My Dealings With Obamacare

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When Obamacare was announced, I didn’t really have an opinion.  I was open to the idea especially since it meant that insurance companies couldn’t deny me because of my pre-existing condition (diabetes).  Because I work for a small company, this was beneficial because my business would no longer be charged a ridiculously high rate and if we didn’t have a group plan, I still couldn’t be denied.  Everything seemed OK.  Then everything changed and now I have a very negative impression of Obamacare.

Back in December, I shared some health insurance woes with you. Just to refresh you, my husband and I were on a group health insurance plan for our small business and the plan ran November 1st to October 31st.  Because we are a husband/wife company and no other employees, Obamacare did not recognize us as a small business so we were dropped from group coverage.  We started an individual plan effective November 1st only to find out that the individual plans run January-January so I had my individual plan from November 1st-December 31st only.  I had selected a plan where I paid everything 100% until I reached my deductible.  I found out in November that I was pregnant so I had two OB appointments during this time frame and I also had an endocrinologist appointment and I ordered diabetes supplies.  I wasn’t concerned about having to pay for each visit 100% because I thought I had the plan for a full year and I knew that once I reached the deductible, the expenses would be a little more manageable.  But then I discovered that my deductible and OOP max started over January 1st and all the money I spent on those doctors appointments was gone.

I was mad.  I was mad because we were using a broker at the time and he didn’t divulge the information to us that our plan would reset January 1.  If I had known that, I would have selected a different plan where I wasn’t paying for 100% of the costs up front and instead would have selected a plan where my visit cost a $50 co-pay or something.  Because I was mad at my broker and because the new year and new plan was starting January 1st, we decided to switch plans.

Instead of using my broker, I decided to try the healthcare.gov website (aka Obamacare).  I didn’t know much about healthcare.gov other than it was a marketplace for health insurance plans.  The website was fairly easy to use (other than some delays because I was applying December 15th which was the deadline for January 1st insurance) and before I knew it, I had selected a plan and paid for it.

Thinking everything was good now, I went into the new year optimistic about my new health insurance plan.  I went to the ER January 2nd, where I gave them my new insurance and everything seemed to work fine.  Three days later, I followed up with my OB because I didn’t like how the ER handled things and when I showed up to that appointment, I found out that my new insurance plan doesn’t work with my OB!  I was shocked!  I had selected one of the best plans available through healthcare.gov.  How could they not work with my OB?

It turns out my OB’s office (and many doctors throughout Richmond) doesn’t work with Obamacare plans.  There is a little X on my insurance card that means I went through healthcare.gov and that changes the entire plan completely.  The SAME exact plan is available through my insurance company’s website as it is on healthcare.gov but going through the marketplace adds an X to the plan’s name.

So I had a decision to make.  Do I switch insurance plans effective 2/1 (open enrollment was still going on so I could still change) or do I stick with my plan and find a new doctor? This question caused quite a bit of research.  Because I had gone to the ER on January 2nd, I had a huge hospital bill to pay that was applied to my deductible and OOP max.  I did not want to lose that money so I had to figure out if that money would apply to the new plan.  After MANY phone calls and emails, I heard from many sources that my deductible and OOP max would carry forward to the new plan-phew!

So I went directly to my health insurance company’s website to apply for a new plan that my doctor would work with effective February 1st.  The problem was when I applied, it still had my old broker’s name on the account.  I did not want to use him for my new insurance plan because I was still mad about losing more than $1500 in November/December.  So I found a new broker.  Luckily, this guy has been amazing.  He actually fought to make sure we got in writing and confirmed by multiple sources that my deductible and OOP Max would carry over.  I felt confident putting my money in his hands.

By January 15th, I had applied for the new insurance plan directly from my insurance company’s website using my new awesome broker and I thought things were good.  Here comes another problem with Obamacare.  Even though the plan was with my insurance company, because it was through healthcare.gov and not directly through my insurance company’s website, I had to cancel my plan through healthcare.gov.  My insurance broker told me to wait until we got confirmation that my new plan was approved.  We got that notification on January 19th, which happened to be my birthday.  I waited until January 20th to call and cancel.  When I called, they said they needed 14 days notice to cancel a plan, even though I had already been approved for a plan from the same exact company! 14 days notice meant that I had to pay a portion of February, which I did not want to do.

Again, we had to make many phone calls but we eventually got the plan canceled effective February 1st.  Now here is the weird part…about a week later, I received a check in the mail from my insurance company.  It was only for a portion of my monthly premium so I had no idea what it was for.  I called the company and they said it was my money and that my account was squared away so go ahead and cash it.  I was confused because I knew that no money was due to me.  I had paid for the new plan for February back when I applied and I had canceled the old plan for February.  Again, after much research, I found out that healthcare.gov and/or my health insurance company refunded my portion of February that I paid for the OLD plan (which was about $70 cheaper).  The portion was for all of February minus the first 4 days (which I wasn’t able to cancel initially).  I was still confused what was going on. I logged onto my health insurance company’s website and they said I owed money for February but it was the amount for the OLD plan even though I had already paid the amount for the NEW plan.

I had no idea what was going on.  If I called my health insurance company, they couldn’t tell me what was going on.  I called my broker and he did some investigating and finally figured out what was going on.  It had something to do with the fact that I was working with healthcare.gov to cancel my old plan.  Apparently, when I called to cancel they refunded the portion of the month and then when we got the cancelation approved for February 1st, they then sent a check for the remainder of the amount for the old plan (I hadn’t receive it yet).  The balance on my account was the amount I paid for the new plan minus the amount I was refunded for the old plan, or $70 my insurance company thought I paid for February’s premium.  I finally received the check in the mail for the remainder of the amount and then I had to go onto the company’s website and pay the same exact amount they had just refunded me!

All during this time, I was worried if I had insurance or not.  The month was getting close to being over and my insurance company still showed an outstanding amount.  I luckily was able to figure out what was going on with my broker’s help and now I am squared away.  I have paid March’s premium and everything seems to be just fine now (at least in terms of money).

Now there is a second part to this story and that was the deductible and OOP max.  As I mentioned previously, I was worried about these amounts carrying over from my old plan to my new plan because I had already spent a lot on the ER visit.  I was told they would carry over but when February rolled around and my new plan started, the money was not there.  I called my insurance company and emailed them several times and I also got my new broker’s help and luckily by around February 10th the money had been updated.  The crazy part was that someone at my insurance company had to manually edit it so I had to go and make sure it all got carried over correctly.  The week while we were investigating and calling everyone I was nervous about it carrying over but I had gotten multiple confirmations it would.

December was spent pissed off that I was losing money because the individual plan reset January 1st.  Because I decided to not use my old broker, I ended up getting screwed again.  I had to make MANY phone calls and emails to healthcare.gov and my insurance company to straighten out billing, deductibles, plan information etc.  One of the most frustrating parts of this whole experience was the fact that we had an Obamacare plan.  Because of this, our insurance company wouldn’t talk to us.  They told us that we had to go through healthcare.gov and straighten things out with them even though our plan was with their company! We had a plan with our insurance company in January through healthcare.gov but it had an X on the name.  We switched to apply directly through our health insurance company directly and we got the SAME EXACT PLAN but because we went directly through their website and not through Obamacare, we no longer had an X in our plan’s name and we had to pay about $70 more per month for the same exact plan.  One thing that I learned is that Obamacare is not the way to go.  Doctors don’t work with those plans and the health insurance company doesn’t want to help you because you didn’t apply directly through them.  It might be cheaper but it’s definitely not the way to go.  Cheaper isn’t always better as I learned the hard way.

However, there is some light at the end of this tunnel.  During this time when I thought I wasn’t going to be able to carry over my ER fees, I started to look for a new OB and a new hospital.  My husband and I did a hospital tour and asked around and finally decided on a new OB.  Even though we switched plans so that the new plan could work with my old OB, after all the research, we decided to go with the new OB’s practice.  The hospital I’m going to deliver baby #2 at is closer to my home so works out well since we will have baby #1 to worry about.  The plan is about $70 more expensive per month but it’s worth it to be able to go to any doctor’s office in Richmond and not have any weird constraints because we have an X on our plan name.

January and February were spent dealing with a bunch of insurance mess.  All the phone calls, emails, stress, research, etc made for a very trying time.  I’m happy I found the new broker I did and I’m happy that I now have a new OB practice that is a little more convenient.  Now that it’s March, I’m happy to hopefully have all this behind me.  We are paid up through April for our premiums, the right plan seems to to be in place and our deductibles and OOP max appear to be correct.  Between how sick I felt in the first trimester and then having to deal with the stress of this, I’m hoping things calm down now for the rest of my pregnancy!


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