My First Trip To The Doctor Under Obamacare

[stopbush]

Long story short, my family qualified for the Medicaid expansion under Obamacare. That's CalOptima here in CA.

I was fortunate to be able to secure Kaiser Permanente as our network provider. I had KP from an earlier employer-provided plan. I liked them then, and I was ecstatic that I was able to get the family enrolled under CalOptima. Ecstatic because KP wasn't accepting new patients when our CalOptima kicked in on January 1. I applied for KP in January, but we got bumped to a different provider. Last month, CalOptima called us out of nowhere to inform us that KP was now taking new patients. I drove over to their offices in Orange on April 28 and was signed up to KP, effective as of May 1.

I called KP on May 1 to set up an appointment. They still had me in their system from 3 years ago, so they were able to get me started immediately. I needed to see a dermatologist - they were able to get a referral from my old primary physician without my having to pay him a visit. Both my KP primary physician and dermatologist are the same doctors I was seeing 3 years ago. Bonus!

So I visited the dermatologist today. He checked me out, gave me a prescription and ordered blood work done in advance of his possibly prescribing a new medication.

My costs for today:

Office visit Co-pay $0 (co-pay was $30 on my employer-provided KP plan 3 years ago)
Lab work $0
Prescription $0 (copay on this same prescription was $45 3 years ago).

Total time at the KP offices: 35 minutes. Everything is under one roof at KP, so I was able to get checked in, see the nurse to have my blood pressure taken/vitals reviewed, see the dermatologist, stop at the lab for blood work and pick up my prescription, all in about a half hour.

NOTE: were it not for the Medicaid expansion under Obamacare, MY FAMILY WOULD NOT HAVE HEALTH INSURANCE.

Thank you, Mr President!

BTW - my wife has her first KP "getting started" appointment today at 11:30.

On edit: the results came back from my labs - everything was well within normal ranges. KP sent me an e-mail around 4 pm and I checked out the results at their website.

[Arugula Latte]

1. Fantastic!

[yeoman6987]

7. Most Medicaid patients will have a zero balance.

[RKP5637]

2. Great!!! K&R!!! n/t

[stage left]

3. That's wonderful.

Thanks, Obama.

[uppityperson]

4. Congratulations. I have the problem that my rural county takes 1 type where the neighboring

counties with specialists take ones mine doesn't offer. I have to go to the next county to see an ENT, but can get in much faster and have to drive only 15 min further so am content. I like the low prescription costs, every little bit helps. It will take a bit for it to come together, am glad for what I can get help with.

[FSogol]

5. Awesome. n/t

[House of Roberts]

6. This is what the law is all about. Glad you're better off.

First use of my BC/BS insurance through ACA, was refilling prescriptions today. My monthly bill was $53, and now it's $25. Knocking $28 off the $503 premium, I'm insured for the month for $475. I hadn't had insurance since January 2013, so I feel much more secure.

Is my $503 a month helping someone else get to see a doctor? I sure hope so.

[stopbush]

8. Of course, I'd be better off if I was employed.

Then I could afford a health plan under the ACA.

Thank the stars Obamacare expanded Medicaid. This is a life saver.

BTW - let me offer a hearty FUCK YOU to all of the Rs who are still trying to overturn Obamacare, especially those seeking action in the courts. Overturn the ACA and my family is shit out of luck. And until we reach the point of being SOL, you are torturing us with the very real fear that we could lose the health coverage we just acquired under the ACA.

I have no job. We're living on my wife's part-time income and what's left of our investments. Is it really too much to allow us to have a little peace of mind by leaving our ACA-provided health insurance alone?

So I say it again - FUCK. YOU. FUCKING REPUBLICANS/LIBERTARIANS/CONSERVATIVES!

[Lady Freedom Returns]

14. +1 on that!

I have a job now, but it is only Part time. I get full time I can get the same plan as I have now on AHCCCS ( AZ Medicaid) for a price that won't hurt.

[lululu]

18. Easy for me to say

but I would not worry about the ACA going away. The horse has left the barn.

[Recursion]

9. K-P's model really is good for a lot of health care needs, too

I hope more groups start emulating that...

[stopbush]

28. I love that KP is all under one roof.

Had we gone with a different health provider, I would have had to have seen my PCP first to get a referral to the dermatologist. The labs would have been another referral to another place on another day. Same with the prescription. I would have been running all over the place for a couple of weeks to get done what I got done in 35 minutes today.

Another reason I was ecstatic to reconnect with KP.

[hue]

10. Wonderful! & great to hear Your Wife is getting checked up!!

[Leith]

11. I Have a Happy ObamaCare Story, Too

I have been unemployed since July. When I was working, the company kept switching to cheaper and worse plans to save money. 3 ~ 4 years ago, they settled on a plan that my doctor's office did not take. RATS! My husband & I both liked all the doctors there, but we couldn't afford it.

So, we had to switch to a doctor where it was a 3 week wait to get an appointment.

Until we qualified for MedicAid and found out that the doctor's office took it. We didn't waste any time making them our Primary Care Provider.

A few days ago, my husband got a sinus/ear infection and went to the office. There was $0 copay and he got right in. Except for a mixup with a prescription, it was smooth sailing. We have coverage and our preferred doctor back again. Yaay! Why don't ACA foes put us into one of their commercials? (/snark)

[Kber]

12. What a relief!

[Lady Freedom Returns]

13. I would not be getting my Theropy and treatments without it!

If it was not for the ACA, I would be unable to get treatment for my PTSD. It would be allowed to get worse and worse. And I don't even WAT to think what kind of hell I might be going through if it was allows to get worse with zero treatment.

So, THANK YOU MR. PRESIDENT!

[FreedRadical]

15. Right now I am recovering from a surgery I had two weeks ago.

Were it not for the ACA, I would have continued to try to work until my condition put me into the emergency room and become life threatening. All for a relatively minor issue done as a day surgery. I am truly grateful for the ACA.

[frazzled]

16. I am so happy to hear this real-life story

I don't know why, but it kind of brought tears to my eyes. I know there are a million stories out there in the Naked City, but this too is one of those stories, and I'm sure there are thousands of others who are benefiting as you are.

What a load off your mind to know you and your family have one less thing to worry about. Your life is about to get just a little bit easier--or a lot! You can concentrate on all the other issues that life brings, and not having to worry about finding or paying for your medical needs.

[iandhr]

17. But but but...

…. Third way cooperate sellout. It's wasn't single payer so it doesn't matter the law is helping you. POS used car salesman.



I am seriously glad you are helped by the ACA. I was as well. I wish some people who post on this site will think of the 7 million people who were able to get care instead of ***** about how it wasn't single payer. But I won't hold my breath.

[riqster]

19. Bravo! So glad to hear.

[KansDem]

20. BENGHAZI!!!

No, really, it's a great feeling to have affordable health care! Congrats!!!

[Doctor_J]

21. don't forget to thank me

My employer provided coverage went through the roof this year, due in part to the insurance profiteers' 500 billion dollar guarantees. The president may have signed this thing, but other working stiffs are paying for it.

[stopbush]

26. Thank you?

Wanna switch positions?

YOU go unemployed for 3 years and I'll take your job and your "through the roof coverage." I'll be the "working stiff who is paying for the ACA" and you can be the unemployed person with a wife and two kids who couldn't afford a health plan if the ACA didn't exist.

Yeah, I don't feel even a pubic hair sorry for your gainfully employed ACA "problems." I've paid into employer-provided health care programs for over 35 years, and I never once felt ill abused because my too-high co-pays and premiums helped out some poor slob who was worse off than me.

[Doctor_J]

32. that's a little narrow minded

You are willing to offer thanks to the president for signing heritage care into law, but insult one of those paying for it. My annual max is now nearly a fourth of my take home pay. I am happy that you're able to see a doctor, not that happy that working stiffs will be providing most of the disgusting profits to big insurance

[stopbush]

37. Explain to me how your premiums are supporting Medicaid.

They aren't.

[LanternWaste]

39. Much as is requesting a thank-you from those who may now afford health insurance and care.

"that's a little narrow minded..."

Much as is requesting a thank-you from those who may now afford health insurance and care (insert distinction without a difference here to better insure no one think your guilty of the same thing you indict others for).

[JoePhilly]

34. My employer coverage stayed the same.

Plus no co-pats, free preventative coverage, and cheaper meds.

Maybe your employer is screwing you.

[Cha]

22. ..

[eyeofnewt]

23. Thanks Obama ~

As a healthcare worker of many years, it's great to hear positive stories related to ACA. If I had a nickel for every time I've heard patients say they couldn't buy their medicine because of rent, food, other expenses.... I'd be rich.

What kind of person would deny even one person access? It boggles the mind to imagine that mind set.

[japple]

24. Hip, hip, hoorah! Thanks for informing the folks here at DU!

Hope everything goes well for you and your family!

[bhikkhu]

25. Fantastic - that's about how things have gone for me in Oregon

I qualified for OHP in January and was all set up by the 15th (in spite of all the horror stories about how badly things went here).

My first thing was going in for a flu shot - I got out my wallet and my OHP card, they typed it into the computer and said "no charge, its all covered".

Then both of my daughters got eye exams and glasses, again no charge. They had to pick from the "covered" frames selection, but they both found ones they really like.

I had a consult with a doctor myself, first time in 15 years, who gave me a clean bill of health - though he said to expect a more thorough physical next year based on my age. Again, no charge.

Being a part of a working health care system is a really good feeling - like being worth something, like my work has some value (though it pays little enough that I qualified for full subsidized coverage), like I'm now considered a contributing member of general society.

[stopbush]

27. Thanks for all the feedback.

It's nice to have some peace of mind these days.

Bonus - my trip to the doctor today has inspired me to lose a little weight. I was up about 10 lbs from where I was 3 years ago. Though I walk about 3 miles every morning, I've put on weight due to the mindless eating that happens when you spend your days puttering around the house and surfing the web looking for jobs.

I've just got to cut down on my caloric intake. That's always been an easy thing for me to do - I go on an Atkins-esque low-carb diet, drink lots of water, eat small meals throughout the day and try not to eat after 7pm. I've always been able to drop weight on that plan in a reasonable way. Instead of reaching for food, I need to reach for the water bottle. Weight loss is about 70% diet management and only 30% exercise - I've got to be better about the food management end of things. And, I'll try to extend the length of my walk while I'm at it (gives me more time to listen to music anyway).

If I hadn't gotten back to the doctors this week I wouldn't have had a few red flags go up on taking better care of myself. If the ACA wasn't here, I wouldn't have gone to the doctor. If I hadn't gone to the doctor...well, you get the idea.

It's all good.

[SheilaT]

29. So glad to hear.

And some of the benefits of Obamacare are more subtle. I'm pretty sure the reason I had no co-pay for my shingles vaccination back in December was thanks to the ACA. At my age, that would be basic coverage. I'd actually planned on using up the amount left on my medical savings plan (whatever it is really called, the money taken out of my paycheck to cover co-pays and so on) at the end of the year by getting my shingles vaccine. I'm 65, so it was about time. A friend a few years older had something like $200 she had to pay after her insurance covered whatever they covered.

Nope. Went in to the chain drug store, told them I wanted it, they had it on hand, didn't even ask to see proof of age and I'm thinking they took my insurance card. Have forgotten all the details. No copay. Wow.

I also think the ACA is the reason I got a refund of an earlier copay for a doctor visit, because it was something that was supposed to be covered with no copay under the new rules.

I was employed and had employer health care until the beginning of this month, and I'm now on Medicare. I like Medicare even better. I signed up for an Advantage plan which will have zero doctor visit copays, and my one prescription went from a ten dollar copay to a four dollar copay.

I honestly think that we will move to some sort of universal basic coverage, perhaps a single payer system, within a decade or so as more and more people understand how good this kind of system is.

[Zavulon]

30. At least you qualified.

I went from full-time with health care to part-time with none. And since I cannot afford to pay 27.33% of my new, lower gross income level for a policy that provides me less health care than I used to have, I am without health care entirely now. Great time for it, too, as I'm in my mid-50s.

The "Affordable" Care Act isn't great for everyone. It hurt me very, very badly. Government is supposed to help us, not hurt us, and for every story like yours there's at least one like mine. Good for you that it helped you, but please don't assume it's an automatic good for everyone. It's what cost me all health care and 40% of my gross income. Eventually I'm going to be forced to either live in my car or see which of my friends will take me in until I can get back on my feet, that will happen no later than this fall unless things change drastically and in one fell swoop.

When I read a story like yours I should be elated, and I try to be, but I can't. My life has never been worse and the ACA is the reason. There's nothing "affordable" about it for me, and I'm not the only one.

[Indykatie]

31. ACA Has A Cap On Premiums That is Less Than 27.33% of Income Please Explain Your Comment

[karynnj]

36. Are you saying that the reason you went from full time to part time was ACA?

(or more accurately your employer's reaction to ACA) Otherwise, I don't really follow what you are saying. I had read that many companies which were NOT paying for healthcare for full time employees would move them to part time to avoid the cost. As you had healthcare to begin with, I don't get the linkage to ACA as the cause.

Is the plan that is over 27% one offered at that cost by your employer? It seems higher than the % that people were suppose to pay under ACA if buying from the exchange. Are you in a state that did not expand Medicaid, where you are left in a gap where you get no help for unaffordable insurance costs.

More important than my understanding the (likely unintended) policy consequences , I hope that things turn better for you and you find a full time job. Your description of what you face is terrifying otherwise. Best of luck.

[stopbush]

40. I don't pretend to know what research you've done on Obamacare,

but I know that in my case, I started out thinking it would work one way and discovered it worked a different way.

I called CalOptima in September, intending to buy a policy on the exchange. But once I entered all of our financial info, I was sent over to the MediCal part of their website. I then received a phone call from an agent who explained the Medicaid expansion to me. The first explanation wasn't correct - the agent thought there was still an assets test in the qualifying process. I called back a week later and got a different agent who had the correct info, and things moved forward from there.

The only reason that our family qualified for the Medicaid expansion is because the ACA removed the assets test from the process that determines eligibility. Before the ACA, a family of 4 could have no more than $3300 in assets to qualify. Those assets included owning one car. Our assets are much higher than that, mainly because I saved a lot while I was working.

Under the ACA, eligibility is based solely on current earned income. As I'm not working and my wife is working part time and owns her own business, her net income qualified us for the Medicaid expansion. I haven't been able to find work in 3 years (but I still look every day).

Call your state ACA administrators. You may be surprised at what they can offer.

[iamthebandfanman]

33. ive used

my newly acquired Medicaid a total of 5 times so far ..
had a $3 dollar co-pay every time..

way better than that $70+ payment before to see someone

I did have to switch my network tho... ran into some problems in my small town with the original.. plus they had assigned my PHP to a dr 3 hours away from where I lived.. ick!
luckily it was all very easy to get changed/sorted out. maybe 15 minutes on the phone?


I totally get why republican governors have tried so hard to stop Medicaid expansions in their states... the recipients aren't likely to forget the good deed any time soon or who gave it to them..

[Capt. Obvious]

38. You left out the most important part

How many people are on the death panels?