Thursday, March 13, 2014

A Question of Healthcare

Hater of "Obamacare"?  Want it kicked to the curb?  Last week the Republicans voted to be rid of it for the fiftieth time.  I, on the other hand, am a fan of the Affordable Healthcare Act.  While those fighting against it must surely not be in need of healthcare or are sitting pretty with a nice cushy policy, my situation isn't so delightful.  

I've spent the last four years after my divorce (which meant giving up the best snappy little federal Blue Cross Blue Shield health care policy) working for insurance.  I found a job which matched my personality, family schedule, and included an option for insurance.  I did not understand just how poorly that insurance, also through Blue Cross Blue Shield, covered my needs and the expense of it all.  The option for insurance at the company was not a the benefit like it had been when I was a school teacher.  In the end, I was paying $180 a WEEK of my meager office job paycheck for a policy with a $5,000 deductible, an office visit, co-pay, and paid half of my very expensive meds needed occasionally for my Crohn's.  How expensive were my meds?  One thousand dollars for one month answers that question.  Though the work insurance plan covered a preventative colonoscopy, it did not cover for anyone with a problem (not the same as a pre-existing condition, mind you) without meeting the full 5K deductible first.  My gastroenterologist had a fit when I told him I couldn't afford to have him do what he needed to do to keep an eye on significant things like the early colon cancer detection.  I jacked up to the highest level of medical savings plan out of my small check just to be able to maybe cover one month of meds if needed.

When the Healthcare Marketplace opened, I waited for some of the kinks to get worked out and applied October 2013 thinking, "There is a good chance there is something more affordable than my costly work plan."  It took a couple of hours, which was spent looking for social security numbers, tax returns, and pay stubs.  Much to my surprise, the Marketplace said my new husband and I qualified for Bluecare/Tenncare which is Tennessee's uninsured program. People warned against state care, saying, "You can't pick your doctors, and the only ones on it are of poor quality."  However, I decided with the expense of my work policy made it important to pursue the option. 

I took off valuable work hours and went to my scheduled appointment with a social worker at the Department of Human Services.  Desperate people were all around me talking to one another about which pantry to ask for the next meal, state housing, and health problems between extended smoke breaks. Some smelled like alcohol sweats. Some people were literally talking to themselves.  One young father held his oversized jeans up by the crotch as if there were no other options. Human Services offered a slice of life I've not experienced since I lived in the city.  There were three security guides asking, "Are you applying for help today?" and kicking out those who were not. I waited more than an hour to have my social worker to take me through the locked doors to her office space.  Her desk looked as overwhelmed as she was- like an avalanche of paper and mayhem.  She typed my name in the computer but could not delete the records of other clients under the same last name on my profile.  Nothing she could do.  She looked at my numbers and said, "No matter what Marketplace says, you will not qualify for any state benefits.  Wait for a letter in the mail."  

I also want to explain what it meant to take off work with insurance being an option not a benefit at that job. In my case, if I'd ever taken off two days or more of work for any reason, I would have OWED money for my insurance out of the next week's check and not been paid for the three days I did work.  That is how expensive that insurance option ended up being!  

I got the letter stating disqualification from state benefits of any kind in the mail after a few weeks.  I went back to Marketplace and was told to appeal, so I could see other options.  I started the appeal process.  I got my first call from Marketplace to discuss my case during church on Sunday morning with no number to return the call.  They called again during work and scheduled a 7pm appointment call when I was home with all my financial and personal information.  Marketplace did not keep that appointment. They did not call to cancel either.  I got another call at work and scheduled a second night time appointment which they did not keep either.  Not long after and quite out of the blue, I got Bluecare insurance cards in the mail! Marketplace called back and told me to cancel my appeal if I was happy with Bluecare.  

I told the truth about the hassle of getting here, so now let me tell you the rest of the story.

I started discussing the implications of such a thing with the insurance lady at work just when managers at work demanded (not asked) me to return to a position I no longer wanted, because the department had "gotten behind in my absence". That job had become impossible and dreaded by me over the course of years.  Contrasted to the fabulous new position I was asked to leave, I realized it was vital for me to make a big change. I took a big girl pill and quit the dreaded job in hopes of finding something I'd enjoy doing forty hours of my week. 

I haven't found anything yet, but I have begun to use my Bluecare.  I developed a bump on the bottom of my foot and had to get it checked out.  I began also experiencing some Crohn's issue for the first time in a 18 months.  I called my family physicians of twenty years who graciously accepted my new insurance.  Really! The PA there sent me via referral to a foot doctor and a new gastroenterologist.  My former gastro doc who treated me for 20 years did not budge on taking Tenncare, and I respect his choice.  I held my breath on both referrals and after my visits.  I worried it might be lots like my Human Services visit.  However, I could not be more happy with the care with dignity they have provided to me so far.  I am set for a colonoscopy, unfortunate foot surgery, and got my big money meds.  The meds I paid $500 a month for with my work insurance cost $3 with Bluecare. Got that folks? My jaw dropped at the pharmacy when I was asked for the money.  I don't think I'm expected to pay for the other procedures.  I am full of gratitude and speechless at this turn of events.  Tell me how I couldn't be a fan of the Affordable Healthcare Act?

What is the lesson in all this?  I dare you to put me in the entitlement category after missing ONE sick day of work in the last four years, and paying dearly for not so hot insurance.  I will find another job, and I'll probably end up paying a heap for health insurance there too.   In this interim, I am not sweating bullets on what to corner to cut to afford, so I can live in wellness.  

If you hate "Obamacare" on some principle, consider also those in need and what prejudice you might hold. You might be surprised at who is experiencing something "for the people and by the people.



  

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