Wednesday, December 11, 2013

More on Insurance and the PPACA Exchange in VT - this one is political

My current insurance has completely denied the consultation in Boston, which is the same situation I mentioned last week.  The insurance company offered to "help", after I complained.  Basically, they said that a second provider that I've seen locally could appeal the decision and they would get around to processing that appeal as soon as possible.  But, by the time that happened and I got another appointment could easily be a month into the future.  So, I opted for a more local teaching hospital and I have an appointment next week.  This isn't a bad option, but it wasn't my first choice.

The prescription I was fighting for has been completely denied, so I'm buying an expensive medication out of pocket.  Apparently, there is a loophole that could potentially be exploited.  My doctor could give me another medication for a period of up to three months.  If I then claim that the other medication doesn't work, I might be able to get coverage for my preferred medication.  I told the nurse at the doctor's office that I don't want to buy that other medication and I don't want to use it.  Even if I bought it, I wouldn't use it.  If I never used it, I guess I could claim it did nothing for me.  But, that would mean buying medication, throwing it away, and essentially lying to the insurance company.  While I'm not a fan of the games they are playing with me, I'm not willing to play games and waste money to skirt their rules.

And, my wife's employer has refused to budge from her current stance on coverage for us for next year.  In reality, she has doubled down, making things even worse.  My wife's employer originally agreed to allow us to purchase a platinum plan that would limit our out of pocket expenses for the next year.  The policy would have cost more than our current policy, but the net cost would have been a reduction.  But, the same company that has built the troubled national exchange was also hired to implement the VT exchange.  My wife works for a benefits management company, and her company has been helping other companies to get signed onto the exchange.  Yet, my wife's company has declined to do that for their own employees until 4/1.  And last week, they decided that the current policies will continue through all of 2014, not just through the first three months.

We currently, quite honestly, have the worst health care coverage we have ever had.  The policy is expensive and the out of pocket expenses are high.  By forcing us to stay on this policy for the entire year, we will be taking a large hit - possibly as much as $10,000 (or more) for next year, and only some of that will be pre-tax.

So, I've been teased by what's available in VT under the PPACA.  And, due to poor performance by the state and a contractor, I can't have it.  And that will cost me a lot of money.  So, when you hear people complaining that the ACA plans are expensive, I'm a case where the provisions to allow people to keep poor policies will have a significant negative effect.  I didn't want my old policy.  I wanted the exchange policy.  And I can only have it if I pay for it completely out of pocket.  I've thought about that option, to be honest, and it's a crapshoot.  It might make sense to do that, in some ways, if my wife's boss would add her policy contributions to my wife's paycheck for one year.  But even then, the tax ramifications are highly complex and it's hard to know how things would work out.

Under the exchange policy, I could see the doctor in Boston that I want to see.  I could receive treatment in Boston if I chose that.  Instead, I'm stuck for another year on the worst insurance policy I've ever had.

Regretfully, someone else in my family is also dealing with a significant illness right now, so the high deductibles of the old policy, at the family level rather than personal level, will continue to cost us money.

So, by allowing certain poor policies to continue through the next year, I'm being very negatively affected.  If the PPACA had been fully implemented as defined, my situation would be much better.

But, I'm sure the insurance company is happy.  I just hope I don't end up bankrupt in the next year due to this situation.

1 comment:

Harriet said...

I am sorry that this is happening to you.