15 Days on the Obamacare Marketplace
Posted on March 13, 2014
My Personal Experience Finding Affordable Care Act Insurance in New York State
by Liz Jackson
I have spent the last 15 days navigating New York’s Health Exchange, and it has been quite a learning experience. This process has had a lot of ups and downs. And while I don’t want to admit this, the downs started very quickly. Getting a NYS Government ID turned into a comedy of errors. After a multitude of failed attempts, I eventually had to create an ID under my partner’s email address. I was then able to change the ID to my email address once I had finally succeeded in logging in. The effort it took to get logged in proved worthwhile, as my healthcare is now a lot more affordable.
The biggest and most frustrating problem was the provider search. The results were consistently conflicting. For instance, my Primary Care Physician’s office sent out the following email:
But when I searched for her in the Marketplace, these were her results:
I called her office and they assured me they did not accept Emblem. I called Emblem and they assured me she was covered. Eventually her office called Emblem. She was not an Emblem provider.
The same went for my Psychiatrist. The Marketplace showed she was a Fidelis provider. She said she wasn’t. She believes she was listed as a Fidelis provider because the hospital she worked at a decade ago accepted Fidelis.
A search for SuperNeuro did not yield any results (if you don’t read my blog regularly, SuperNeuro is my beloved Neurologist). As she works for a large hospital, I knew the results were a mistake. She kindly forwarded me to an insurance director who helped me figure it all out. SuperNeuro is covered by a couple plans now and will be covered by more in the near future.
I also have a doctor that is not currently covered by any Obamacare plans (this was actually correctly reflected on the Marketplace as a search for her came up empty). I knew I needed to find a plan that covers out-of-network physicians. I quickly discovered that there aren’t any New York plans that offer out-of-network coverage. I panicked at first. But I found optimism in a recent press release from The Department of Health and Human Services. In it, Sibelius said they are “Strongly encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes”.
My Health Republic rep was patient and curious. She put me on hold for about 10 minutes while she researched my complicated request. She emailed me a form called an ‘Access to Care and Transitional Care’ to give to my doctor. She was cautiously optimistic on the phone with me, but she wanted to help. So she gave me her direct line and email.
My call to Oscar, on the other hand, was upsetting. When I hung up, I started crying. The rep told me that if a doctor is not covered by the Affordable Care Act then they probably did not meet the pristine conditions of ACA insurance standards. He said (without any knowledge of my doctor’s name or background) that this doctor would likely be investigated by the government and prosecuted if need be. (Oh and he also told me that SuperNeuro was one of Oscar’s providers. SuperNeuro’s office later confirmed that she is not an Oscar provider.)
Since Oscar uses “technology to make insurance simple, intuitive, and human” I sent them a 3-part Tweet. After following up with a couple more Tweets, I eventually got a call. The manager immediately asked me for the rep’s name. I didn’t remember it, but he assured me the rep was not on his team. I asked him to explain why my doctor would be investigated and prosecuted by the government. He told me Oscar doesn’t tolerate the actions of this rep. I asked about providers and he told me they would be dropping many of their 40,000 doctors to ensure more insurance savings. I asked about continuity of care and referred to the HHS press release. He said he had never heard of it and laughed my request off saying good luck with that. I never received a form, I was not provided next steps. What I did receive was this email:
I learned from this situation that issues can and will come up. And it doesn’t necessarily make the issue Obama’s fault. Clearly Oscar was at fault. And it felt destructive. It felt insensitive.
So I went with Health Republic. And I’m happy with my decision. I like the idea of participating in a Co-op. I’m also nervous and scared. It will take weeks to hear back about my out-of-network request. I also won’t be able to see SuperNeuro for a couple of months while she gets on-boarded, so I have to hope that I don’t have a flare up. To hold me over, I scheduled appointments with both doctors on the last day of my existing insurance plan.
I was speaking with SuperNeuro’s insurance director, and she told me she was very impressed with the effort I was putting into my healthcare selection. It has been quite an effort. I have a chronic condition and will fight for every healthcare right I have. I will do everything in my power to keep my medical support team in tact. I deserve nothing less. We’re all deserving of this. Isn’t this the point of the Affordable Care Act? To make insurance affordable and accessible to all?
Speaking or affordability, I will be saving a lot of money on my new insurance plan. I will have a better selection of physical therapists and I will receive a gym stipend… grandma yoga, here I come! Health Republic even offers acupuncture. I feel uncharacteristically giddy about Health Republic.
I’m still upset with Oscar. I have unanswered questions. I want them to know how insensitive they were. Because I’m a passive aggressive person, I am considering Tweeting awkward medical questions to them. I want to see how they respond. So this is my question to you:
If you are in the process of shopping your state’s Marketplace, this is my advice to you. Give yourself time. Be patient with yourself and the process. It’s not easy. But it wasn’t easy before the Affordable Care Act was implemented. There are navigators out there who are eager to help. Use every resource at your disposal. Know your rights. Care for yourself.
3/14/14 Update: Michael, a manager for Oscar health gave me a call this afternoon. We spoke about the discomfort I felt after my initial call to Oscar. He assured me there was no government program. I felt a bit like the worlds stupidest Edward Snowden, asking him if he’s sure the government won’t spy on my doctor if I ask for certain benefits. But it was a question I needed reassurance with. A simple seed of an idea had grown into my mind, creating distrust of a process I was trying to navigate.
The call was a nice reminder that nobody is out to cause any harm to anyone. Everyone wants to help. Everyone involved in the Obamacare beginnings is trying their very best. The rooting for the success or failure of the ACA has trickled down to me. I felt very angry after the incident with Oscar and I believe I wanted them to feel the pain too. This is a learning curve on so many levels. From Obama to my doctors to Oscar Health to me. We’re all navigating this together. I believe Oscar will do a lot of good work and will appeal to many who may not have otherwise sought health insurance. I may still tweet awkward medical questions at them. I have a hilarious list compiled and I’d regret it if I wasn’t the first.
I hope you will consider signing my Change.org petition that poses this question: J. Crew sells glasses. Why don’t they sell canes? Why are some assistive devices celebrated and mainstream while others (like canes) are relegated to the hidden underworld of hospital shops and medical warehouses?