#Obamacare: people who think they have coverage get hit with massive bills
**Posted by Phineas
Correct me if I’m wrong, but wasn’t our new, glorious, designed by unicorns healthcare system supposed to prevent things like this? If you signed up for coverage and made your payments, you weren’t supposed to get crushed by the ensuing medical bills, right? All those horror stories from the dark days before
Obamacare the Affordable Affordable Affordable Affordable Affordable Care Act (1) of people with unbearable financial burdens? Gone. Banished forever. Not gonna happen ever again in our new progressive paradise.
Just ask Alex Szablya of Washington:
Alex Szablya just wants the best health care she can get for her children. So she got a gold plan, the highest level possible with the Washington Health Benefit Exchange. She picked a plan with Lifewise, an affiliate of Premera Blue Cross.
In early March, her 16-year old daughter had a medical emergency. Alex drove her to the nearest hospital, which was Seattle Children’s. Alex says doctors there felt her daughter’s situation was so dire she needed to be admitted to the hospital immediately. She was there for nine days.
Then came news that her stay, which involved specialized mental health care for adolescents, was going to cost $36,000 and her insurance would only pay for half because Seattle Children’s was considered on out-of-network facility.
She thought by going for the highest premium PPO gold level coverage offered the state exchange, a majority of the bill would have been covered.
“I’m paying a premium for that and I’m willing to pay that premium, but I expect to get services that are not so limited by the insurance companies,” she said.
Premera told her to take her daughter to facilities either in Yakima or Bremerton, the one a three hour drive and the other two hours away via ferry, while Seattle Children’s was just 15 minutes away. Now, where would you go with your child in an emergency? Remember that she bought a gold plan. Among the many problems we’ve heard about regarding the exchanges is that is can be hard to tell if a particular doctor or hospital is included. Ms. Szablya might well have looked at the online offerings and just assumed that, of course, nearby Seattle Children’s would be included. When you have an emergency, especially one involving your child, you’re not going to stop, call your insurance agent, and ask if a particular doctor or hospital is part of the network. (via Katnandu)
An even worse bill awaited Larry Basich of Las Vegas, who thought he had done everything right, but, after undergoing triple bypass surgery, found himself on the hook for over $400,000:
The hospital bills are hitting Larry Basich’s mailbox.
That would be OK if Basich had health insurance. But he doesn’t.
Thing is, he should be covered. Basich, 62, bought a plan through the state’s Nevada Health Link insurance exchange in the fall. He’s been paying monthly premiums since November.
Yet the Las Vegan is stranded in a no-man’s-land where no carrier claims him, and his tab is mounting: Basich owes $407,000 for care received in January and February, when his policy was supposed to be in effect. Instead, he’s covered only for March and beyond.
Basich has begged for weeks for help from the exchange and its contractor, Xerox. But Basich’s insurance broker said Xerox seems more interested in lawyering up and covering its hide than in working out Basich’s problems. Nor is Basich the only client facing plan-selection errors through the exchange, she added.
Xerox, meanwhile, said it’s working every day to fix Basich’s problem, and its legal counsel is routine.
In the rollout of the Affordable Care Act and its insurance exchanges, you can find a success story for every failure (2). But Basich’s case is extreme.
Be sure to read the whole thing. Basich worked for weeks to make sure he had coverage, both using the crappy online exchange and telephone help. He’s dealt with Xerox and even gotten Governor Sandoval’s office involved. His case is so bad that Harry Reid won’t even call him a liar; his office is instead trying to help.
The problem in this case is the web site, itself. It looks like Xerox did almost as good a job with it as Oracle did with Oregon’s exchange. While payments have been deducted from Basich’s bank account, UnitedHealthCare has no record of his coverage beginning when he was told it would begin, the exchange says he signed up with a different company (even though he has proof otherwise), and that company has no record of him and doesn’t want to be stuck with the bill.
Before this ever gets worked out, the stress may drive Mr. Basich to another heart attack.
In both cases, the the articles miss the mark when attributing blame. By limiting its networks, Premera is doing what any company would when faced with government mandates that impose highers costs: find ways to control them. In Larry Basich’s situation, Xerox deserves all the blame that can be heaped on it, but they’re not the root.
The source of the problem isn’t corporate greed or incompetence: it’s Obamacare, itself. All these problems people are experiencing are due to the top-down mandates that are the essence of the Affordable Care Act. A bunch of legislators and bureaucrats trying to control by law something as complex as the health care system of the United States was bound to fail. And that ongoing, rolling disaster is causing real-life misery for Americans all over the nation.
It has to go.
(1) There apparently are five “affordables” in the bills name. Just ask Nancy Pelosi.
(2) Why do I think that last sentence was meant to deflect the ire of Harry Reid? “Sure there are success stories, too! Just trust us!”
(Crossposted at Public Secrets)