00 a month for and i find that almost no doctors take this insurance in fact I feel as if I have the “plaque “when i asking if a particular doctors takes it! Even when you going to their website that refers you to Doctors that are supposed to be in network most don’t take it! I’m really confused as to why I pay so much and get so little? Why do doctors not take this insurance can someone explain it to me? I originally had Blue Cross through the government and I paid a little bit more but i found virtually every doctor excepted my insurance. What’s the difference? When i talked to someone from Blue Cross they told me by Jan 1st 2015 most doctors that except the regular Blue cross will be forced to except the pathway. Does anyone know anything about this? thanks

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