Why Obamcare gets an “F” from this Single Mom

Watching Covered California Unfold

Like most American citizens, I watched intently as Mr. Obama and the Washington politicians battled over this groundbreaking Health Care Reform legislation. All the time wondering, once the groundswell of argument settles, how this Affordable Care Act, or as it has been newly termed, the Astronomical Cost Act, would really work for American citizens? What will be the REAL fallout those of us who are not (thankfully) indigent, but work hard everyday in our independent businesses to earn a living and support our children? What will be the run-off, missteps, not considered results of this ill conceived, unprepared, and not ready for the nation program?

Somewhere in the lack of organized, thoughtful, and THOUGHT-THROUGH implementation of Covered California and Obamacare, I fell through the cracks of confusion and unclear communication. What will happen to the other 10 million plus single moms, as well as other small business entrepreneurs like me? Sixty-percent of those businesses in the US are currently home-based businesses and 7 out of 10 of them are run by women.

Covered California in the Real World

As a self-employed, working single mother of two daughters, I don’t work for a company who subsidizes my health insurance and I am not eligible for federal subsidies. I have had to support the healthcare costs, for my children and myself, over the past 10 years. And I have faithfully done so all by myself. I continue to believe health insurance is a vital expense, despite the fact that the rate on my personal family policy skyrocketed $300.00 a month with the advent of Covered California and Obamacare on January 1, 2014. Nevertheless, when I received my new insurance card from my carrier, on January 1, it retained at the bottom those 3 comforting letters for me, PPO. I felt assured that the level of care I thought was important for my family, would remain intact. I believed the extra expense was worth the cost. Thankfully, my family is healthy.

Covered California’s Affects on this Family

Unfortunately for me, I became one of the initial victims of an Obamacare perfect storm. I got to experience, first-hand, how Covered California and Obamacare, functions at its worst.

The unthinkable happened… on January 19, 2014, while I was out of state on a business trip, I tripped and fell injuring my thumb. The following morning, after my return to California, my regular physician was able to get me an appointment with the top local hand specialist. I immediately went to his office. After a thorough review and x-rays, this specialist determined that I’d severed the ligament in my right hand. I needed surgery right away.

I was sent to his business office. In standard office procedure I handed my PPO insurance policy card to a staff member, who then called the insurance company to ensure that all elements of my procedure would be covered under my policy. While on the phone both parties determined that the physicians preferred surgery center was not covered under my policy. Another facility that is in the plan’s network was suggested and agreed to.

The anesthesiologist, who was at one time covered under the policy indicated by insurance card, was no longer in-network as advised by the insurance carrier. Yet, neither the insurance company, nor the doctor’s office, offered an alternate in-network option. Instead, I was told that expense would have to come out of my pocket.

The most egregious and confusing aspect in this whole process was that neither the insurance carrier, nor the physician’s office confirmed that the hand surgeon was still in-network. The doctor’s office assumed, based on my insurance card, that I was covered and the insurance carrier, albeit fully aware of my pending operation, never questioned, checked or confirmed the physician’s network status.

I confidently moved forward on January 23, 2014, with this physician and the surgery, knowing all the right steps had been taken to secure my good health care under my insurance policy.

On February 12, 2014, I returned to my physician’s office to get a new splint for my thumb. It was then that the doctor’s business staff person informed me that my 2014 health insurance plan, a Covered California plan, would not cover my splint. It appeared that due to this policy change there were many aspects of the health care provided over the last three weeks, that would have been covered under my old plan, and were now NOT covered.

Covered California Financial Fall-out

This "brilliant" healthcare reform act, which I've learned is actually just a disguised redistribution of wealth, will at a minimum cost this hard working entrepreneurial single mother an additional $3,600.00 annually in increased premiums. On top of that, my deductible is now significantly higher as well as my maximum annual out of pocket costs when I use in-network providers.

What I truly didn't realize, until my accident, is that I would have virtually no coverage if any of my providers were not in my carrier's network under this new Covered California plan. I always believed that my policy provided me the choice to receive coverage from any specialist or hospital, whether or not considered by the insurance company to be an in-network provider. Under Obamacare I can certainly still do so. Except with my current coverage, only if I can solely afford the entire cost, for that out of network provider, with no maximum cap!

The medical bills for my surgery are estimated to be in the $20,000 range and any portion of that which has been determined to be out of network is now my sole financial responsibility. That's because Mr. Obama didn't care enough to make sure the insurance companies provide coverage to us, the small entrepreneur, no matter where we receive medical services. How on earth can anyone view this as “affordable’ health care for every American?

The Postscript

My health insurance carrier, whom verbally assured me in November 2013, my plan was NOT changing, in fact, DID. Then on February 14, 2014, three weeks after my surgery I received a letter dated January 29, 2014, informing me that my new healthcare plan is now an EPO with a completely different network of providers. I should be expecting new insurance cards in the mail shortly. A clear indication of the absolute ineffective Obamacare/Covered California implementation, and the unclear confusing communication between the health care providers, the insurance carriers and the public.

Who Else will suffer the Affects of this Ill-conceived Plan?

While I am neither a registered Republican nor Democrat, nor do I consider myself politically active, in this case I have to agree with the Republicans. People like me, who are neither protected by a big company policy nor qualified for the subsidies currently offered, must be returned to our original health policies.

 

 

 

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