My Experience on the New York State Health Exchange (NYSHE)

I was laid off in June of 2013. I was paying for COBRA to the tune of $535 per month. I had United Healthcare/Oxford. In November, I received word that the plan would go up to $615 in December of 2013. The $535 was hard enough, but the $615 just wasn't doable. I figured I would try the New York State Health Exchange. In mid December I searched for plans where my doctor was part of the network. A slew of plans came up. I chose the coop, Health Republic of New York. The premium was $438 and change per month. A doctor visit carried a $30 copay not subject to deductible and I didn't have to have a referral to see a specialist. I bought a dental plan for $11.00 per month. A great deal I thought. Then it started. I couldn't log into the insurance company website (which is where I would make payments, get the plan documents, etc.). I couldn't get the plan documents. When I called, after waiting on line for 20 minutes, people didn't know what I meant when I said plan documents. They offered to send me a summary of benefits. They offered to have me speak with a "counselor." I just wanted the plan documents because I wanted to know what my coverage was. I explained to them that the summary of benefits was not a binding document. They told me they emailed the plan documents to me. They told me they sent them to me. No dice. I asked the company to send them again. They emailed me the plan documents, in the form of a link to a their website. I could simply log in to my account and down load them from there. The only problem was I still couldn't log in. I called again. I had the same conversation. I asked that they send me the plan documents in an attachment to an email. The representative agreed but said it would take 48-72 hours. "To send an email?," I thought. Oh, well, either way I would have them. (All this time, they kept asking me to pay the premium. Funny, but I got letters in the mail with the premium. I received reminders by both mail and email (once I received four emails about 2 minutes apart). Still no plan documents. When I explained that I was not going to pay a premium when I couldn't even see what I was getting, silence.

Fast forward to December 31, 2013. I tried to call again to get my plan documents. No dice. Finally, I got them later. Pretty good. It was a gold plan. Decent coverage It had just a $250 deductible. I had had a physical scheduled with my doctor under my old insurance. I finally got it canceled (that's another story). So, on 1/2, I called to reschedule. I knew I had to have blood work done, so I called the doctor's office to find out which lab to go to. When they asked me my insurance, they told me they didn't take the insurance I chose. I called the insurance company. The woman assured me that, no, they did take the insurance they were just mistaken. She told me she would call them to ask what the deal was and that she would call me back with whatever the answer was. I did a search on the insurance company website for my doctor. According to their website, my doctor was in network. So, at this point, both the exchange and the insurance company said my doctor was an "in network" doctor. I called the doctor's office again. They gave me the number of the billing person. I called her and spoke to her. I told her the situation. I said I had Health Republic, but that, since they were a new company, they were using the network of another insurance provider called Magnacare. The billing person said that they had canceled with Magnacare....in 2011.

I called the insurance company back again to speak about this. I told her that their database indicated that my doctor was affiliated with St. Vincent's hospital in lower Manhattan, a hospital that has been out of business for about 2 years. The woman then explained to me that doctors could be affiliated with more than one hospital. I explained that that was not the point. The point was that their database was at least 2 years out of date. Then I got the response of all responses: "Just because he's listed on the exchange doesn't mean he takes the insurance." Not much literally makes me speechless...that did.

So, then I chatted with the exchange again regarding this (there is an option in New York to chat with someone rather than wait 60 minutes on the phone). I asked the woman if I couldn't rely on the exchange website to be correct, how was I supposed to know if I was choosing the best insurance for me. She then gave me the links to all of the insurance plans on the site. So, I checked all of them. My doctor was listed as a provider in two of the websites' databases. The kicker was that he was listed as taking 5 or 6 of the exchange plans, when he only takes one. In fact, Blue Cross Blue Shield listed my doctor as an "in network" doctor. However, when I contacted them, they said he was an existing BCBS doctor, but they didn't know if he would take the exchange BCBS. I later found out he doesn't.

My doctor called me today to speak about this. He told me the two exchange insurances he accepted. One is United Healthcare/Oxford. The lowest premium was $577. If I wanted the equivalent insurance I had when I was paying COBRA, it was $630. The lowest Oxford plan had a $3,000 deductible. Office visits were subject to the deductible, and after that they only paid 50%. Now, preventive visits are $0, but I'm not sure what that covers. The other one he takes is $477. Again, office visits are subject to the copay of $600 after which the copay is $30.

What I thought was a great plan at first has quickly become a complete disaster. The exchange was almost 100% wrong about what my doctor took. I signed up for a plan that the exchange said my doctor took to being coverage on 1/1. Thank God I didn't pay the premium because it would have been for naught. The reason it is very important to me to keep my doctor is because I have had this doctor for 10-15 years. He knows my history, which includes two surgeries; he knows the drugs I have to take, and he knows crotchety me. We have developed a relationship. I understand changing doctors sometime. Sometimes it helps to have another person (although I disagree in this case). However, THIS is not the scenario under which a person should have to change doctors, particularly when two of the big selling points of this (sorry, but I have to call it what I think it is) debacle was that I could keep my doctor and my insurance would go down.

People are going to lambaste me when I say this. However, I think this was nothing more than window dressing so that a president who possesses no leadership skills, no moral core and no core beliefs could "brag" about something he knew would be a farce and would not, COULD NOT, deliver on what he was saying. The man has no fight. The man is incapable of fighting. As much as I hate to say it (after voting enthusiastically for him once and reluctantly for him the second time), Hillary was right. There just isn't any there there. He is soulless. He should have known that the private, for-profit insurance companies would never do right by the American people. There may be no preexisting conditions, but the hoops one has to jump through just to find the information to sign up for bad insurance is just too coincidental. I have the wherewithal to fight through this. I can completely understand why a father or mother would see something like this and throw their hands up in complete despair.

There is a solution, and it is single payer. No deductibles. No "networks". No "what if I have insurance in New York but get sick in Ohio" mess to deal with.