My Momma Told Me, You Better Shop Around

If you are a fan of Consumer Driven Health (CDH), here’s another reminder and example of how a little diligence can save you some large in our sadly opaque and confusing healthcare environment.  While saving $ is rewarding, it is still frustrating that 10 years after starting this blog, there is such little transparency when it comes to the cost of healthcare.

So here’s the story.  I went to the Gastro Doc because I’m suffering chronic pains in my stomach, and he orders up a CT scan of my abdomen and pelvis.  I contacted the company where the order had been sent to find out what this was going to cost.  I have  a high deductible health plan (HDHP), and knew I could be on the hook for the entire expense.  After conferring with my insurance company (United Health Care), they advised me that the cost of the scan would be $2,265.58.  However,  “lucky for me”, because the procedure would throw me over my individual deductible, I’d only be on the hook for $1,295.26.  Holy spit Batman!

Also “lucky for me” my personal portal to my United Health Care plan (MyUHC)) has this nifty cost estimating tool, which allows me to input the procedure, and it will kick out cost estimates for service providers near me.  The best quote/estimate for my procedure was $373 for a provider 8 minutes from my house.  I could have paid more with any number of other providers,. There were more than one in the lower price range but most were LESS than the $1,295 OOP would have paid had I not shopped around.

I saved $922 just for shopping around.

Not to throw a wet diaper on my breathtaking savings, but getting to the $922 savings, while not a killer, was not without out some pain and elevated blood pressure.  I’ll spare the commentary here, other than to say, it took a fair number of phone calls and diligence to put this puzzle together. Except for Subspecialty Imaging who did the procedure ( yes they get a plug here, and a big thank you to Rhonda and Sam)  and who were fantastic every step along the way;  there were lot’s of phone calls to my Doc and UHC which left me scratching my head as to why no one was more interested in making this process seamless.

Moral of the story?  Listen to Momma.

 

The Arrogance of Our Soon to be Former President of The United States

For the past two weeks I’ve been hearing (in the media) a lot about President Obama’s effort to “protect his legacy.”  It reminds me of the last week of my Junior year of high school when I jumped into my big economics project.  I’d blown it off for the entire year but still thought I could pull an A.  Nobody remembers that project now.  If they did, it would serve as a study on how not to approach life’s big challenges, and of one student’s incredible arrogance.

Because this site is oriented around healthcare, I want to focus on the legacy question in that context.  To the degree I have been personally involved in self-insuring my family since before the ACA, I believe I have some credible perspective.  My situation is representative of at least some individuals who have been directly involved in Obamacare.

 A good place to start with an assessment of the ACA is to go back to the President’s original statement of his objectives for what he wanted to accomplish with his healthcare initiative.  On June 11, 2009 at a speech in Green Bay, Wisconsin, President Obama launched his presidential push for universal healthcare.

He stated,  “After decades of inaction, we have finally decided to fix what is broken about healthcare in America. We have decided that it’s time to give every American quality healthcare at an affordable cost.” He also said, “We have decided that it’s time to give every American quality healthcare.”  And this one was very powerful too,  “The status quo is unsustainable. If we don’t act, and act soon to bring down costs, it will jeopardize everybody’s health care. If we don’t act, every American will feel the consequences in higher premiums.”

In my opinion, if we want to  assess the President’s legacy related to his accomplishments on healthcare, we must answer the questions stated as objectives in his 2009 speech.  Specifically, have we given every American:

1. quality healthcare?
2. at an affordable cost?

As the “deal was done” the White House published an outline of the meat of the ACA  on its website (article pasted below as link above may not be live much longer).

Again, in my opinion, the President’s legacy as it relates to healthcare should be judged against his efforts to improve the quality and affordability of healthcare.  For at least one reader of Robert Pirsig’s, Zen and the Art of Motorcycle Maintenance, the question of whether the President’s legacy will support the objective in an improvement in the “Quality” of healthcare leaves him scratching his head.  Instinctively, I would say the quality of healthcare has not been significantly impacted for positive or negative by the ACA.  However, were one to apply Pirsig’s Metaphysics of Quality (MoQ) to the question, I suppose an argument could be made that “quality” has improved.

Is Medicaid better?  Is Medicare better?  Do we have better drugs as a result?  Have the quality of outcomes improved? Are Americans living longer?  Is it easier to see a doctor?  Are our Emergency Rooms more efficient? Is infant mortality down? Are accidental pregnancies down?  Are those enrolled in Obamacare healthier than they were before?

What about the ACA’s success at achieving better healthcare at an “affordable cost?”  Based on my personal experience with Obamacare and more recently the $6,500 bill for an MRI of my son’s ankle presently in dispute; survey of one says, the ACA has been less than successful.  In fact I get rankled every time I hear a statistic that correlates the number of individuals enrolled in Obamacare as a metric for success.  I wonder how many folks there are like me out there who paid for 100% their own insurance prior to the ACA but because of it were basically forced into Obamacare. Why?  Because their premiums skyrocketed (mine well over 100%), and they were now eligible for/needed a government subsidy/hand out.  I wonder, how many individuals enrolled in Obamacare believe they are receiving healthcare at “an affordable cost?”  Let us not forget the concepts of “insurance” and “healthcare” are not synonymous.

I have no problems with the objectives outlined by President Obama. I believe there are admirable and successful pieces of Obamacare but on the whole it appears fatally flawed.

I think if  Congress, the outgoing, and the incoming administration would conduct a study of those enrolled in Obamacare to survey its performance against the original “promises of Obamacare,”  it might level the policy playing field a bit.  It would be  enlightening for all of us.

In the meantime, I suggest a reading of Hans Christian Andersen’s, The Emperor’s New Clothes. 

QED.

Overview below from:  the White House President Barack Obama website referenced in link above

Overview of Health Reform

Health reform puts American families and small business owners in control of their own health care.

• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps over 32 million Americans afford health care who do not get it today – and makes coverage more affordable for many more. Under the plan, 95% of Americans will be insured.
• It sets up a new competitive health insurance market giving tens of millions of Americans the same choices of insurance that members of Congress will have.
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years – and more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

Health reform bridges the gap between the House and Senate bills and includes new provisions to crack down on waste, fraud and abuse. 

It includes a targeted set of changes to the Patient Protection and Affordable Care Act, the Senate-passed health insurance reform bill.  Health reform reflects policies from the House-passed bill and the President’s priorities.  Key changes include:

• Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
• Closing the Medicare prescription drug “donut hole” coverage gap;
• Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families and increase protections for out-of-pocket costs;
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans.

Yes, Dental Implants Are HSA Qualified Expenses.

Six years ago I wrote a blog about dental implants. Yesterday morning I had the hole in my mouth plugged with my first implant.  Strangely, I got a comment on my post from six years ago suggesting dental implants are not qualified for HSA reimbursement.  I am still scratching my head over that one.

Anyway, I am here to state once again that Dental (not to be confused with breast) Implants are still considered qualified medical expenses.  IRS Publication 502 states:

Treatment to alleviate dental disease include services of a dentist for procedures such as X-rays, fillings, braces, extractions, dentures, and other dental ailments. But see Teeth Whitening under What Expenses are Not Included Later…

Now you might say, “Hey Amigo, that language does not say implants are included” but the point is they are not specifically excluded (nor are crowns or bridges) however dentures are specifically included. And under exclusions Publication 502 states:

Generally, you cannot include in medical expenses the amount you pay for unnecessary cosmetic surgery. This includes any procedure that is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. You generally cannot include in medical expenses the amount you pay for procedures such as face lifts, hair transplants, hair removal (electrolysis), and liposuction. You can include in medical expenses the amount you pay for cosmetic surgery if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease.

Example.

An individual undergoes surgery that removes a breast as part of treatment for cancer. She pays a surgeon to reconstruct the breast. The surgery to reconstruct the breast corrects a deformity directly related to the disease. The cost of the surgery is includible in her medical expenses.

In can say unequivocally, chewing meaningfully promotes the proper function of the body.

If you are still scratching your head, click here or here or here for additional references that specifically address dental implants.  Until someone in Congress or the President decide chewing is not meaningful to the function of the body, you are good to go with those implants.

Healthcare.gov Customer Service – Think Edge of Tomorrow/Judgement Day

So almost two months ago now, I got a letter from Healthcare.gov advising me that I needed to verify income.  Sad, when one is unemployed, but a hoop one is willing to jump through when suckling off the government milk jug.  Supposedly, said information could be submitted online, but we could never figure out how to do it.  But being compliant citizens in need of insurance, we made a copy of the letter, along with copies of all the related proof of non-income and mailed it into the address provided on their letter.

Case closed right?  Nope. Only just beginning.

Toward the end of September we received a letter the Healthcare.gov advising that they received information from us, but unfortunately “life event changes” may not be made by mail and must be transacted online.  Life Event Change?  Huh? I didn’t make no stinking Life Event Change.  So they got my info…but put it in the wrong place.  No worries, just ignore until further notice; a strategy successful for about a week.

Last Friday night at about 7:00 p.m., in the middle of dinner no less, the phone rings and it’s my friends at Healthcare.gov  advising that they need my income info.  Oh boy, here we go.  We explained that the government clearly received our information based on the letter they sent us and asked the representative if they would track it down.  Nope, the customer service (hah) rep can’t touch that and refers us back to the 1-800 customer service # so we can speak with someone who can help us.

Called that # today and did a repeat of the call last Friday night.  It’s an “amazing” infinite loop.  They want us to send in all the information again because danged if they are going to try to hunt anything down from their end.  They made note in the file that we had called in and supposedly we will not put our insurance at risk.  I think the enrollment period for next year is in about a month, so my strategy now is to roll my eyes a few times, ignore their harassment and absolute incompetency, and hope the problem either goes away.  Or maybe the paper work that I sent in finds its proper home.

Have you been to the netherworld of Healthcare.gov?  It’s starting to make me feel like I am in Tom Cruise’s fantasy world, but without the payout.

The Cynical Slave — Self Selected Slavery into Obamacare – Final Thoughts on the Affordable Care Act

I feel dirty. I do not feel like a patriot. I feel like I need a Boric acid shower. On one level I am totally ashamed. On another level I did the best I could financially under difficult circumstances.

I worry as an average middle class American, I have just stepped into the death spiral of government dependency. I know I am a burden on my neighbors, even if temporarily.  I am very uncomfortable.

Today, I am unemployed and in “transition” as the outplacement folks like to call it. Today, I pushed the button on healthcare.gov and enrolled into the Humana National Preferred Bronze 6300/6300 HSA eligible insurance plan. My coverage begins in three days.

But here’s the rub. In December of 2012 I paid the last premium payment on my Humana One individual insurance plan prior to stepping back into corporate America and into a group plan provided by my employer. The plan I left 17 months ago is eerily similar to the one I just enrolled in some major exceptions. I have outlined the highlights below

Old Plan	New Plan
Family Deductible: $10,500	Family Deductible: $12,600
Monthly Premium: $310	Monthly Premium: $778
Maternity/Childbirth: NO	Maternity/Childbirth: YES
Meds count to deductible: NO	Meds count to deductible: YES
Lifetime Max Payout: (?) $3-$5MM est.	Lifetime Max Payout: Unlimited
Government Subsidy: None	Government Subsidy: $557 per

So, for a 151% increase in premium from less than two years ago I also get a 17% higher deductible. I get some benefits, I don’t want or need (like maternity). I do get the benefit of no coinsurance lifetime maximum and my meds drugs count toward my deductible, but I would trade those for a lower premium and lower deductible.

You may be reading this and wondering, “Why is this guy complaining, with the government credit, he just lowered his premium by more than a third of what it was in 2012?” Well, first off, I hope to become employed, in which case I have to pay the difference back. Secondly, for as long as I am receiving this credit, I am a symbolic slave to my government plantation master and burden to my neighbors. Lastly, because insurance is so unaffordable, and healthcare is so expensive, I have had to take the low road. And that bothers me.  It humiliates me.

I need a job….fast.

The Chronicles of Obamacare Enrollment – Lessons Learned

A few random lessons learned from my six (I think) attempts to enroll for insurance eligibility on Healthcare.gov (see previous postings for colorful details):

• One can input essentially the same information into the healthcare.gov forms repeatedly, expect and receive different results (goes against the laws of nature I know).
• If one wishes to re-open for revisions an existing enrollment form, one should expect to re-answer some of the previously answered questions because some previous answers appear to be arbitrarily deleted.
• There is no identifiable logic to which answers are saved, and different ones may be saved between enrollment or revision sessions.
• If one is speaking with either a Representative or Specialist, just know, they are working off the same form in seemingly the same web application you have access to.  Therefore, they will experience the same problems you are.  For example, in filling out the form, they are as likely to get kicked off the site as you are. In otherwords, their tools to help you are NO BETTER than what you have.
• The only difference I could tell between a Representative and a Specialist, is that a Specialist has the ability to go back into your enrollment application after it has been submitted to revise information. BUT REMEMBER, even if one wants to change one field in the form, the act of going back in at all will arbitrarily wipe out info previously input.  Therefore, do not expect the Specialist to be able to work through the revisions faster than you can on your own.
• If you put in your estimated annual income,  but you have no income at this moment and  enter $0 monthly income into the form, expect to be kicked into the Medicaid bucket.
• If you are kicked over to state Medicaid, Healthcare.gov and its representatives will tell you must get proof from the state that you are not qualified. In my case they suggested a three way call or a letter from the state.
• In Georgia, to qualify for Medicaid one basically has to be disabled, have no income, or be a child of a parent with no income to qualify. Even though the information I provided Healthcare.gov and its representatives clearly suggests I could not qualify for Medicaid; if the enrollment notification says you may be qualified for Medicaid, the Representative and Specialists not lead you around this issue—basically they will shut you down.
• For one of my enrollment attempts I agreed to have my application “reviewed” (kicked up the ladder). However, the specialist could not and would not even guess, either how quickly my file would be reviewed or even how I would be advised. To this date and it has been close to a month at this posting, I have had no communication from healthcare.gov. (beware of black holes)
• Due to some sort of internet security threat I was asked to re-set my password with a new one. I reset it with the old one and it worked just fine.
• In all my conversations with the Healthcare.gov representatives and specialists, not one time have they ever suggested that they do not really have the tools, training or knowledge to effectively do their jobs, nor have they ever registered any frustration with their lack of tools.   They will however,  admit at times their customers do get frustrated from time to time and I was thanked multiple times for being nice. These folks seem obliviously bulletproof.
• Do not expect empathy, any sense of humor, or too much guidance from representatives.   Once I realized this, it made my interactions far more tolerable.
• There should be some quick pre-screening tools to determine eligibility and even subsidies, however, these are limited. When calling healthcare.gov, they will not pre-screen you. You will have to go through the entire enrollment process to see if you qualify to purchase off the exchange.
• Each time you call Healthcare.gov, plan to have an hour to spend with your new friends.
• Some (if not many) of the questions I answered in the enrollment process, online, were not asked when I enrolled by phone (for example, COBRA is a specific one not asked by phone).
• Do not expect a representative or specialist to advise you with regard to how you answer the questions; especially related to income. I made it very clear over multiple calls, that I was unemployed and my goal was to get as large a subsidy as legally possible. In order to do so, one must answer the questions in a certain way. However, the representatives and specialists either do not know, are unwilling or are not allowed to really help you obtain the correct subsidy.
• If you know approximately what your subsidy should be, there is a chance, if you are patient (and I mean REALLY patient) that you can keep re-working your enrollment application until you get results that align with your expectations. In my case, because I knew about what my subsidy should be based on my situation and qualifications, I just kept re-working the enrollment form until it got into the ballpark of reality (this was accomplished over many hours and weeks).
• Remember in the end, your subsidy is pegged to an estimate, so if you under or over estimate it, you will be obligated to true up come tax time, but as best as I can tell, there is no penalty for being unable to predict the future.
• When attempting to enroll for insurance through Healthcare.gov expect (a) TMD experience 🙂  (Google it).

Step Through The Wardrobe Of Obamacare and IntoThe Magical Land of Narniaozlamabad.

After a three plus week recovery, regrouping and re-strategizing period, I decided to start over on my healthcare.gov enrollment; this time with a representative vs. an attempt to go it alone.

After an hour and forty five minutes on the phone with first a representative and then a specialist, it appears I can take advantage of a $557 per month subsidy to help pay for my insurance. My goal from the beginning was to find affordable insurance, which, with the subsidy, is a bit closer to reality.

I am going to spare a long rant this time, because, in my next posting, I will try to summarize my learning. Hopefully that might help you, should you find yourself in my shoes. Suffice it to say the process was a painful schlep through the muddy and foul stinking trenches of Obamacare.

CONGRATULATIONS. You qualify for a $3 Obamacare Tax Credit.

 

So this past Monday (that would be April 28, 2014 for future readers), I decided not to put my trust in the supposed case worker assigned to review my Obamacare enrollment application. As of this posting, it has been over a week since I was supposedly assigned to my case worker, but have received no acknowledgement and have no clue if I have a case worker or if Priscilla was blowing smoke.

Anyway, I girded by loins, went back into my application, under the premise of updating my income and re-enrolled. Once again, some of my information was saved and some not. I am guessing the data input took a half an hour or so. Anyway, after putting all the same information back into the system…. again…. for the fourth time…., I nearly fell out of my chair when it actually said I was qualified to enroll. Furthermore, my unemployed family is entitled to a $3 per month subsidy which would lower the monthly premium on the cheapest plan to $738 per month BUT…. it only has a $12,600 deductible/out of pocket max.

So annualized if you add my premiums to my maximum out of pocket, I will have to spend $21,456 before I get real relief. Is this affordable healthcare? In fairness, one does get the benefit of the insurance companies’ negotiated rates with healthcare providers, but one must become very sick and in my case very broke, before getting any relief.

I want to mention once again that at the end of 2012 I was on an individual insurance plan with Humana. The premium for my high deductible health plan was $300 per month and my max out of pocket was $10,400. My total annual exposure was $14,000 (total annual premium plus maximum out of pocket).

So what does all this mean? It means I am going to step back and assess my options off the exchange, take a break from this nonsense and then try again.

Perhaps Obamacare Should Be Called Obamadon’tgivarip?

I find it mildly humorous and mildly disturbing that President Obama is doubling down on his rhetoric regarding the 8 million enrollments into Obamadon’tgivarip, aka Obamacare.  This in light of my personal experience so far with the Affordable Care Act (ACA).

So this morning I began round four with the actually nice, hugely apologetic, and functionally impotent folks at healthcare.gov.  My mission was to speak with a real person and try to understand why, despite the fact that I am recently unemployed, I am not actually eligible to enroll in Obamadon’tgivarip.  I am becoming a bit cynical, but not wholly unobjective.  This on the heels of my failed third attempt to enroll.

I did speak with a live human; two in fact.  First with Robert, who looked at my eligibility letter and confirmed that it said…what it said, and who then transferred me to Priscilla.  Priscilla in turn confirmed that the letter said….what it said and ultimately could not help me.  Turns out neither Robert nor Priscilla could actually look at my application.  There neither could not begin to help me troubleshoot my application, which, as previously noted says I am both eligible and ineligible to purchase through the Marketplace.  After Priscilla asked me a bunch of questions, including whether I was recently unemployed and on what date, she said she would refer me to a case worker who would review my file and would be “in touch.”

She could not tell me when my file would be reviewed (wouldn’t even venture an estimate when asked) or if I would be notified by phone or email.

Here’s the rub, the clock is ticking on my 60 day window  (but it is more like 45 if I don’t want a coverage gap in June) to enroll for healthcare on the marketplace which should be possible from the date I lost my job.  I can COBRA if I have too to the tune of $927 per month, which for a guy with no income at the moment is not a sustainable value proposition.

So, for the moment I look for employment and wait for the next chapter of my healthcare.gov story to unfold.

As an aside, if you look at the bottom right hand corner of healthcare.gov there is a logo depicting The White House and a website called USA.gov with the slogan “Government Made Easy” under it.  I have no clue what USA.gov’s role is in the Marketplace, but if it is to make it “Easy” they are getting an F- in my book.

Obamacare – Welcome To The Land Of The Lost

Apparently I am both eligible to purchase health coverage through the Marketplace and I am also ineligible. At least that is what my eligibility letter says…

So last Friday I went through the online enrollment process…online….again. If you want the history of my first two attempts read my previous post. Friday was attempt #3.

I spent 1.5 hours re-applying/re-enrolling, ultimately to be told on my eligibility letter that (and I am paraphrasing here) while I am eligible to purchase health coverage through the Marketplace, I cannot enroll at this time. So in effect, I am NOT eligible (although I actually am) to get coverage. Can you see why this might be confusing and perhaps frustrating?

During the course of attempting to complete my application, I was booted off the site four separate times. Each time I was kicked off, I had to go back and re-enter various bits of information which were not saved prior to me being disconnected. I should mention, because there are four members in my family, I had to answer most every question 4 times….over….and over…..and over again.

I fought the healthcare.gov website for 1.5 hours and was then dismissed. You can pick your own colorful adjectives for the word “dismissed” and you will probably have a sense of how I felt I was being treated. Rejected if you will.

I should note, that during the process a tree fell on a power line down the street, and I completed the application using my mobile hot spot. I was determined to succeed.

WRONG! I think it was divine intervention that the tree fell on the power lines, because the power was knocked out for 5 hours and by 7:00 Friday night, I knew I had until Monday to cool off from my rejection.

In the meantime I am sitting here wondering if anyone is actually benefitting from Obamacare, if the government is counting all 3 of my applications as enrollments, what the heck I put on my application that caused the rejection, if this will ever be resolved, and why exactly am being forced to waste my time mucking around with this when my time would be better spent trying to gain employment with a friggin’ health plan.