THCB

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

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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pelyphinMaryRebecca@BobbyGvegasElaine Coker Recent comment authors
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pelyphin
Member
pelyphin

I would be willing to bet that most of the respondents here still voted for a Democrat or a Republican when the 2016 elections rolled around. What was it Einstein said – about the definition of insanity? To address the actual topic, with some perspective as a few years have gone by, this was my experience with Obamacare. I registered for a plan during the initial November signup period, with BCBS. The Marketplace accepted the registration, and BCBS never got it. Fixing the mistake couldn’t be as simple as faxing the relevant documents over, oh no. The case had to… Read more »

pelyphin
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pelyphin

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pelyphin
Member
pelyphin

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Mary
Guest
Mary

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… Read more »

Alison
Guest
Alison

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!

Bob Hertz
Guest

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… Read more »

Bob Hertz
Guest

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.

John Ballard
Guest

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… Read more »

Alison
Guest
Alison

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… Read more »

Alison
Guest
Alison

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… Read more »

Alison
Guest
Alison

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… Read more »

John Ballard
Guest

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… Read more »

Rebecca
Guest
Rebecca

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.

John Ballard
Guest

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… Read more »

Jenn
Guest
Jenn

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.

Vince H
Guest
Vince H

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… Read more »

Alison
Guest
Alison

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… Read more »

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Alison
Guest
Alison

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 abowleslmhc@gmail.com 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… Read more »