Obamacare/Trumpcare Horror Stories

[gotbeer]

Insurance rates going up: New concerns for Obamacare

Quote

The largest health insurer in Texas wants to raise its rates on individual policies by an average of nearly 60 percent, a new sign that President Barack Obama's overhaul hasn't solved the problem of price spikes.

 

[DowningRules]

My horror story...buckle your seatbelts. It's going to be a bumpy flight:

Quick background: I had good and self-selected insurance prior to Obamacare. Despite what the president said, even though I liked my insurance, I couldn't keep it as my insurer eliminated my plan and offered a new and similar plan but for about twice the rate of the previous plan.

I was frustrated and upset and made a mistake: I let California appoint me my healthcare provider.

Came down with what appeared to be a rash on my arms and neck.

I booked an initial appointment with my general practitioner. Soonest I could be seen was one month. I didn't want to wait because it was getting uncomfortable so I paid out of pocket to see my own dermatologist. She tried all sorts of things but determined, ultimately that it was an allergy. She gave me a very good deal on an allergy test as she had sympathy for my Obamacare situation. She'd seen it before. Allergy test revealed some allergies, but there were more, shown by outbreaks on my face. She told me she had done all she could and that I should see an allergist,

She referred me to a good and notable allergist. I made an appointment. I was stoked to get in after only a week's wait. Went to allergist and I gave the receptionist my Obamacare insurance card. They told me there was no referral on record. I informed that my dermatologist referred me. They called my dermatologist's office to have them fax over a referral. I waited for this to be cleared up, excited to proceed with the appointment.

Nope. My dermatologist is not in the obamacare system. They need an authorized referral. A doctor in the Obamacare system. Paperwork, etc. I said, "Screw it. I'll pay out of pocket." Receptionist said uh-uh. Since they know I have Obama insurance, and that info was now in their system, it could be construed as insurance fraud. Huh!!?! I was denied seeing the allergist even though I had an appointment and would've paid cash.The allergy doctor was probably 15 feet away from me and waiting to see me. They told me to see my obamacare assigned general practitioner to get a referral for an allergist. Ok.

Went to the doctor, finally. (About a month later). I waited an hour to be seen. Since it was my first appointment, they had to ask a bunch of questions. A nurse, or office worker...I don't know what she was because she couldn't speak English tried to get info out of me. Since we literally couldn't speak each other's language, some kid about 16 years old came in wearing shorts and flip flops and started translating for the lady. I have no idea if what he told her was accurate and vice versa. It was all Vietnamese.

I almost walked out but luckily I was called in for the examination (waited another half hour). Doctor GP said it looked like I had an allergy. THank you. But, before he could refer me to an allergist he had to refer me to a dermatologist and that would take some time for approval. I left the office empty handed though he did order me a prescription for prednisone. Amazing that he didn't tell me how to take it or anything. It's not the kind of drug you want to throw around, but whatever.

I had to call almost daily to see if I was approved for a dermatologist. Finally, after about two weeks, I was approved. The bummer is, you can't ask for an appointment until you get approval. So I called to make an appointment with the dermatologist. Another two weeks of waiting. Still had a bit of the rash.

Went to the dermatologist. Doctor was too busy to see me but the physician's assistant spoke English so that was a bonus. She said I needed to see an allergist. I knew this over a month ago. Probably two months by now. Obama would have to approve the visit to an allergist. Ok.

A week went by and I called. Not approved yet. Call later. I called a couple day's later. I was approved and they were about to call me. Uh huh.

I went to allergist. He said it looked like I had an allergy. But I would have to be tested to see what I was allergic to. This would take some time because these tests would have to be approved by Obama. Uh huh.

Called a couple weeks later. Yes. I could be tested. Yay!

Went to get tested. Not allergic to foods.

Now, I am awaiting approval for environmental testing.

Meanwhile, I got a letter from the Franchise Tax Board. I underpaid my state taxes. Obama/Jerry Jive Ass Brown want more money to cover the cost of my insurance.

So, I owe more money and after months of waiting for doctor appointments and all sorts of approvals, my health issues have not been resolved. The irony is that I've probably paid about $500 out of pocket to figure out my problems. Should I ask Obama for reimbursement?

If I get something terrible like cancer or say, a heart condition, I am screwed. Diagnosis and treatment will come way too late.

This is why Trump is getting so much support. And I write that without even being a Trump supporter.

[fan_since79]

Now THAT's a horror story, DR.

What a swell thing this 'affordable' care act is turning out to be. 

 

[fan_since79]

My latest horror story, but not as complex as DR's.

I've got arthritis starting in the hands. Heberden's nodes on the fingers (bony swellings on the joint nearest the nail) and one of them has increased in size over the past six months. Primary care doctor doesn't want to give me a referral to a rheumatologist (they're encouraged by the IPA and probably the insurance companies to give as few referrals as possible). He told me it's "age related" and there's nothing I can do about it. "You'll get used to it." Now I'm reading that such a condition can lead to deformities and the fingers turning sidewards at the last joint. Oh, and there's pain too. He said "take an Alleve". He's an otherwise excellent doctor who is helping me manage my newly diagnosed diabetes and a minor heart condition, but arthritis? No, just get used to it.

 

[nate]

@DowningRules sounds like you have an HMO (BCBS CA?).  With Obamacare having such narrow networks you will want to switch to a PPO that won't require referrals.

@calscuf surely you knew that your wife would lose her company sponsored health insurance when she quit her job

[fan_since79]

9 hours ago, calscuf said:

Here's my horror story.  I kept my plan.  It went up in price a little.  It's still shitty because health insurance companies are shitty and only care about profit.

We should talk about my wife, who had melanoma and lost her health coverage after she moved and quit her job.  She was able to get health insurance since they couldn't discriminate because of her pre-existing condition.  Or my many clients who don't just clog up the emergency room anymore when they have the flu, because they're now covered and can go to their primary doctor or an urgent care.  

You guys are too smart to actually believe the health insurance carriers are losing money and need our pity.

Glad your plan went up only a little, and that your wife was able to get insurance to treat her melanoma. Hope she's okay now.

My plan was cancelled and I had to choose one from the exchange. The premiums doubled. 100% rise. Then 10% in each of the next two years. I have diabetes, a heart condition, arthritis, and a pre-cancerous condition of the esophagus. Medicare is just a few years away. I can't wait to turn 65.

The companies are not losing money, that's true. But in order to pay out all the claims from sick people while healthy young people are not participating in the risk pool, and make their profits, they need to jack up premiums. At some point you're going to get some sticker shock, it's inevitable.

[gotbeer]

10 hours ago, fan_since79 said:

My latest horror story, but not as complex as DR's.

I've got arthritis starting in the hands. Heberden's nodes on the fingers (bony swellings on the joint nearest the nail) and one of them has increased in size over the past six months. Primary care doctor doesn't want to give me a referral to a rheumatologist (they're encouraged by the IPA and probably the insurance companies to give as few referrals as possible). He told me it's "age related" and there's nothing I can do about it. "You'll get used to it." Now I'm reading that such a condition can lead to deformities and the fingers turning sidewards at the last joint. Oh, and there's pain too. He said "take an Alleve". He's an otherwise excellent doctor who is helping me manage my newly diagnosed diabetes and a minor heart condition, but arthritis? No, just get used to it.

 

That's what my doctor told me also.  It's just age.  /sigh

[DowningRules]

I don't mind if my health insurance provider is making money. Gives the provider incentive to keep me as a customer. I have no misgivings that this is what I am ultimately: a customer.

Under Obamacare, I am a potential vote.

[nate]

Glad to hear your wife is better now @calscuf.  Still can't figure out in what world someone decided to marry you though

 

You don't get insurance through your law firm?

[fan_since79]

Emergency rooms are still insanely crowded in California. A friend's sister had a sudden attack of what turned out in the end to be very low blood sugar, but she had no idea what was happening for six hours as she sat in the ER waiting to be seen by a doctor. Shaking, rapid heart beat, profuse sweating, dizziness, and sitting there in a state of anxiety with scores of others. She's not diabetic or hypoglycemic, it just came out of nowhere. It took ten minutes to treat her, but six hours of waiting?!

[Adam]

My GPs nurses don't even give blowjobs anymore. 

[Tank]

sounds like he probably spends a lot of his time in chicago.

mostly in the summer, i'd imagine.

[mtangelsfan]

On 6/3/2016 at 9:36 AM, Adam said:

My GPs nurses don't even give blowjobs anymore. 

Those dudes have moved on to better patients.

[nate]

Dealing with a dipshit ambulance chaser like @calscuf suing to cover claims for a member that never paid their premium.

I am sure some story will come out that we are a big bad insurance company for denying these claims, which is why such a bs lawsuit is brought up in the first place, I am sure our legal has to weigh the bad press (for us following the rules given to us by CMS) vs just paying the claims.  Glad that isn't my job.  I just provided proof the member was billed properly and timely and never paid us a penny and therefore was never active.

[Jay]

So is that an Obamacare problem or just a health insurance problem in general?

 

[fan_since79]

More than 90,000 Coloradans will lose their insurance coverage in 2017 and others will be subject to rate increases of as much as 40%, as four large insurers cancel plans and hike premiums. 

http://www.denverpost.com/2016/06/06/rate-hikes-proposed-2017-colorado-health-insurance/

[mtangelsfan]

At least they can still smoke pot.

[Jason]

1 hour ago, mtangelsfan said:

At least they can still smoke pot.

I heard it cures everything

[red321]

19 hours ago, fan_since79 said:

More than 90,000 Coloradans will lose their insurance coverage in 2017 and others will be subject to rate increases of as much as 40%, as four large insurers cancel plans and hike premiums. 

http://www.denverpost.com/2016/06/06/rate-hikes-proposed-2017-colorado-health-insurance/

Reading, and understanding what you read, are apparently two separate things.

 

 

[Taylor]

19 hours ago, fan_since79 said:

More than 90,000 Coloradans will lose their insurance coverage in 2017 and others will be subject to rate increases of as much as 40%, as four large insurers cancel plans and hike premiums. 

http://www.denverpost.com/2016/06/06/rate-hikes-proposed-2017-colorado-health-insurance/

Luckily my wife and I have Kaiser, which isn't one of the four companies mentioned in the article. Still sucks, though. Thanks, Obama!

[Adam]

It really doesn't make sense for insurers to offer individual plans any longer if they're not forced to. 

[fan_since79]

10 minutes ago, red321 said:

Reading, and understanding what you read, are apparently two separate things.

 

 

Those people will lose their plans and have to find new options on the exchange, often with much higher premiums. What part of my statement was incorrect?

[fan_since79]

14 minutes ago, Adam said:

It really doesn't make sense for insurers to offer individual plans any longer if they're not forced to. 

Obamacare forces them to do a lot of things. They have to insure people regardless of pre-existing conditions, they have to insure everybody who applies, they have to provide free colonoscopies and other services, and yes, they have to provide individual plans through the federal exchange or exchanges in their state. The article mentions that they're canceling their PPO plans and steering individuals into HMO's, which are less costly to the companies as coverage and treatment options are more restrictive. A patient has to run an obstacle course often to see a specialist, and they don't have a choice of which doctor to visit. 

Also, healthy young people are generally not signing up, and the risk pool is overloaded with sick, older people. This is causing actual losses to the companies, who must raise their premiums to cover them. 

Single payer is coming sooner rather than later. The premiums in Obamacare are going to be unaffordable for most people very soon.

[nate]

34 minutes ago, Adam said:

It really doesn't make sense for insurers to offer individual plans any longer if they're not forced to. 

Many of the state DOIs are forcing companies to offer individual plans if they offer other plans in the state.  Same with on and off exchange individual plans, most DOIs require you to do both or neither.

[red321]

38 minutes ago, fan_since79 said:

Those people will lose their plans and have to find new options on the exchange, often with much higher premiums. What part of my statement was incorrect?

Again...go back and read the article, carefully.

Yes, some plans will no longer be offered, that doesn't mean they lose insurance coverage, it means they have to do what any smart shopper should do...review their options every year. It's just like people do in open enrollment. When my company changes plans, it doesn't mean I lose my insurance, it means I go through open enrollment and make new choices.

Also, companies asking for a 40% increase does not mean rates will increase by 40%. You are quick to post "huge rate" increase articles...and yet never follow up when the final rates are set, usually with a significantly smaller if not an actual decrease. Sucks...but that is the way insurance companies and state commissioners work. Insurance companies submit request for big rate hikes...they negotiate with commissioners...and then final rates are set. You also didn't appear to point out that some companies suggested a rate decrease...and that while two companies dropped coverage (one being UHC who is not a significant player in the individual market), a new payer decided to offer plans. I think that's called free market, but I'm a liberal so maybe I'm just confused on how that is supposed to work.

ACA is not perfect, by any stretch...a lot of adjustments need to be made...and if we had a functioning congress some of those changes might have actually occurred.