Adventures in Healthcare

After years of buying into an employer healthcare plan through the public school system and then a few years of chancing it as an uninsured adult, I finally started buying my own health insurance this past August.

Oh, how mature I felt, looking up and comparing plans online, signing up for dental and vision coverage, paying my first monthly bill. Little did I know that my plan would include a rider that barred me from all coverage for preexisting conditions. The only reasons I go to the doctor anymore are for my lady checkups, my therapy sessions, and to check on my migraine condition.

Under my new health insurance, only my well-woman checkups would be covered.

In waltzes the Affordable Care Act (ACA or ObamaCare) in all its gilded glory. No pre-existing conditions! Affordable coverage for all! Sign up now!

So, blinded by the promises of coverage for my mental health and central nervous system needs, I signed up for a personal plan under the ACA on December 24. Whoopie! I would be covered!

And then, January 1, when I went to pay my bill online, I found not the bill for the new $170 ACA plan, but a bill for my old, shabby $114 plan (that included dental and vision insurance, mind you).

A quick phone call to my health insurance provider figured out the problem: I would receive the new bill in the mail, but I could pay the it over the phone right now. They would refund me the money I already paid for my January installment on my old plan–I paid it just to ensure I still had coverage for January, I had heard too many horror stories about people losing coverage before they even got it–and they would cancel my old plan right then.

A mere two weeks later, I needed a refill on my prescriptions. I take an inexpensive generic for migraine and an expensive generic for anxiety/depression ($250/mo). When I called the pharmacy that Friday, they told me I needed a doctor’s note for both. Guess it was time to make an appointment, so I made one for the following Monday.

I sat in the doctor’s office, filling out beginning of the year paperwork while the receptionist dealt with my new insurance. She called me back up to the window with a frown, “Ms?” uh-oh, I thought, no bueno. “As it turns out, we’re no longer in your network.”


“Yeah. This has been happening a lot lately. The kind of insurance you have is basically TennCare (Medicare) that you pay for.”

I hand her back the clipboard, “Thanks. I’ll work on finding another doctor.”

It wasn’t until I was down the road that I realized I needed my prescriptions refilled. I figured I would do that when I got home. I was too mad. So what does one do in situations like this? Call Mom.

“They did what?”

“I know!”

“It’s so hard to find another doctor! It’s harder to find a good doctor than it is to find a husband!”

“I know! I’ve known my doctor longer than I’ve known my fiance!”

“Do they expect you to just find one in the next month?

“He’s a family doctor too, so I was thinking about leaving my ob-gyn and letting this guy into my pants!”

When I called the office, they were kind enough to give me another three month’s refill on my prescriptions. I guess it was like the last goodbye kiss. Thanks for all the good years, here’s something to remember us by.

So today, I finally sat down and tried to figure out my prescription situation. It started when I tried to pay my bill online. Turns out my online registration was tied to my old plan, so I had to re-register. After paying my bill, I went to the prescription area and searched for mine. They kept coming up as “not covered by this plan.” What what what?

Thankfully, I am a pack-rat, so I pulled out the folder with my plan information. I think I still have the folder with my plan information from my first health plan in 2004, if you want to see that, by the way. In my brand new 2014 health plan, there’s a list of covered prescriptions–who knew!?

Right there, on facing pages–8 and 9 to be exact–are my generic prescription drugs, both Tier 1, listed plain as day.

Holding back tears, trying to breathe, I called up my insurance company. Thankfully, there was a long enough hold time before sweet little Erica picked up the phone, and I steadied my voice. I explained my situation; she transferred me.

Crystal, my godsend, you shining beacon in an unforgiving world. Crystal spent 30 minutes looking over my health plan, reading through the information and trying to figure out why I had been denied coverage.

Remember that rider I talked about 700 or so words ago? The one about preexisting conditions? Yeah. That had transferred over to my new plan. Why would it transfer, despite the ACA legislation? Who knows? Because it saves my health insurance company thousands of dollars in the long run? Perhaps. All I know is that sweet Crystal, my knight in shining headset will be calling me when she has successfully removed the rider from my plan.

And then its inexpensive prescriptions for everyone!

Ok, just for me, but who’s counting?


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