It was a pretty good day, warm for mid-winter. After lunch at Gourmet Kingdom with friends, I cruised down West Main to the Carrboro Post Office, I found a parking place near the back door and checks from two different clients and, best of all, our new health-insurance cards.
I had put a lot of work into obtaining those pieces of plastic with the Blue Cross and Blue Shield logo. That is getting ahead of the story, though, or at least failing to provide sufficient context.
The existence of the Affordable Care Act, aka Obamacare, helped me choose to “retire” in a very active self-employment. For 15 months it worked quite well. Even with the so-called tax credit our premiums were high, but with my January knee surgery and large set of health-care providers, we hit the out-of-pocket expense limit before spring arrived. After that, other than co-pays, our cards gave us free care and prescriptions.
Anyway, back to my pretty good day. I crossed 54 and gave the new card its first workout at Carrboro Family Pharmacy. The friendly folks there seemed happy to see the card. The $4 co-pay didn’t bother me. I set off to Chapel Hill North, via Hillsborough Road/Old 86 and Eubanks Road, to see my primary-care physician.
Never miss a local story.
A letter from BCBS had set off all my efforts to obtain insurance for 2016. For 2015 Becky and I had sailed along the same Blue Advantage plan as the year before. I expected 2016 to follow suit. November, however, brought the letter. BCBS claimed that I could obtain comparable coverage for a mere $200 per month increase in premium payments.
I had steeled myself to grin and bear it. What are you going to do? What I did was to compare the benefits of the 2015 and 2016 plans. They proved comparable in the sense that I could compare them. The comparison showed roughly half the number of in-network providers for 50 percent more in premium payments.
This set off a series of phone calls and emails between my insurance broker and me, combined with numerous visits to healthcare.gov. I tried to divine the best course among the limited options available in a state that cared so deeply about its citizens that it refused to set up its own exchange and rejected Medicaid expansion. I made spreadsheets and did my due diligence. According to the in-network roster on BCBS’ website, Blue Value carried more of our providers including our primary physicians. It did not enter my mind that I was researching prior to January 1. I made my choice and paid my premium on line.
All I had to do next was wait. I read the reports about their systems meltdown and experienced personally the phone lines that stayed busy 24/7. A friend, ironically a doctor, with four kids related her horror story about how she and her husband had paid three grand without yet receiving proof of coverage.
We were among the most fortunate. Our cards arrived on the first day of coverage. That pretty good day continued at my doctor’s office. The results from my blood work showed most everything heading in the right direction. Her scales proved my weight was doing the same.
I bounced back down the hall to the front desk and whipped out my pretty new card. Instead of sharing my joy, her friendly assistant appeared crestfallen. “Blue Cross won’t let us take Blue Value. We’ve asked and asked because so many of our patients are on it. They keep saying we’re too small We’re in-network for all their plans except those through the Marketplace. It’s like they want to make sure it doesn’t work.”
Too small for in-network. I guess that’s the converse of too big to fail. Nice move, Blue. It shows how much you care about the people you insure. No worries, the computer melt down and collapse of customer service is such a public relations crisis it will keep this on the back burner awhile longer.
So instead of my $10 copay, I pulled out my debit card to fork over $115. And down the road I went toward the end of a pretty rotten day.
Art Menius lives in White Cross. You can reach him at firstname.lastname@example.org