Obamacare and Me, Part II
He's back -- sort of!
I haven't been heard from much on my Facebook page, Google page, website or blog recently because over the last few weeks, I've been undergoing medical treatment for a life-threatening illness. I'm going to tell you about some of that now, and also update my difficulties with being forced by the Affordable Care Act to switch horses in mid-stream, as it were -- changing insurance providers at the height of my medical crisis.
In December I documented the events leading up to my first surgery in my blog entry, "Obamacare and Me." At the end of that episode, I appeared to be in good coverage shape, having successfully sorted, out on my own, the conflicting advice given to me by the confused employees at the Healthcare.gov chat center. My surgeries were scheduled, I had my new health insurance ID number in hand, and everything seemed fine.
Not so fast.
The first surgery, which was an outpatient procedure, was uneventful. But three weeks later, on the eve of the second surgery, I received a call from my new insurer telling me that neither of my doctors was an approved provider under the terms of my new plan. The insurer approved the upcoming surgery anyway under the principle of "continuity of care." This was the right thing to do, since both doctors had been treating me under my old plan, and since the need for the procedures was quite urgent. However, I was told that I would need to choose new doctors going forward.
This was quite a shock. Before signing up with my new insurer, I had verified via that insurer's web site that my primary care physician was an approved provider. Then, before my old insurance expired, I asked my primary care physician to refer me to a specialist who also would be on the new plan. He did so. I then double checked with the specialist to make sure he was indeed an approved provider with my new insurance company. His staff assured me that he was. My first surgery was an outpatient procedure and did not require advance authorization from the insurer. But the second surgery, taking place 3 weeks later, involved a hospital stay and did require authorization in advance. That is when the flag went up.
For me, it turned out to be a near miss. The truth was that both doctors were approved providers with the insurance company I had chosen, but not for the exchange plan I had purchased. I found the company website to be unclear on that point, and both doctors' staffs were confused about it as well. The case manager for the new insurer who contacted me the night before my second operation assured me that there was massive confusion on this point all around due to the fact that all the exchange plans were brand new, and provider contracts for those exchange plans were still in negotiation. Provider lists would not be finalized until the end of the open enrollment period. At the time, she didn't know whether my doctors were or were not signed up for the exchange plan I had chosen or would be in the future; she said it could simply be a matter of the paperwork not having been completed or not having shown up in the computer system. Also, she told me that although she had fought to approve my surgery under the "continuity of care" principle, she informed me there was a question as to whether my previous surgery would be paid for! She advised me that if the payment for that first surgery were to be rejected, I should appeal, and said my chances of winning would be good.
However, the company sent me a statement three weeks later showing that the costs for the previous surgery would be honored as well. This was an incredible relief to me, as you might imagine -- and speaks well of the provider I have chosen. But all of this has caused the rest of my hairs - what few I have left -- to turn grey.
Now I'm trying to avoid changing doctors. My specialist is an internationally known urologist who saved my life during a very difficult surgery. I like my doctors and want to keep them, as we were all promised at one point that we could. I have discovered, to my dismay, that my specialist is not yet on any of the plans offered through the government exchange -- so if I stay with Healthcare.gov, I'll definitely have to change to a new doctor. But my new insurance provider does offer different non-exchange plans that do include these doctors (hence the confusion, which a salesman told me today is widespread among its customers and providers). Since I do not receive a marketplace subsidy, I am free to change to a non-exchange plan -- otherwise, I'd be hosed. I'm evaluating those plans now, and if I can afford to switch, I will. At first glance, it appears a non-exchange plan with this same company will be affordable and may even save me money, depending on the benefits I select. I learned I have until March 15 to make this decision under the terms of the open enrollment.
There is a lesson in all this for others who are going through the open enrollment process under ACA. There is a great deal of confusion on all quarters because of the radical changes mandated by ACA, a.k.a. Obamacare. If, like I was forced to do, you are changing plans or have already done so, it appears there is still time to make sure your new plan meets your needs and will allow you to see your current physician. Even if there's been a mistake on that point, as there was in my case, there is a chance it can be fixed. In my case, no exchange plan with my new insurer will allow me to see my current physicians. But the company does offer other plans that will allow me to keep my doctors. I must decide by March 15, which is the deadline, I'm told, by which April plans must be purchased under open enrollment. I'm motivated to stay with my new company because it has treated me very well. But if I need to do so, I can explore going with a different company as well, without penalty. In any case, any medical bills I have incurred to date will be honored even if I switch.
Good luck to you! And if you know any insurance agents or can find one, my advice is to find one to help you, if you must buy new insurance. (A nod to my friend Randy Foulds in California on that point). This process, as it turns out, is very complicated to try to navigate on your own.
Meanwhile, on a personal note, I'm happy to say that my long term prognosis is good. In mid-December (right as I was signing up for insurance via Healthcare.gov, in fact) following a CT scan I got that phone call we all dread: "Mr. Carr, you have a 4 cm mass on your left kidney." Subsequent tests showed that the growth was even larger than that, and was a form of cancer called transitional cell carcinoma. I spent the next six weeks not knowing whether the rest of my life would be measured in months, or in years. On January 30, I went into surgery to remove the kidney. The specialist, who was also my surgeon, told me afterwards that the surgery had been very complicated because the kidney was enlarged to twice its normal length and had wrapped itself around the renal artery, requiring great care to remove it. As I said, he's very well known and respected in his field, and he was up to the task. But afterwards, in response to a direct question from me, he admitted that, after inspecting the lymph nodes in the surrounding area, he was concerned about whether the cancer had spread. He also hastened to point out that there was no way to tell visually. So, my wife and I waited another tense week for the biopsy results to come back. The results were clear. There is no evidence the cancer has spread.
I'm not out of the woods, of course. The medical profession measures cancer survival rates in five-year increments. My prognosis is very good but I'll have to undergo close monitoring from now on. That's why it's so important for me to retain my fabulously skilled physician. But if all goes well, I may live long enough to die of something else altogether.
Meanwhile, my recovery progresses. I'm not quite back on my feet just yet. I've lost 15 pounds and my appetite has not returned. Plus, the aftermath of a surgery like this is quite painful. But I get around a bit better every week. I hope to resume writing my third novel soon. Meanwhile, I'll have an exciting announcement (well, exiting to me, at least) about my first novel later this week.
I want to close by extending my heartfelt thanks to my surgeon, Dr. Sanjay Ramakumar. And also to the many friends and even strangers who've been praying for me, via personal prayers and organized prayer circles. I am very fortunate to have such friends and such support.
I haven't been heard from much on my Facebook page, Google page, website or blog recently because over the last few weeks, I've been undergoing medical treatment for a life-threatening illness. I'm going to tell you about some of that now, and also update my difficulties with being forced by the Affordable Care Act to switch horses in mid-stream, as it were -- changing insurance providers at the height of my medical crisis.
In December I documented the events leading up to my first surgery in my blog entry, "Obamacare and Me." At the end of that episode, I appeared to be in good coverage shape, having successfully sorted, out on my own, the conflicting advice given to me by the confused employees at the Healthcare.gov chat center. My surgeries were scheduled, I had my new health insurance ID number in hand, and everything seemed fine.
Not so fast.
The first surgery, which was an outpatient procedure, was uneventful. But three weeks later, on the eve of the second surgery, I received a call from my new insurer telling me that neither of my doctors was an approved provider under the terms of my new plan. The insurer approved the upcoming surgery anyway under the principle of "continuity of care." This was the right thing to do, since both doctors had been treating me under my old plan, and since the need for the procedures was quite urgent. However, I was told that I would need to choose new doctors going forward.
This was quite a shock. Before signing up with my new insurer, I had verified via that insurer's web site that my primary care physician was an approved provider. Then, before my old insurance expired, I asked my primary care physician to refer me to a specialist who also would be on the new plan. He did so. I then double checked with the specialist to make sure he was indeed an approved provider with my new insurance company. His staff assured me that he was. My first surgery was an outpatient procedure and did not require advance authorization from the insurer. But the second surgery, taking place 3 weeks later, involved a hospital stay and did require authorization in advance. That is when the flag went up.
For me, it turned out to be a near miss. The truth was that both doctors were approved providers with the insurance company I had chosen, but not for the exchange plan I had purchased. I found the company website to be unclear on that point, and both doctors' staffs were confused about it as well. The case manager for the new insurer who contacted me the night before my second operation assured me that there was massive confusion on this point all around due to the fact that all the exchange plans were brand new, and provider contracts for those exchange plans were still in negotiation. Provider lists would not be finalized until the end of the open enrollment period. At the time, she didn't know whether my doctors were or were not signed up for the exchange plan I had chosen or would be in the future; she said it could simply be a matter of the paperwork not having been completed or not having shown up in the computer system. Also, she told me that although she had fought to approve my surgery under the "continuity of care" principle, she informed me there was a question as to whether my previous surgery would be paid for! She advised me that if the payment for that first surgery were to be rejected, I should appeal, and said my chances of winning would be good.
However, the company sent me a statement three weeks later showing that the costs for the previous surgery would be honored as well. This was an incredible relief to me, as you might imagine -- and speaks well of the provider I have chosen. But all of this has caused the rest of my hairs - what few I have left -- to turn grey.
Now I'm trying to avoid changing doctors. My specialist is an internationally known urologist who saved my life during a very difficult surgery. I like my doctors and want to keep them, as we were all promised at one point that we could. I have discovered, to my dismay, that my specialist is not yet on any of the plans offered through the government exchange -- so if I stay with Healthcare.gov, I'll definitely have to change to a new doctor. But my new insurance provider does offer different non-exchange plans that do include these doctors (hence the confusion, which a salesman told me today is widespread among its customers and providers). Since I do not receive a marketplace subsidy, I am free to change to a non-exchange plan -- otherwise, I'd be hosed. I'm evaluating those plans now, and if I can afford to switch, I will. At first glance, it appears a non-exchange plan with this same company will be affordable and may even save me money, depending on the benefits I select. I learned I have until March 15 to make this decision under the terms of the open enrollment.
There is a lesson in all this for others who are going through the open enrollment process under ACA. There is a great deal of confusion on all quarters because of the radical changes mandated by ACA, a.k.a. Obamacare. If, like I was forced to do, you are changing plans or have already done so, it appears there is still time to make sure your new plan meets your needs and will allow you to see your current physician. Even if there's been a mistake on that point, as there was in my case, there is a chance it can be fixed. In my case, no exchange plan with my new insurer will allow me to see my current physicians. But the company does offer other plans that will allow me to keep my doctors. I must decide by March 15, which is the deadline, I'm told, by which April plans must be purchased under open enrollment. I'm motivated to stay with my new company because it has treated me very well. But if I need to do so, I can explore going with a different company as well, without penalty. In any case, any medical bills I have incurred to date will be honored even if I switch.
Good luck to you! And if you know any insurance agents or can find one, my advice is to find one to help you, if you must buy new insurance. (A nod to my friend Randy Foulds in California on that point). This process, as it turns out, is very complicated to try to navigate on your own.
Meanwhile, on a personal note, I'm happy to say that my long term prognosis is good. In mid-December (right as I was signing up for insurance via Healthcare.gov, in fact) following a CT scan I got that phone call we all dread: "Mr. Carr, you have a 4 cm mass on your left kidney." Subsequent tests showed that the growth was even larger than that, and was a form of cancer called transitional cell carcinoma. I spent the next six weeks not knowing whether the rest of my life would be measured in months, or in years. On January 30, I went into surgery to remove the kidney. The specialist, who was also my surgeon, told me afterwards that the surgery had been very complicated because the kidney was enlarged to twice its normal length and had wrapped itself around the renal artery, requiring great care to remove it. As I said, he's very well known and respected in his field, and he was up to the task. But afterwards, in response to a direct question from me, he admitted that, after inspecting the lymph nodes in the surrounding area, he was concerned about whether the cancer had spread. He also hastened to point out that there was no way to tell visually. So, my wife and I waited another tense week for the biopsy results to come back. The results were clear. There is no evidence the cancer has spread.
I'm not out of the woods, of course. The medical profession measures cancer survival rates in five-year increments. My prognosis is very good but I'll have to undergo close monitoring from now on. That's why it's so important for me to retain my fabulously skilled physician. But if all goes well, I may live long enough to die of something else altogether.
Meanwhile, my recovery progresses. I'm not quite back on my feet just yet. I've lost 15 pounds and my appetite has not returned. Plus, the aftermath of a surgery like this is quite painful. But I get around a bit better every week. I hope to resume writing my third novel soon. Meanwhile, I'll have an exciting announcement (well, exiting to me, at least) about my first novel later this week.
I want to close by extending my heartfelt thanks to my surgeon, Dr. Sanjay Ramakumar. And also to the many friends and even strangers who've been praying for me, via personal prayers and organized prayer circles. I am very fortunate to have such friends and such support.
No comments have been added yet.
