Ellen (ennienyc) wrote,

Adventures in healthcare

I had health insurance under a small group plan that a broker set up with Oxford. It was not cheap (my tax program flagged the premiums as being too large a percentage of my meager freelance income), but my longtime PCP (primary care provider) Dr. H at Cornell was in the network, and it was adequate.

I was hearing horror stories about freelancers losing their coverage with the upcoming ACA and asked the broker if I would need new insurance. She was still dealing with Oxford, but it looked like sole practitioners would be forced out of small group plans and made to get individual insurance. The Times had an article about that very thing, featuring someone I happen to know from high school.

The broker came back with the expected news that I was on my own. She did not have any good alternatives to the state exchange, so off I went. Reports that the NYS site had no problems are wrong. The site is very clunky. The doctor search was temperamental, and listed Dr. H 10 different ways with slight address variations. I clicked on every one, and all pointed to one United HealthCare plan. I was trying to avoid United on principle (they also own my previous carriers Oxford and OptumRx, so I wasn't doing a good job of avoiding them), since they downsized me out of a job after taking over MetLife's health business (where I worked as a statistical consultant in health claims from 1979-1996). But they were the only game in town.

Not very affordable either. The premium for the Silver level was about the same as I previously paid, but with a $2000 deductible (former HMO plan had no deductible). Total costs are probably more than my freelance income. Additional investment income (thank you, Mommy) will probably put me over the limit for state financial help. Luckily, it's only for 3 years, until I'm old enough for Medicare.

I enrolled in the United plan, plus a small dental plan (I previously had a limited dental schedule plan that the broker threw in). When I went online to look up another doctor, the exchange system listed me as pending twice (what a system!), but it appears I'm only enrolled once. At least I thought I was enrolled. I didn't hear anything until I got a call from United asking where my premium was. That was the first I'd heard about it. They allowed me to pay over the phone, and eventually I received both the original letter requesting payment, and a plan booklet.

The letter mentioned a billing site, and there I found my member ID and was able to register for the main UHC site. Turns out the system had automatically assigned me a doctor (a different Dr. H, so let's call him Dr. D). When I tried to change to Dr. H (who is indeed in the network for the new plan), I got an error message. I called and was told I couldn't change until 1/1. I did this on that day, and found that it wouldn't be effective until 2/1! Oy, so I'm supposed to go to a completely different doctor and then leave?  I have some ongoing issues, plus I'm on my last pair of monthly contacts and need a referral (insurance won't pay for the lenses, but covers some of the exam since I have floaters that need monitoring).

I had an appointment with Dr. H's office this afternoon (optimistically assuming the insurance would be straightened out) and didn't want to wait another month. I called and the nice man put the change request in the system (I  already did that myself, but OK). Then put me on hold and came back with the unfortunate news that there was still no way to activate it before 2/1. I asked to speak to a supervisor and was told they might not call back for 2 days, a little late for my appointment. I asked if I could have Dr. D just refer me to Dr. H, and they said that might work.

So I tried to call Dr. D's office. The number on my insurance card (which I don't yet have, but exists online as a PDF) led to a Caribbean sweepstakes line (dialed it twice). I'd heard tales of the health exchange referring people to auto mechanics and coffee shops, so that's par for the course.  Googling gave a number at St. Luke's (they must have picked the nearest provider). I have nothing against St. Luke's, but I've always used Cornell. The woman there informed me that Dr. D was no longer there, and hadn't been for at least a year. They assumed another doctor in the group could be used as a PCP (though this is not certain). They wouldn't refer me to Dr. H over the phone, so I made an appointment for tomorrow.

I called back United and told them my PCP didn't seem to exist, and they said he must have signed up with the exchange. They gave me another number for him. I didn't get a cupcake store, but the nephrology department at St. Luke's. They also said Dr. D was no longer there, and double checked their directory.

Back to United a third time. I confirmed that my PCP did not exist, and I had a perfectly good PCP if they could just make him effective now. They conceded that perhaps there had been errors in assigning PCPs (ya think?) and told me that Dr. H would indeed be entered and for his office to call if they had problems (since my card still has the phantom Dr. D). I canceled the appointment with Dr. D.

Boy, this is fun. Now I have a headache.

Update: Just got a secure email from United. Had to go through a rigmarole of registering for this Cisco thing in order to view it. Finally  opened it, and it was just acknowledgment of my request to add my email address to my account. When I first signed on the United web site, my email was missing. It said I had to add it through the NYS exchange, but the exchange DID have my email so somehow it wasn't communicated.

What next?
Tags: health insurance

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