MY PERSONAL DAY WITH THE ACA (AKA NYSTATEOFHEALTH)

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It’s three months into the new year. How we doing?  Ed Koch had that quintessential phrase follow him around for years.  He had the nerve to ask people and they told him.  Since January I’ve been overwhelmed with the antagonistic nature of the new health insurance that is mandated.  My old insurance which I had for five years was a PPO.  Not great but covered everything I needed it to and though there were glitches in time where a doctor or two didn’t accept it, in time all the doctors I needed to see did.  That’s not the case with this new insurance regime.

First of all: New York State created their own health marketplace instead of opting to use the Federal health channel.  Citizens of New York be heard “You cannot have a PPO as an individual member.”  Options are gone. Although there are different insurance agencies that offer coverage – all benefits are the same – all are HMO’s for individuals and no more sole proprietor status.  Sole proprietors are now lumped into individual category which were always those who didn’t work, or couldn’t work, and had a higher premium attached to it than a sole proprietor.  Promised last fall by the insurers that if a doctor of hosptial took their current HMO then they would take the new one through the healthmarketplace.  However, not so. Come January 2014 this health debacle unfurled a nastly reality. All is not the same.  Doctors were being told “they could not participate”, or they were in fear of even lower reimbursement rates than medicare participants so they opted not to take it at all.  It was three weeks before I ever got my ID number and that was after calling three different times and waiting an hour and fifteen minutes each time to speak to a BCBS representative.

If it wasn’t for my tenacity and persistence I would have been like thousands who just never got the ID card or number for the month of January. One thing I will say they are up on is sending out the monthly premium bill.  In fact I got two for the month of January!

Why isn’t this mess on the evening news a few days out of the week? This is something I don’t understand.  New York State screwed its citizens with or without the Cuomo administration knowing what was going on.  According to the New York State Attorney General’s office there are thousands a week filing complaints regarding lack of coverage or misleading information that led people to believe they had one coverage then the insurance companies turned it around and changed provider networks. Blue Cross Blue Shield is the largest  health insurance carrier in New York state and has had the most complaints. All Blue Cross Blue Shield across the country is now under Wellpoint a public company that seems to care more about its stock price then the care hundreds of thousands who signed up for coverage with them expect.  Changes are a coming. How we doing?  Not well.