Posted in Rants

How the ACA is Being Corrupted and the “Opiate Crisis” is Ruining My Life

Last year, I had Medical Mutual of Ohio health insurance, purchased through the marketplace on Healthcare.gov. It was great insurance, the deductible was reasonable, the monthly payments were $376.00; a little high but still cheaper than what I was paying pre-ACA. Open enrollment came about and the bill was going to jump up to $476 so I had to shop again. The choices were suddenly horrible, even for the best plans available here in Ohio. The gold plan for Summa had 3 free doctor visits, $345 per month but a $6500 deductible. I wanted this one but hubby argued, saying it was horrible, like not having insurance at all. So reluctantly, I went with the Anthem Blue Cross/ Blue Shield for $414 per month but only a $1500 deductible. Of course, my doctor takes Anthem. It’s a huge company and almost every doctor accepts it. Little did I know….

Six months into the year, I find out that Anthem is not applying my doctor visits to my deductible. I tried to call and was put through voice menu hell, never speaking to a real person. Then the email argument started. It turns out my doctor is not covered under my particular policy. Remember that “Obama lied- you can’t keep your doctor if you want to!” complaint? Guess what… The insurance companies are finding all the sneaky-ass loopholes they can find in order to screw us out of our money while providing the least amount of service. My doctor wanted me to have a sleep study to find out why I am waking up 19 times per night. (My Fitbit tells me I am not really sleeping at night) I had the appointment lined up and had to cancel because Anthem didn’t get back to me as far as letting me know if it was covered or not. Two weeks later, I get a letter stating they determined it was “medically necessary” but would not state that it was covered. All this time, I am still arguing about them covering my regular doctor visits. They say because my doctor is not in my policy, none of the tests he orders will be covered, and I need to find a new primary care physician within my plan.

So I (tearfully) inform my doctor’s office about what is going on and begin the search for a new primary care physician. I use the search tool on Anthem’s patient portal and find the listing of doctors available in my area. Most of them are within a “community health care clinic” and not board certified in their stated specialties. The few private physicians available only have one or two-star ratings on Healthgrades.com. So I start visiting offices to see who would take a patient such as myself, one with several chronic conditions with several prescriptions (including opiates) to deal with them all.

The first one outright denied me, saying their office does not prescribe 3 of my medications. They suggest I go to the office a few doors down. (That woman was on the approved list also) I walk in and it looks like a back alley abortion clinic. Tile floors, blank walls, metal folding chairs in the waiting area… The check-in counter is occupied by a lone receptionist who looked and acted high. There was a table covered with stacks of patient files, out in the open, haphazard and teetering. I should have turned around and left, but I was hot, tired and resigned to whatever hell I had to put up with. I reasoned, maybe it was a new office. Maybe the doctor is just starting out. I started filling out paperwork and made an appointment. Then the doctor shuffled in and dug through the files, and shuffled back out. She was ancient. I later looked her up online and found out she got her medical degree the year I was born, 47 years ago. I canceled that appointment and sent a note off to my doctor’s office, telling them NOT to release my records to her office. Healthgrades only had one star for that very old lady.

I decide to try the “community health care clinic”, even though you never know who you are going to get. They have 20 doctors who rotate around 5-6 locations and you get stuck with whoever is available. I am assigned to a very young doctor who just graduated last year. I figure, what the heck… He may be young but maybe he has an open mind and knows more about the current studies on my illnesses. Everything is going fine until he says he does not prescribe long-term pain medications and I would be referred to a pain clinic. I told him I already signed a pain contract with my regular doctor so he said I could just continue seeing him for pain meds. I would rather pay the fees myself than go to a pain clinic. I’ve heard horror stories about people being cut off from their meds and sent to a psychiatrist.
I have given up on the sleep study and other things my regular doctor wanted me to do and I figure I only have to stay healthy for 5 more months until I get a better health care policy so I can go back to my normal doctor full time.

I write a note to my regular doctor, letting him know that I got the new primary care physician as the insurance company demanded but would continue to see him for pain management. I get a note back from his secretary stating that he cannot prescribe my pain medication if he is not my primary care physician and that I would have to go to a pain clinic if that is what the new PCP said.

SOBBING…… I wrote back stating that I was told previously that this would not be a problem. I am not leaving my regular doctor, I only signed up with the other one because if anything terrible happens to my health, I will need him to sign off on testing. The insurance company will not cover anything ordered by my regular doctor. What do I do? Should I renounce all affiliation with the new doctor just so I can get my pain medication? What the everloving FUCK? Of course, it’s the weekend now and I have to fret about this until I can call on Monday. My husband is now saying to stick with my original doctor and we will just pay the bills. That is fine as long as I don’t get sick in the next five months.

Anthem Blue Cross and Blue Sheild is ripping me off, endangering my health, and there is not a damn thing I can do about it.

Still sobbing.

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