Over the past several months, I have read a lot of comments, opinions and articles about The Affordable Care Act, also known as, Obama Care. Many of the aforementioned publications promulgate false information and or partial factual information about the same. It is my intent through writing this publication to educate the public by publishing my own personal experiences, about how Obama Care has affected my medical care.
My experiences with Obama Care started when I signed my wife and I up with Blue Cross insurance in November of 2014, through the Health Care Marketplace. At that time, I was recently laid off and did not have any insurance.
I could write for days about how difficult it was to use the Health Care Marketplace website, but for the sake of brevity, I will simply state that I have never used a more screwed up website than the website people must use to sign up for Obama Care.
In choosing my insurance, I chose a family plan with Blue Cross. My first shock with Obama Care was the cost of my insurance with Blue Cross in comparison to having what I thought was similar coverage with them through my former employer.
Through my former employer, I paid $295.00 per month to Blue Cross for medical coverage for my wife and I. For the most part, we could see whatever doctor we chose but were given better benefits if we used doctors within their network. Our out of pocket deductible we had to meet to receive full benefits, were approximately $3,200.00
With Obama Care, I was charged $490.00 a month for my wife and I, which was our contribution to our new insurance premiums with Blue Cross. Additionally, by giving up our tax credit at the end of the year, the government paid just a hair under $1,600.00 per year towards our new insurance premiums owed to Blue Cross for my wife and I.
If you do the arithmetic concerning the aforementioned payments, the sum of our new insurance annual premiums, was approximately $7,400.00 annually. Considering that we were only paying $3,540.00 a year through my former employer to the same insurance company, in 2015 Obama Care was costing my wife and I, $3,840.00 a year more than we paid in 2013. Affordable Care Act?
I have to take the blame for not reading my new insurance policies fine print because when I first signed up for the new insurance, I basically thought that I was being provided the same coverage I enjoyed previously with Blue Cross, with the exception of paying a little higher out of the pocket expenses and copay’s for doctor visits and my prescriptions. I was definitely misinformed!
In January of 2015, I fractured my left knee in two different places, while bowling at a local bowling alley. I immediately went to the hospital because it was a weekend and my doctor was out of town.
My first experience with my new insurance came when I was discharged from the emergency room with a $500.00 copay that previously would of cost me $200.00 Unfortunately, the outrageous copay I was charged was just the start of a long nightmare that frankly I would have a hard time believing if I had not gone through it myself.
The following Monday, in a boat load of pain and with a referral from the hospital, I called and made an appointment with my primary care physician. A week later, I went to see him and was politely told that he did not accept my new insurance. Though I repeatedly asked him why my new insurance with the same provider I had been using for years to pay him was no longer acceptable to him, I was never given an answer.
When I got home I called Blue Cross of Texas, and spent well over 6 hours on hold waiting on agents from various departments, before I was able to speak with an agent who told me that I needed to go on their website and select a new primary care physician in my area. Seems simple enough, does it not?
Surfing the Blue Cross website, I was given a choice of about forty doctors who allegedly accepted my new insurance; included in said list, was my own primary care physician. It did not take me long to find out from my previous experience with my own doctor and from calling every doctors office on the list of providers in my area, that only two of the doctors on the list, actually would accept my new insurance.
Signed up with a new quack…I mean doctor…..no I mean quack, the next day I called my new quacks office to make an appointment to see her. Still in a boat load of pain, I was told that the first available appointment with her office would be late in February of 2015.
Approximately 6 weeks after I made my appointment and after having been forced to go without medical care for my infirmity for over two months at that point in time, I was finally able to be seen by a doctor. The quack spent about five minutes examining me and diagnosed me with arthritis in my knee and basically told me to take some Tylenol as needed for pain and to follow up with her in a month.
It took every bit of self-control I had not to hit her so hard in the mouth that her teeth would come out the back of her head. However, I chose to call the other doctor I found on the list and made an appointment to see him. Five weeks later I was sitting in his office.
My new primary quack, though he could not speak very good English, took pity on me and referred me to see an orthopedic doctor. He prescribed me about a weeks worth of Vicodin and told me that his office would call me in a few days to tell me who my appointment would be with for my referral to an orthopedic specialist.
After waiting about a week, I called his office and was told by the nurse that Blue Cross had to approve his request for me to see an orthopedic specialist and that they would call me when they got approval, allegedly in less than 2 weeks.
Over the next two months, I gained a lot of weight because I could not walk. I was laid up in bed and in pain beyond explanation. After gaining about 100 pounds, I found that with about 25-30 maximum strength Aleve’s, I could at least limp around the house.
Around the third week of April, I received a call from my primary quack, informing me that I had an appointment the first week of May with an orthopedic specialist. My primary quack’s nurse had no explanation on why it took so long to get the approval from Blue Cross, but after calling them three to four times a week over the past two months, what else could I say to them?
In the first week of May of 2015, I went to my appointment with an orthopedic specialist. I was full of hope as I had read many good things on the internet about the doctor I was suppose to be treated by. Can you guess what happened when I got there? If you guessed that his office did not accept my new insurance, you are absolutely correct.
When I got home, I immediately called my primary quack’s office and explained the situation to them. About two weeks later, I received another call from them informing me that they found a doctor that would accept my insurance and that they had made an appointment for me to see him around the second week of June 2015.
At that time of my ordeal, I was having colossal problems with my blood pressure and kidneys from daily overdosing on Aleve gel caps, but what could I do. I had to be able to walk to be able to go on job interviews and get some exorcise. Stupid me did not realize by compensating for my pain by putting most of the pressure on my other leg and ankle, I managed to tear my Achilles tendon.
Around about the second week of June, a sub par orthopedic specialist examined me. He took some x-rays of my knee and immediately referred me to have an MRI done on my knee. For the sake of brevity, I will only say due to Blue Cross having to approve the MRI and finding a place that would accept my insurance to do it, I had my MRI done around the end of July 2015, with a copay of only $690.00 to have it done.
About three days after my MRI was done, my orthopedic doctor called me and asked me frantically if I come to his office that afternoon. He went on to advise me that if I had any crutches around the house, I should immediately start using them because I had no business walking without them.
When I got to this office, he showed me the MRI of my knee, while repeatedly telling me that it was a miracle that I had previously walked in and out of his office without crutches or a wheel chair. I have two fractures in my knee with over a ¼ inch separation in them.
My doctor prescribed more Vicodin for me and told me that I would need surgery to correct the fractures in my knee. He told me that he would get me in as soon as he could but he would need to get permission from Blue Cross to do the surgery. Again for the sake of brevity, I received a call about three months later informing me that I was scheduled for surgery around the third week of October of 2015.
I was so happy when my surgery day arrived. I went to the hospital a little nervous, as it would have been the first time I had ever been hospitalized, but after enduring the pain I had gone through for over 11 months, I was ready to have it done. Can you guess what happened next.
I cannot begin to tell you how shocked I was when I got to the hospital and was told that my doctor could not come to perform the surgery because he no longer accepted my insurance. To compound the issue, the hospital could not provide me a surgeon to perform the operation, so therefore I would have to find a new orthopedic surgeon.
Again for the sake of brevity, I will not rehash all the same crap I had to go through and the time involved in doing so, to get an appointment with my primary quack, a new referral and approval to see another orthopedic specialist and being sent again for a new MRI requested by the new orthopedic doctor.
About the second week of December 2015, I had an appointment to have another MRI done on my knee. Three days prior to my appointment, I received a call from the place that was suppose to perform the MRI, informing me that I would need to pay them a copay of $2,800.00 prior to having the MRI done.
It is now February of 2016. I have been unemployed for over a year. I have gone on three job interviews and was politely told that when I can walk correctly again, to give them a call. I am financially ruined and I could not buy my wife a box of tampons on credit. Everyday, I wake up and go to bed in extreme pain. I spend the day on my computer applying for jobs that I am not physically capable of doing, even if I was hired to do so. My friends and family tell me to keep my head up as my situation could not possibly get any worse. They were wrong!
In March of this year, my new coverage with Blue Cross, if you could call it coverage, will start. My part of the monthly premiums are now over $800.00 and my out of pocket deductible, before they will pay for anything, including prescriptions, is $10,800.00 Due to my weight, I now require blood pressure medicine that will cost me over $200.00 a month. The surgery I need, will require I come up with $10,800.00 before I can be admitted to the hospital for the same. To see my primary quack and or orthopedic doctor, after March 1, 2016, will cost me a minimum of $200.00 a visit.
Considering I am broke, selling my precious possessions to keep a roof over my wife and my head and to feed us, the probability of me ever walking right again and spending a pain free day, is about the same as me winning the Powerball lottery.
Because this has been lengthy, I will not bore you with the insane reasons I cannot obtain Medicare and or disability from the government, so I will finish this long diatribe with some words I hope President Obama will read one day.
Mr. Obama, I hope one day that you and your family actually have to rely on Obama Care to take care of any infirmities you or your family may succumb too. The Affordable Care Act? Are your fricken insane?