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My Obamacare experience

Posted: May 12, 2014 2:00 a.m.
Updated: May 12, 2014 2:00 a.m.

I read Gary Horton’s April 30 column on his experience with the Affordable Care Act (“American Medicine has become a joke”) and decided to share a story.

My most recent experience is trying to understand exactly what kind of plan I have and who will take it. Since my previous plan did not meet the criteria of the ACA, my husband and I had to chose another one.

After much research, we chose Blue Shield PPO Preferred. Both my husband and I are independent contractors, so we pay our own insurance premiums. The monthly total is as much as our mortgage.

I spent a lot of time trying to decide which plan covers our current doctors. All of them said they take Blue Shield PPO.

What everyone failed to mention, and I don’t think they understood it at the time, is that an individual plan is treated differently than an employer’s plan — although I’m assuming our per-person premium is probably higher.

Even our insurance agent said if we buy the policy as an independent, rather than through Covered CA, we will have more in-network doctors.

When I recently searched the Blue Shield website, all the doctors were listed as providers. It wasn’t until I received my insurance card and plugged in my ID number that most every name dropped off.

They were considered “out of network.” Some doctors will tell you, “Yes, we take Blue Shield PPO” but fail to mention they will charge out-of-network pricing.

Two weeks ago I had a surgery scheduled at a prominent hospital and reminded them my insurance changed April 1. No problem, as they took Blue Shield PPO.

The afternoon before my surgery, I received a call that they were actually “out of network.”

After a number of phone calls to understand what happened, I canceled the surgery. The out-of-pocket cost would run well over $20K for an outpatient procedure.

There is no such plan as a Blue Cross PPO plan for Los Angeles and Orange counties on independent coverage.
I am now back to square one in trying to understand what will happen next.

Our insurance agent checked into the Blue Cross EPO Plan, as the hospital took this insurance. Only one doctor was listed, and a call to his office confirmed he did not take Blue Cross EPO.

The agent spoke to customer service at Blue Cross and was told that some of the listings are incorrect. So it is a challenge to understand who is in network and who isn’t.

Last week we received a letter from Covered CA thanking us for joining — even though we purchased our insurance through an independent agent.

The letter said Covered CA is required to send a voter registration application to all participants. 

That seems very strange to me so I contacted our agent. He had not heard about it until I sent him an email with the letter attached.

I just hope this all gets straightened out soon. Both my husband and I have always had good insurance coverage, but these recent changes leave me feeling very uncomfortable. 

I no longer have the same coverage, and never will as long as we are self-employed.

Penalizing entrepreneurs in order to provide insurance coverage for the masses doesn’t seem right.

Valerie Tippy is a Santa Clarita resident.


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