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Uncovered California
I've shared my gripes about Covered California before, such as here and here. I've got more to add.
I'm self-employed, so I get insurance through the so-called Covered California system of health insurance. California is one of the many states that decided, in its infinite wisdom, to not hang off the federal government's healthcare.gov site, but instead spend $100 million of its own to re-invent the wheel.
So instead of one wholly integrated federal health care system, we have something like 30 disparate systems, all of them expensive, and none of them perfect. Indeed, "not perfect" is an absurd understatement, roughly equal to Oprah being "not petite." Allow me to offer my own personal example.
When I initially signed up for the service in December, I decided to be cheap and buy the Bronze level of service, since my medical needs are approximately zero. The signup went decently well (although it was clear the web site was sorta kinda broken), and I was on my way. Healthnet was the private insurance carrier that provided my lame-ass Bronze coverage, and that was that.
A couple of weeks later, I decided Bronze was a pretty pathetic level, and that Silver would be a more appropriate product for me. Now, in a just and sane universe, I would have signed on to the web site, clicked the Upgrade button, agreed to the higher premium, and we would all go on with our lives. Ho ho ho! Nope. Not even close.
I debated whether or not to share with you all I went through to execute this ostensibly simple procedure, but honestly, even with the most riveting writing, I would lose all of you along the way. There were many steps, many phone conversations, and many dozens of hours expended on this ridiculous act. There were false starts, dead ends, and wrong turns. If there is a Hell, they surely will model it on my experience upgrading from Bronze to Silver.
But that was weeks ago. I'm not going to go back down that path, because, at long last, I finally got the upgrade done, and I was on my way. So what am I griping about now?
It's good that you ask, because I just happen to be typing right now, and I'd be glad to respond.
On Friday, my doctor's office contacted me to tell me they weren't getting paid, because my insurance had been cancelled. Umm..........what? Given what screw-ups both Covered California and Healthnet are, I wasn't shocked, but after spending so much time and energy finally getting upgraded, it made me sick to think I'd have to venture back into The Land That Competency Forgot to deal with this.
But, sure enough, I logged onto Healthnet and was greeting with the following:
For my convenience. For. My. Convenience. You douchenozzles! The last thing you care about in the world is my convenience!
So then I called them, and I felt kind of honored, in a way, because as luck would have it, I managed to reach the winner of the World's Most Dim-Witted Person contest to help me. What a treat! So after speaking with her at great length (because, let's face it, my time has no value), it was determined that..........my premiums were promptly paid, yes. I hadn't done anything wrong, yes. But, according to Ms. Dim, Covered California had cancelled the policy on April 3 for no reason, and that Covered California was in the process of fixing this, and it would be all just dandy in a week or ten days.
See, the beauty of the State and a Private Company partnering like this is they can always blame
one another. There's nothing easier than extending one's index finger Over There to indicate whose fault it is. I've noticed they do this a lot. And so they did it a again.
Although I could have just left it at that, I'm not naive enough to think that everything was going to work itself out, so I called Covered California (which is akin to the proverbial jumping out of the frying pan and into the fire, because let's remember, at least Healthnet is a private company). So, after a lot of waiting, I reached a human at CoveredCA and told her the situation.'
She carefully examined my records and said, nope, they didn't cancel me, and there was nothing untoward about my account at all. She had no idea what Healthnet was talking about.
Well, OK, fine. But while I had her on the phone, I explained to her that I'd like to be able to log in to my own CoveredCA account from time to time, and my username and password weren't working.
She explained to me that the username/password I had wouldn't work, but that I should create a new account, just like I did the first time, and enter a special Case Number when prompted in order to "link" to my information. OK, fine. So she told me the access code, letter by letting, emphasizing which letters were uppercase and which were lowercase. I carefully repeated it back to make sure I had it right, because getting a human on the phone is time-consuming enough.
Later on, I went to the web site, and I dutifully started to create a new account. I saw the field she mentioned, which gave me a sense of relief, because that's where I was supposed to enter my code:
I carefully entered the code and clicked the Submit button. It waited a moment, and then up came a dialog box saying that the code wasn't valid. Although I knew I entered the code carefully, I tried once again, this time, triple-checking each letter. I clicked Submit. Same deal. I tried a third time. No change.
Thus, I called them yet again. After a long while, I got another human, and I explained the situation. She said to me, and I'm not making this up: "Oh, yes, that's the correct Access Code. But those don't actually work."
It soon became evident that the entire Access Code schtick was just a sorry waste of time. It didn't work at all. And when I expressed astonishment that their $100 million site had this error, she laughed, "Oh, that's nothing! That's one of the small problems! You wouldn't believe how many glitches there are."
NEWS FLASH: I had thrown out the figure "$100 million" a couple of times, I realize. This was just a dumb guess. I took the time to actually find out what it cost, and I'm sorry I didn't do better research for my readers. Turns out the costs were $489 million. Sorry 'bout dat.
In any case, I am a healthy, relatively young person, and the preceding has been a taste of my experience. I can't imagine what someone with real health needs would go through. But I'll close by saying this: I realize I piss and moan and bitch about people who work for Goldman Sachs, or JP Morgan, or wherever else. But you know what...........they're supposed to make lots of money, and it just so happens they're very good at it. Getting hired at a place like Goldman Sachs is a very big deal, and although these people are no saints............they are good at what they do. They have to be, because private enterprise doesn't tolerate otherwise.
When you're dealing with state bureaucrats, however, it's an entirely different universe. You are dealing with some of the dumbest folks on the planet, fiercely protected by entrenched unions, and utterly devoid of incentive to do anything but punch a clock and get through their day.
The old saw, cited for years to avoid national health, about government-based health care having "the efficiency of the post office and the sensitivity of the IRS" was far too optimistic. I'm here to tell you.............it sucks out loud. So, for your own sake, don't ever get sick.
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The Health care system is broken...and has been broken long before the ACA came along. Four problems MUST be fixed before things will get better.
1. End of life costs are THE MOST SIGNIFICANT part of most people's healthcare costs. On average, we spend more money in the last several years of life, than we do in aggregate before then....(yes, there are exceptions, and yes maternity costs are not included).... Heroic medical makes news, sounds great, and COSTS A TON. Until we get our minds wrapped around the idea that at some point we're gonna die, and when we get to that point we will be faced with imperfect decisions, we will continue to thrash around and spend tons of money for no good outcome.
2. The masses have to stop thinking about Health Insurance as a "one small fee pays all". Insurance is there to protect from LARGE unrecoverable expenses...not pay for every doctor visit.
3. Effective methods of containing out-of-control price escalations have to be implemented. The current system fights all moderate cost alternatives. Not every healthcare visit requires a top notch specialist...or tons of expensive tests...or for that matter even a doctor, but the system is constructed to channel people down the most expensive routes.
4. Big Pharma needs to be corraled. Prescription costs are out of control.....(and NO these idiots do not spend all their money getting drugs approved).
Hoo boy! NOW IT'S CLEAR: we need MOAR IMMIGS amnestied and made See-tee-zens to pay for this mess.
https://eradica.wordpress.com/
Yep.
Boots on the ground observation of obamascare:
1. Windfall profits for hospital conglomerates: they have bought up doctor practices and now make you come to the hospital for all your care. Most of the small percent of doctors who are good doctors that were suckered into this are starting to figure this out because they are now hospital employees and the good docs leave. If the doc doesn't get up and go, the hospital after two years, cut em loose and hire "midlevel providers" so that iff you go to an urgernt care, ER or admitted to a hospital, the odds are you are seen by a PA or ARNP. Why? Because they are cheaper!!! Now if you think an evaluation by a midlevel provider is equivalent to a board certified physician, then you probably think Burger King is as good as Ruth Chris. When these bureaucratic behemoths lay people off, it tends to hit those that actually see and touch patients and rarely the bureaucrats running around pushing papers, attending meetings and eating donuts with their coffee. Also, Check out the salaries of their CEOs!!!
2. Windfall profits for insurance companies: They have jacked up monthly premiums, they have jacked up deductibles up to $12K and have tightened the screws on what they cover which will be exponentially worse when ICD-10 implements. Now if you have a large deductible and your "provider" in an integrated health system hospital orders an MRI, you go to the hospital, get an MRI and you get billed $3-4K vs. $1K if you have the MRI at an independent, free standing, nonhospital affilated office. Same for minor procedures done at the hospital vs. a surgery center or office. Hospital gets to legally charge you any where from 4-10x more than what a surgery center or office charges. Also, check out the salaries of insurance company CEOs and officers.... that would pay for a lot of health services for patients.
3. Windfall profits for bureaucrats: The exponential growth of bureaucracy at federal and state levels with this Affordable Care Act as well as insurance companies, hospital integrated health systems and corporate practices of medicines costs huge amounts of money!!! This is money that is siphoned off the top to pay bureaucrats and their infrastructure and their health insurance, sick days, vacation and retirements much of which is better than the average tax paying serf and peasant..... this is money siphoned away from providing health care services to patients.
4. Windfall profits for impersonal care: The days where the doctor knows who you are and actually cares what happens to you are now history. You are now a number, get plugged into a cookbook style practice of health care delivery and the odds are every time you interact with the system you will likely see a different "provider". The concept of everyone is an individiual and is different is truly lost on these bureaucracies and a one size fits all approach is being implemented.
Regardless of all the problems of the previous health care system, most patients received the right care at the right time.... now it is line up and wait, one size fits all, and good luck..... obamascare, ya gotta love it and if you voted for the idiots who made this happen, how do ya like it now?????
I'm a former American medical practitioner. The worst thing about current US health policy is that they no longer tell doctors in advance which planes are going to crash.
Peeved.
We also need incentive for the best and brightest to become family doctors. In my area, we are importing 3rd world doctors to fill our medical needs. Soley due to the fact that Medicaid and Medicare pay less than $.40 on the dollar for services, and 53% of the puplic prior to ACA was on Medicare or Medicaid(in my area). Who wants to spend 8 years in school, and $500,000 in student loan debt to get paid half of what you are worth?
Yes it's been broken for a long time, it started in 1965 with Medicare and gov't fixing prices in a "freee" economy
Moral of this story : Everything klepto.gov touches turns to shit !
oh man.........I'm an independent health insurance broker in state that elected to go with the Federally Facilitated Marketplace. I enrolled close to 1,000 customers on the FFM between November and April. I can tell you that in many cases, to enroll the customer properly, it took multiple accounts and applications on the FFM. When the gov't throws out 7.5 million people signed up for coverage, I'm convinced that a large share of those are duplicate or triplicate applications due to enrolling multiple times to overcome glitches in their website, which were MANY. The enrollment process was so complicated, that our local "navigators" and "certified marketplace consultants" started sending people to ME because they couldn't figure it out.
I do happen to live in one of the poorest counties in my state, so the subsidy numbers may be abnormal; 9 out of 10 people that enrolled in my county recieved a subsidy of at least 50%. Which means if you have a family of 4, and your premium is $1,200/month, the gov't is sending a $600/month check to the insurance company, and you are billed for $600. I can count on one hand the number of people that DID NOT receive a subsidy. I can't see how this law continues to work without MOAR taxes.
The reason I chose to work with the BEAST, is because of O-care forcing two of the insurance companies I sell for to cancel their individual plans that did not meet minimum essential benefits. The reason they didn't meet essential benefits is the plans did not cover maternity. Many of my customers are single male loggers, truck drivers, and farmers. Not much chance their gonna get knocked up. I lost close to 1,500 customers on January 1st due to these plans cancelling, and many of those self employed folks ended up on MEDICAID because they have enough depreciation and write-offs to fall below 100% of the Federal Poverty Level..........CASH is king.
The good news is if you have cash, you can now get some serious discounts on goods and services. Yea black market economics!!!
Thanks Tim.
Stay healthy. It's our only hope.
there is an alternative. Holistic care... learn about what makes a body healthy, and pursue. Don't believe any shit the medical mainstream tells you, most of it is garbage. the medical system we have in place today encourages ignorance and sickness. it makes things worse, not better. the best thing you can do, is walk away.
I walked away from the medical system years ago, and would only go back if i had some sort of traumatic injury that needed emergency care. for everything else, there are better ways. yeah, work involved... but it is your body. why would you delegate caring for your body to this medical system? it is owned by the same monsters who own the financial system, and they are not looking out for your best interests.
I'm on Medicare now. Basically a shining model of simplicity and efficiency compared to all this BS, but the Medical Industrial Complex can't and won't leave it be.
Congress keeps passing laws to make Medicare "more competitive". Recently I had a health episode that could easily have been life threatening. I went to the ER of a regional (non-profit) hospital, where they did the only responsible thing. They gave me a number of standard tests and kept me overnight to see if my condition would self-correct. Anything else would have been unconscionable.
Later I received a form notice that a private firm hired to audit the hospital's Medicare submissions had denied them payment on some technical ground. Some rule that they were supposed to send me home. Payment to the hospital for admission, tests and services was denied.
Luckily the hospital never went after me for that. But I can imagine how this private oversight system works. A relative of mine who pursued his life's dream, went back to school and became an MD, a specialist in a group practice. He confided to me that he no longer enjoyed being a doctor. The reason: hours every day spent on the phone arguing with clerks about what the insurance companies would allow him to do. Clerks who had been trained in how to pronounce the words they were using and their formal definitions and how to look codes up in a book, but had no Idea what it all really meant.
Next step, computer programs to replace those clerks. Let the doctors argue with a computer! I'm sure that's already happening!
That's the kind of efficiency our Congress is extending to Medicare. New costs for the service providers. Distortion of medical decision-making.
Accomplishing what? New profit centers certainly. Savings from denial of medically indicated services. And perhaps discrediting the idea of Single Payer, Medicare for All.
Is Medicare folded into the new California System yet? Bet that's coming!
Why would you buy health insurance from the government? Are you just really, really stupid? Oh, wait, you want to follow the "law". O.K. kids, here's a news flash, stop following the law.
I suffered no problem with heathcare coverage whatsoever. I didn't join. See how easy that was (and it would have been free for me, completely subsidized by those of you who are so determined to pay). However, I don't run to doctor all the time, I self medicate and diagnose, eat well, exercise, etc and if something big happens- plan to take a vacation in India.
If you self regulate your IRS contributions, you can keep your payments equal to your taxes (if you have to pay those) and then there is zero fine to pay. Wait, they take it out for me! You can stop that. Go to:www.state-citizen.org for details. That type of collection is voluntary.
The only cure for socialized medicine is if people refuse to participate, oh and that goes for war, voting, taxes, law enforcement, courts, fed reserve notes and government.
The idea behind barrycare is not to provide health services for people but to collect data on them. And I agree wholeheartedly with you. This beast is not going to walk itself back, so the only way to slay it is to refuse to participate. Don't forget to add government school to the list. And that includes 99% of all colleges and universities!
California cant even manage its water well enought to produce food so healthcare is way too complicated for the folks working in the system out there. Think about the california surfer dude on food stamps as your agent.
http://www.bizpacreview.com/2013/08/10/california-scheming-surfer-dude-l...
The typical pelosi voter in San Francisco thinks dams are evil, and gets pretty much all of their water, without which there would quickly be no veneer of civilisation there, from behind a big fuck off huge hydro power dam up near Yosemite. Their electricity supply for their electric cars and tasteful appliances comes from there, a little, and from out of state coal burning plants quite a lot more.
Good article, Tim. That's the way I've heard it explained on the tube.....sounds Catch 22ey to me, and surely created broken. If we could only contrain this giant government of ours. It is breaking our backs.
"So, for your own sake, don't ever get sick."
but if you do:
http://www.apollohospitals.com/international_patient_services/
Long offshore health care.
All your digital health are belong to India.
Your time has been monetized straight in to the corporate pockets by those you put on a pedestal, Goldman Suchs, who do nothing "well" except monetize justice and corruption you're bitching blindly about.
Ironically Tim complains about price, while plugging fraud and bailouts for failure of "bank holding companies" rolling more joints of failure -- which is the price. Nice try though.
Obviously, when your on your knees performing fellatio on Goldman Suchs its unfathomable to consider the entire rotten thing is designed to collapse - dont forget your share of the bailout, and swallow.
Your blind empathy for GS means I no longer pursue Tim Knight postings, certainly no competency found at slope of dope.
Your expectations were far too high.
Limit them, or rid your mind of them altogether, and embrace the chaos.
To the tune of "Another One Bites The Dust".
http://sanfrancisco.cbslocal.com/2014/04/21/insurer-admits-nearly-1000-d...
Huffpost had an article about how doctors and the hospitals they work at are NEVER on the same Obamacare policy. If you need surgery, you'll have to pick the hospital or doctor to pay out of pocket, on top of$6K in premiums and a $6K deductable.
And, as predicted, a diagnosis of cancer with Obamacare is a death sentence. Yea, you're insured, but the chemo drugs aren't part of the formulary. You have to pay for those yourself.
Thank every company that circumvents its way from it, they're the ones that made the choice.