Skip to comments.An Obamacare supporter recounts his misadventures dealing with HealthCare.gov
Posted on 01/14/2014 4:12:40 AM PST by Cincinatus' Wife
As we hoisted champagne flutes in the first seconds of 2014, my partner and I toasted all the usual things people do as they look ahead to the coming year. Health. Happiness. Love. Optimism. Hope.
To that traditional list, we added one more: Obamacare. My husband, Miles, was enrolled in what appeared to be an excellent, affordable plan at the stroke of midnight. Celebration seemed in order.
It had been a tough slog, of course. Wed worried the GOP would succeed in defunding it or undermining it in some other way that would put affordable coverage further out of our reach. Then wed wrestled with that horrific website, struggled to understand the choices before us and waited nervously after we did so to see if the insurance card would actually materialize. It did.
On Jan. 1, we rejoiced. And on Jan. 10, we gave up.
Ten days in, we decided to cancel Miles Obamacare plan, swallow hundreds of dollars well probably never recover and buy him a private policy away from the Federal Health Insurance Exchange Marketplace. His new plan does benefit from many requirements of the Affordable Care Act as well, so thats good.
But even the administrators at Obamacares headquarters have agreed this is the best option. Really.
Thats not how it was supposed to be. After dozens of hours of phone calls that displaced my usual work obligations this week, only one thing is clear: Nobody can give anybody a straight or consistent answer to anything.
Our troubles may strike some as trivial and particular, although they wouldnt if it happened to them. And anyone who wants a successful system as we do must understand that these nightmares are happening across the nation to the very people who want Obamacare to work.
Most just dont have a way to tell the world.
In the summer of 2013, Miles and I, both 41 years old, quit our jobs in Washington. Miles was a producer at WJLA, the ABC affiliate in Washington D.C., but he longed to return to school for a new degree and a different career. I was at POLITICO realizing that my life as a freelance journalist was far more engaging, empowering and lucrative than chronicling the petty, overly intertwined worlds of D.C. politics and journalism.
Even a year earlier, it would have been unthinkable for Miles to walk away from a proper job. He has pre-existing conditions. None are life-threatening or unmanageable, but one requires expensive medication.
This is one of the promises of Obamacare we most appreciated, the idea that unshackling health decisions from employment can liberate people to leave unsatisfying jobs and engage their entrepreneurial sides. How many people have been prevented from pursuing careers that would make them more productive and passionate out of fear that a health calamity could ruin them?
Obamacare helped to embolden Miles to change his life. It is why we left Washington and headed back to the Midwest, a region we came to love while I had an academic fellowship at University of Michigan in 2011 and 2012. I wanted to freelance, write books and teach, and he wanted to go back to school.
We made our move when we did because the academic year was coming, figuring we could shoulder a few months of COBRA coverage for Miles about $420 a month until Obamacare began.
(With no important pre-existing conditions, I got a very good private plan right away through Aetna for about $210 a month. Its evidently Obamacare-compliant, because I liked my plan and, as the applause line goes, I was able to keep it.)
Shortly after midnight on Oct. 1, we hopped onto healthcare.gov to see what the federal exchange had for Miles. As you may have heard, that didnt go so well. When I wrote about that first-day misadventure of glitches and unhelpful phone assistance for New York Magazine, my liberal friends attacked me for judging too soon and providing anti-Obamacare fodder to the haters.
But to us, this really is not about politics. Its about our lives. Miles and I support health reform because we believe that, executed correctly, it can liberate people to pursue their highest and best purposes. As recently as a week ago, that was the angle of a piece I pitched to Time.Com, where I regularly contribute.
And then Jan. 3 happened.
We struggled with the healthcare.gov website for months. Every so often, wed return to find Miles application for eligibility stuck in some pending netherworld. The Phone People said to wait a few weeks and try again. Nothing ever happened, except that the site said at varying times the application was in progress or incomplete. I lost count of how many times I re-entered the same information because some Phone Person told me to try that.
The deadline to sign up was Dec. 23, so by Dec. 20 we were frantic. I finally broke down and called the Obamacare navigators in our region, the folks supposedly deputized to guide helpless souls to the finish line. Only two of the five I reached out to even responded, one to say shed be on vacation for the rest of the year (?!?) and the other to say she was booked solid with other desperate customers. I guess we were supposed to know that the website would never, ever work and plan ahead for that.
The second lady did help, though. She suggested we create a whole new account for Miles because the old one, created in the earliest days of the troubled site, might be corrupted and stuck in some digital purgatory. I did that and, gosh darn it, it worked. Well, sort of.
It turned out that Miles, despite planning to be a student and not expecting to have much income, did not qualify for any subsidy. We received a document supposedly explaining why, but it looked like this to us:
We kept asking the Phone People why. They suggested we download it again or log out and log in again or wait an hour and try again or reboot our computers. I was surprised nobody recommended a little club soda.
On Dec. 21, with two days to go, we shrugged off the perplexing notion that the ACA actually does not provide help for people who have low incomes. Maybe we could figure out an appeal or, perhaps, our accountant could figure it out later.
Subsidy or no, Obamacare offered Miles a seemingly terrific deal: $246 a month for health insurance with a $1,650 deductible through the Blue Care Network, a Michigan subsidiary of Blue Cross Blue Shield. This was comforting; Miles COBRA policy from his WJLA job was under BCBS and our coverage at University of Michigan was under Blue Cross Blue Shield of Michigan. His doctor was in the plan, the price was good, the benefits and co-pays seemed adequate. At long last, he had his coverage. Done.
We shouldve known new problems lurked, but it was Christmas and we wanted to be merry. Then, on Dec. 27, I realized the $30 per month dental plan I chose for Miles offered no dentists within a 20-mile radius of our home. When I ventured back into the morass of healthcare.gov to pick another one, the site wouldnt let me. A Phone Person explained that if I changed the dental plan, it would also invalidate Miles medical plan, too, and he wouldnt be able to start any coverage until Feb. 1. I left the dental plan as it was; the Phone Person told me I could come back in January and change it.
The Phone Person lied. They lie a lot. And this would become very important later.
Three days into 2014, Miles took his Obamacare out for its maiden drive. His stop at the doctor went fine. At the pharmacy, it crashed.
His medication which has cost us a co-pay of between $10 and $30 under every other plan hes had since 2004 including one under Blue Cross Blue Shield of Michigan would not be covered. At all.
Thats $438 out of pocket. Every month. And it wont even go against the plan deductible.
In other words, this nifty $246 Obamacare plan would actually cost $686 a month.
Miles put the $438 on a credit card, all the while wondering what someone without a credit card would have done in the face of going without important medication. He, like most Americans, assumed the insurers word, via the pharmacist, was final. Also, it was late on a Friday, a blizzard and epic cold snap bore down on us and he couldnt know when hed be able to go get it again.
The Pollyanna in me was sure this was some mistake. We spent a lovely weekend watching the snow pile up, confident that the matter would be handled in a call or two whenever business resumed after the storm and polar vortex.
Instead, it turned out to be all I did all last week. My work deadlines got pushed back, interviews rescheduled, emails unreturned. Day after day, I found myself on lengthy calls with countless Phone People trying to understand why this very common medication, covered under every plan Miles has ever had, was now about to become a significant monthly expense. Every time I hung up believing I understood something, it would be contradicted by something else in my notes or some lapse in logic. So Id call again, and Id get some other Phone Person who would blindfold me, spin me around a few more times and let me grope for the donkeys tail yet again.
One thing remained consistent: Miles medication was not in the formulary anymore. Id never heard that term, either, but its the document in which insurers state what they will cover and at what level.
From there, the situation made progressively less sense. The Obamacare Phone People offered no information or explanation, only a mild scolding that I should have checked the formulary before I signed Miles up for this plan. They couldnt have been nicer or more useless.
The Blue Care Phone People, however, were aggressively obnoxious and unhelpful. Time and again, they came up with different answers I would later learn to be wrong: that Miles had exceeded his lifetime limit of a component of the medication (creative, but false), that the Affordable Care Act forced the medication off the formulary (mostly false), that the FDA had pulled the medication from use (made up out of thin air), that no insurer was allowed to cover it anymore (big fat lie).
One Blue Care Phone Lady read off a list of other medications for the same condition that the doctor could prescribe, including the same medication in a different form. That was a possibility, but that wasnt what Miles doctor wants him to take.
Much more troubling than the fact that we received so much worthless and conflicting information was that there was nobody to appeal to, nobody to trust.
For days, I attempted to obtain a credible, consistent answer as a normal person. Then, realizing how futile that was, I contacted the public relations offices of both Blue Care Network and the Centers for Medicare and Medicaid Services, the Health and Human Services division administering the Affordable Care Act. I explained I was chronicling this experience because thousands of people must be encountering similar frustrations.
The CMS folks promised to gather the information I requested, and I did get some. I sent one spokeswoman the illegible eligibility document that showed only pages of weird symbols; she opened it on her computer just fine. I sent her screenshots of what I saw, she acknowledged that this was weird and faxed me the actual document. It did explain that Miles didnt qualify for a subsidy because his expected student income was so low that he should apply for Medicaid. That seems like an easy enough, perhaps even reasonable, answer. Why couldnt any of the many Obamacare Phone People have told us that? And is it really possible I was the only one having trouble opening the document properly?
Nobody from Blue Care Network responded to my request for information or an interview.
When the Blue Care Phone People claimed the FDA and/or Obamacare had banned this form of Miles medication, I became skeptical. If that had been so, it wouldve been a gigantic medical news story given the millions who take this medication, but it wasnt. So I logged onto my Aetna account to check if my policy covered it. I learned it was considered generic and would cost not $438 but a whopping $15. Huh. I called Aetna; a Phone Person confirmed this. Their formulary still included the drug. We were more baffled than ever.
Aetna had plans on the federal marketplace as well, so I returned to HealthCare.gov to seek out a different plan for Miles. The site, however, incorrectly surprise! believed Miles hadnt yet enrolled in the plan he was in.
Thus, I found myself back on the line with an Obamcare Phone Person. This time, however, I was told that once someone is enrolled in a plan via the marketplace, they cannot change it until the next open enrollment period in November. The only time to change plans, I learned, was before we paid the first premium.
This was news. In late December, remember, I had asked about changing the dental plan. I had been told then that I couldnt do so without canceling the medical plan as well and postponing coverage to February. All we could do, they said, was cancel our plans. We were stuck.
All of this was passed along to CMSs publicists, who vowed repeatedly to provide answers. They promised, that is, until they changed their minds. On Wednesday, I received some boilerplate information and a note: Unfortunately, nobody is available for an interview. The material they sent was clearly cut-and-pasted off HealthCare.gov an explanation of why we couldnt change our plans and how we should have known that this common medication would not be covered in our plan. There was a line in there about a three-day appeals process when a medication is denied; this was the first time in countless phone calls or emails that anyone even suggested there was such a process. Shouldnt that have been the first thing the Obamacare Phone People said?
It was time to get out of the Obamacare fun house.
Our math had changed. Initially we hoped to get Miles a plan for less than the $421 cost of his COBRA. Now Miles was stuck in an Obamacare plan for $246 plus $438 out of pocket for his medications. Anything less than $690 a month was now a bargain.
Miles hadnt been able to get covered independently in 2013 because of his pre-existing conditions, but the ACA now prohibits that exclusion. And I knew from earlier research that Aetna covers his medication. So I called Aetna. They had an excellent plan for Miles for $335 a month that we could start in February. It was outside the federal exchange and wasnt eligible for any subsidies but, at this point, so what?
Knowing this restored a modicum of confidence in the ACA. Without it, Aetna wouldnt as we learned in 2013 offer Miles any plan at all. So we were grateful, at least, for that.
But I still needed answers, so we held off on signing on with Aetna. Why did Aetna cover the drug but Blue Care didnt? Why didnt Blue Care cover the drug when every other Blue Cross Blue Shield plan Miles had had did? Why were we told we couldnt change the dental plan and still have coverage on Jan. 1? How do we cancel our Obamacare plan?
After CMSs no-comment email, I offered a respectful but pointed reply: Thanks for trying. This system, which I toasted on Jan. 1 and had such high hopes for, is unraveling. I hope you understand that. If you with your access cant obtain actual answers to these very common problems, there is no hope for it.
That actually dislodged something. The next morning, Tony Dawson, a specialist from CMSs Center For Consumer Information and Insurance Oversight division called. He listened to the whole story. His conclusion was startling: He agreed that our best course would be to dump our Obamacare plan and buy the Aetna one.
Dawson was sympathetic and, dare I say, honest. He reiterated that we couldnt change plans in the exchange, but he said he would see about getting special permission to switch dental plans because I had tried before the deadline and had received incorrect information.
He also offered a plausible answer to the mystery of the formulary. Insurers write their own formularies. Neither the FDA nor the Affordable Care Act forced them to remove this medication. It was likely, however, that Blue Care made the change in part during negotiations with CMS regarding what plans would be made available on the exchange.
Dawson said he would find out why the drug had been dropped. I asked how fast he could do so; he said it would take a quick email. I explained I had a Jan. 15 deadline to enroll Miles with Aetna and be covered for February.
The most refreshing part of the conversation with Dawson was his acknowledgement that normal people, buying health insurance, usually dont think to request the formulary to check on whether a common drug is covered. The boilerplate material that had been provided by CMS suggested the formulary had been easily accessible when we were browsing for plans, but I went back and saw that it actually is still not available on HealthCare.gov. (In mid-December, Forbes writer Scott Gottlieb wrote that the formularies were usually not available as people chose their plans, and he warned people with certain chronic conditions in need of expensive medication might face sticker shock at the pharmacy.)
Anyhow, Dawson promised to get back to me, and he did. He called Monday to confirm this form of the medicine wasnt covered and our best choice was, in fact, to dump our plan.
On Jan. 10, I signed Miles up for the Aetna plan and called Blue Care to cancel. A Phone Person said they cant do it, that policies created through the exchange had to be canceled through the exchange.
I called the Obamacare line. This Phone Person apologized at the outset because the system is down, so he wouldnt be able to access Miles account. Nonetheless, how could he help me?
We want to cancel this policy, I told him.
Oh, we cant do that, he said.
I cant cancel policies, he said. I suggest you call the insurance company. Theyre the only ones who can do it.
But they just told me to call you.
Im sorry, thats not something we can do here.
I know its rude, but I just hung up without saying goodbye. It was all I could do to avoid saying something cruel and regrettable to a poor soul who may or may not be right.
I figured if Dawson ever called me back, maybe he could straighten this out. Otherwise, Blue Care will drop us sooner or later when they realize were not giving them our money anymore.
Some may boil our misadventures down to its core, a bratty dirge by privileged whiners who dont even need Obamacare and are sore they couldnt get their medication covered. But thats just it we, too, need and want more affordable health care. We are precisely the kind of folks they need to make these exchanges work. If its all poor, very sick people, Obama can kiss his legacy goodbye.
Whats more, we have the time and initiative to dig for answers. As journalists, we could tap on the shoulders of people who ought to know, but that failed, too. Even with the looming prospect of being subject to this sort of publicity, nobody could give us complete, prompt or useful information. How are people who dont badger public figures for a living, people who have no other option than to contend with Phone People, supposed to work it out?
But this isnt merely a failure of government though it is that. Its also a failure of the private sector in the form of the insurance industry. Theyve received an unbelievable gift, a government-backed money-minting machine on an epic scale. Nobody really likes them, either. This is their chance, too. And their Phone People are no better despite being significantly more experienced. Their media spokespeople were even less responsive than the governments, and thats a pretty low bar.
Come November, well check back and see what Obamacare plans are available for 2015. We want the ACA to work; the previous status quo certainly did not.
Right now, though, its time to move on. Its easy to shrug that these are the expected growing pains of a massive new system. Thats probably true. But in real time, it is destructive to our finances and potentially bad for our health.
The president promised a system that would make obtaining insurance as easy as buying a book on Amazon.com. Instead, he gave us so far, anyhow one thats about as easy as getting the NSA to stop listening to our phone calls.
I reported this problem on FR yesterday. The ONLY way to stop the other plan from auto-deducting from your account it to move your account to a different and unrelated bank.
Steve’s “husband” Miles.
Couldn’t read any further, queers disgust me.
OOPPPSSS at the 1:10 mark
The Leftist media is loaded with homosexuals.
“Wed worried the GOP would succeed in defunding it or undermining it in some other way that would put affordable coverage further out of our reach.”
1. It’s scary to think people actually believe that.
2. I stopped reading after the first 20 sentances but something tells me this woman never gave the GOP any credit for trying to warn her and stop this mess. All she does is lament her and her husband’s current situation.
Have another glass of champagne dumbass, we tried to warn ya but noooooooooooooooooooo the evil Republicans............................You deserve what’s happening to you.
” My husband, Miles”
So Steve is the wife?
There is good information in this saga.
If nothing else, you can see how any numbers put out by the government must be lies.
The author's name is Steve and he's talking about his "husband", not her husband.
If your intention is to turn off readers STOP!
The information in this article applies to everyone.
One thing remained consistent: Miles medication was not in the formulary anymore. Id never heard that term, either, but its the document in which insurers state what they will cover and at what level.
The part of the article I found most odd was how the wife had to do all the insurance calls and dickering for the husband. I have to wonder why he can’t actually take care of himself. What a batch of pathetic whiners. They wanted something for nothing, and merely got nothing for something as one should expect with such a desire.
Of course the article still ends with their fervent belief in unicorns and pixie dust solutions intact. What utter morons.
Oh, and it’s the insurance companies’ fault.
1. Decoding the text indicates that one of these two has HIV, probably caused by their life style and celebrated by this Administration which scolds for a wide variety of other unhealthy behavior so the additional cost of medications is likely self inflicted. 2. I wonder if Tony Dawson is now unemployed for giving a straight answer to dump the ACA for a private plan.
Gee, the poor little fags are upset because the joint cost of drugs and medical insurance is going to cost him 600 a month. That is what I pay for my individual group plan which my employer pays 40% of the cost. These jerks are blissfully ignorant of what their former employer was paying on their behalf. Worse, they have the temerity to believe that it is the government’s (taxpayers) responsibility to pay for their healthcare so they can pursue their life’s dreams. Sorry sucker, go to work and get your healthcare on your dime, not mine.
How does Steve have the ability to sign Miles up for anything? He is 41 and wants to return to college to get a new career, so he has been on a two year fellowship. These are the Americans who exhibit exceptionalism that the rest of the world hates. And they are whiners. They better get signed up for the Titanic cruise, because the rest have to do so.
Obamacare is dead to me and has been ever since Obama started pushing it. I’ve never been to healthcare.gov and don’t intend to go there. As for my wife and I, bot 60, we’ve just accepted that the US is in a form of “post russian revolution” hell hole and figure we won’t have insurance for the rest of our lives. Ours ended at the end of the year.
This is one of the ways we are going galt and invoking Revelation 18:4.
We will also no longer vote in federal elections. The federal government is also dead to us, though we will continue to file a tax return.
I’m too familiar with this nations history to just lie down like a good lemming and do what the fascists say. It’s why the scariest scene in any movie for me is the first ten minutes of Inglorious Basterds. Eventually they will come, no matter how “small” you are.
It’s husband and husband. I read the entire thing. Nothing new - Obamacare is a giant failure. We told them so.
This is confusing...so it’s husband and husband? Right? Or is there some newly invented terminology for this situation?
Meanwhile, back on the insurance topic...what shocking new development is this? Basically....the 2,000 page law didn’t think to see all the various ways that we utilize health insurance today....in various forms developed by the industry to fit the needs of people. And the government.....knew nothing of the arrangement or the mechanisms already in place? Am I missing anything on this?
A notice to anyone who researches WW II and the initial months of the war. Roosevelt basically “let go” (best wording for it)....all of the players who ran his economy and industry plan since 1933. Virtually all of them had to disappear....to let the real business enterprise in the front door, and allow America to flourish in a way that Roosevelt and his staff could not imagine or allow. It says a lot about the current mess, and why nothing seems to work.
Sorry about that, I was so wrapped up in people thinking the GOP is evil I didnt notice they were gay.
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