Belle’s Insight into the New Healthcare Exchanges–???

side effects obamacare

Living in a Blue state with the new HCA’s going in, is clearly NOT my personal choice for the state. Regardless, the HCA’s are here and your choices are to either jump in and swim or drown. The numbers show that most people signing up thus far are those for the Medicaid programs, fully utilizing the federal incentives. Many people have lost their individual plans that they’ve had prior to 1/1/14 and are still trying to figure out as well as navigate the maze. I have had my new healthcare insurance plan since 1/1/14 and am slowly learning the changes and how its effected my healthcare freedom of choice.

I have spent hours on the phone/internet with my new healthcare insurance company trying to find out the details of my new plan (things you won’t find on the exchange unless you know where to look and how to decipher the fine print). I had recently retired from 35+ yrs in the healthcare field, thus I was fairly confident with my plan choice when I signed up, but I knew there was a lot of fine print that I still needed to discover and decipher. I did have a few up and coming procedures that were previously authorized on my old plan, but with the change, I’ve had to start the process all over again, which also means my overly taxed physician’s office personnel, had to re-do all their work as well.

I selected 1 of the largest insurance companies in the state, mainly because I wanted to choose from what I hoped would have the largest intact numbers of providers in-network, assuming this would increase the odds of my current physicians being a part of that plan. I did select a PPO plan, which I feel basically gives me a little more freedom in choosing necessary providers vs a HMO plan. The largest negative my personal research uncovered was that the states’ HCA plans were so new, that the majority of healthcare providers hadn’t signed on with the plans as of yet, which basically threw wrenches into the wheel, requiring more effort and more paperwork.

In my own case, my physicians affiliated with my up and coming procedures were not part of my new insurance co’s ‘ in-network’ providers. This to me was a huge negative as these procedures have been ongoing for some time and I really didn’t want to have to find someone else to start all over with (tell me that decreases the cost of healthcare overall). It did turn out that the procedures I’m to have done, were unique enough that there were no providers in the in-network system of my insurance co., that could do what I needed to have done. This was a God send because using the out-of-network system (“keeping your own doctor”) is very expensive– your annual deductibles double and there is no limit on your out of pocket expenses. Unless you have very deep pockets, your freedom of choice has been made for you.

There is a provision in most healthcare insurance policies that stipulate that a patient/client can apply for a ‘Benefit Level Exception’ (entails more paperwork/calls for your physicians’ office and yourself) which basically changes your out-of-network provider into a in-network provider for this procedure, since the insurance co. doesn’t provide a provider within a 50 mile radius of your home, for that particular service.¬† I know this doesn’t sound too complicated but don’t be fooled. This process took many phone calls (getting a new rep each call thus having to re-iterate a lot) along with a few heated exchanges, as I had a hard time accepting an insurance co’s opinion of my healthcare vs my own physician’s, who is the only one licensed to practice medicine.

My purpose isn’t to put the fear of God into you, but I do want you to realize that the new process is less user-friendly than the system, prior to the government¬† mandated changes. I dread any losses of freedoms, no matter what their association, but you have to remember that in the case of healthcare, you are the ones paying the insurance co’s premiums and they are supposed advocates for you. Lastly, remember that your physician is the one in charge of your healthcare, NOT the insurance co. Let your voices be heard, stand up for yourself and don’t forget to use your state’s insurance commissioner’s office to get some answers.

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