First let me thank you once more for the help you gave me last month in getting coverage with Coventry.
Once I got covered I began to go to a provider that was told they were set up with Coventry for the ACA. I went for two visits. I was surprised, no shocked, to find a bill in the mail that I owed $150. After another two hours with various customer service people (being passed around like a skunk at a picnic), I was told that my provider was not “in network.” My provider had assured me that they were prior to my ever first going up there. They (the provider) was also quite surprised they were not “in network.”
I also had a lot of medical insurance jargon thrown at me. I had to stop people several time to explain I was not familiar with the insurance terms as I am an insurance outsider. How many of your customers would be familiar with the insiders terms and acronyms?
The outcome was that it was my fault because I had trusted the provider (who was misinformed) and I had not looked it up on a list of providers. This is the first time I had ever heard of a list of providers and the website it was on. They sure made me feel like an idiot not knowing information I never had a clue existed.
If there was real competition in this field I would be looking very hard right now. As it is I have no recourse. I have but 6 months to go to Medicare. Hopefully I can survive until then. I live in fear that if I do have an illness or injury I will fail some proscribed method that Coventry has set forth. Not having all the rules readily at hand all the time, I will no doubt assume that something logical would be the answer and it may not.
I have called my congressman’s office. I am fairly sure that this is not what they expected insurance companies to be doing with the ACA.
My provider was also shocked since they were told they were “in network.” The “in network” designation was supposed to mean that patients that were covered by Coventry could go to them for the stated “in network” costs. After a week of calls they found out that they were “in network” but not for my “plan.” There was a list of providers subsequently sent me that showed me that the “in network” providers for my plan mostly practice in Cedar Rapids, just 50 short miles away.
When I talked with the secretary at my provider’s office she told me that the Coventry person she talked with said the phones have been ringing off the wall with angry customers and bewildered providers. This sure seems like a bait and switch to me, but it would be hard to prove. From what I heard on the Stephanie Miller show from Jackie Sheckner, an expert who has been involved with the ACA from the beginning, every insurance company is doing this.
Once more insurance companies are thumbing their noses at us. While I back the ACA, there are some major problems with it. These problems will not be addressed let alone solved if Republicans are in charge of either house of Congress. We need Democrats to fix the ACA so it works. Better yet we need Democrats to do the right thing and make single payer health care the law of the land
Senator Tom Harkin
The deadline for enrolling in quality, affordable health care under the Affordable Care Act (ACA) is today, March 31, 2014!
More than six million Americans have enrolled in quality, affordable health coverage through the federal and state Marketplaces created under the ACA. In order to take advantage of these benefits, Iowans must enroll by March 31, 2014. They can do so by visiting Healthcare.gov or by calling 1-800-318-2596.
“These enrollment numbers show us that the promise of the Affordable Care Act—expanding quality, comprehensive coverage to millions of Americans, many of whom previously had no access to health insurance—is becoming a reality,” Harkin said. “In addition to the six million Americans who have gained access through the federal and state Marketplaces, millions of Americans have also gained health coverage through the expansion of Medicaid, and more than three million young adults have gained coverage by staying on their parents’ plans.
Iowans seeking health insurance coverage for 2014 can review their options available through our state’s Marketplace—and sign up—by visiting Healthcare.gov or by calling 1-800-318-2596.”
Listen to a public service announcement Harkin recorded to help spread the word in Iowa about enrolling for health coverage through the ACA by clicking here.
To learn more about the benefits of the ACA, please visit Senator Harkin’s website at http://harkin.senate.gov/, or follow him on Facebook https://www.facebook.com/tomharkin or Twitter https://twitter.com/SenatorHarkin.
“Families in Iowa and across the country are seeing the benefits of the health reform law. For the first time, virtually all Americans are guaranteed strong consumer protections and access to health coverage, regardless of a preexisting condition. In addition, because of the ACA, covered individuals receive preventive care, including vital services for women, without co-pays or deductibles, as well as coverage of essential health benefits like hospitalization, prescription drugs, and mental health services. Above all, the Affordable Care Act is about the promise of the health and financial security that insurance coverage brings.
Harkin, as Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, played a pivotal role in the passage of the ACA. He authored the prevention and wellness measures that are part of the law—including the provision that requires health insurance companies to cover recommended preventive screenings with no copays or deductibles—and created the Public Health and Prevention Fund (PHPF). These initiatives help rein in costs across the full health care spectrum and create incentives to prevent chronic disease. Harkin also serves as Chairman of the Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS), which allocates funding for implementation of the health reform law. Link
Should this be The Permanent Democratic Platform?
from January 11,1944 but still fresh and still not fulfilled. When the next war ends…..
Seeing The Light
note to Matt Schultz: It is just as true here as in Wisconsin!
In Memory Of Maggie Thatcher
The anniversary of Margaret Thatcher’s death is about two weeks away. Last year I marked her death with about 50 playings of this song.
Here it is one more time for old time’s sake:
Fifth Anniversary Coming
Believe it or not it is nearly five years since the Varnum v. Brien decision. On April 3, 2009 the Iowa Supreme Court ruled in a unanimous decision that gay people had as much right to marry who they love just as much as heterosexuals did under the equal protection clause of the Iowa constitution. Since then some of the justices lost their jobs by being voted out.
Those judges were then awarded (deservedly so, I believe) the John F. Kennedy Profiles in Courage Award. Iowa was the beginning for what has become yet another round of civil rights. Many other states have followed suit to the point where nearly half of the US states accepts same sex marriage. The Attorney General of Kentucky said the other day that there was no sense in him spending state money to defend the Kentucky anti-gay marriage amendment because it would lose in court.
Look What Scott Brown Ran Into Last Week
a big hat tip to EarlG at democraticunderground!
Note To My Democratic Friends:
RUN ON THE ACA. It is the largest advance in social legislation since Medicare and the civil rights legislation. It is not done, but it has
at long last started!
Since I had written a post telling of my fun with the insurance company I was trying to sign up with through the ACA, I thought I would follow up with a short update.
I now have a card and have actually been to a health care provider a couple of times. Like many I have some blood pressure problems. Nothing too dire, but needs attention. Since I will soon be eligible for Medicare, other tests and treatments can be delayed for a bit.
While the ACA has been a tremendous positive for America, based on my recent experience it is still a bit early to trust insurance companies to fully comply with the ACA. I have an option that others don’t have which is to wait for Medicare.
The ACA is definitely a step in the right direction. I remember full well the nights I would lay in bed trying to decide if that pain or this sensation was worth a trip to the doctor. Since my “insurance” at the time had a high deductible plus the old “pre-existing condition” clause, I could pretty much figure that every visit would be on my nickel. Since doctors post no fee schedules, I may as well as just given them my checkbook. It is not as if I could make a guess as to what the fees and other services might cost.
For five years or more I had to endure what may have been warning signs of a heart attack, sprained ankles, a shoulder that was so painful that I would cry and many various ailments just hoping and hoping it was nothing really serious. I am out of that hell now. Now thanks to President Obama, I do not have to lie in bed wondering if I am dying – wondering if I take a chance at bankruptcy to get treatment. I know I am far from alone with what I went through.
Of course I blame the Republican congress and Charles Grassley for the hell I went through unnecessarily. I saw the hearings and I read the stories.
Republicans and in particular Grassley were resolute in stopping bringing our health care system into the modern age. Not just during Obama’s presidency but since the presidency of FDR. For that reason alone I would never vote for any Republican.
What is really sad is that the power behind the Republican party is still fighting hard to return us to those dark days. And they are fighting hard to end Medicare and Medicaid. Why would I ever want someone who hates America’s citizens so much that they would bring back this form of personalized terror to our country.
I truly thank President Obama and Congressmen Loebsack and Braley and Senator Harkin for standing up for us. You can not imagine how much relief I feel every day knowing that if I have a medical problem I do not have to sit in fear and try to decide between dying or going bankrupt. It wasn’t funny folks, it was reality in my life and many, many others for a long time.
Thank you, Mr. President. Thank you, Congressman Loebsack. Thank You, Congressman Braley. Thank you, Senator Harkin. Believe me, it almost makes me cry to be covered for medical finally.
BUT – now we need to improve the ACA. Really, we need single payer. And we need the citizens to call for it. Loudly
Once more the CBO came out with what should have been good news for Americans. Once more the right wing of America threw up all over it, then proceeded to lie their asses off. Once again just like your little brother when you were younger, you just can’t take them anywhere or they will embarrass you no end. And yet some of your friends think he is really cute and do not care that he lies and cheats.
The CBO last week came out with a report stating that the ACA gives people more control over their own lives. Thus American businesses may no longer have that magical control over their workers lives that they so loved. Up until January 1st, 2014 for most people in the United States the only way they could get health care was through some form of group insurance through their jobs. Since having health insurance is literally one of the basics of life, this forced many folks into jobs. It also often forced folks to stay in jobs they hated because not having health insurance was a worse fate than staying in a job you hated.
This is of course a situation that employers really liked and could easily manipulate. The control of an employees health options and often those of their families gave employers a great situation to exploit. They could do such things as change working hours, cut hours, cut pay, cut benefits and many other things while holding workers hostage with health care benefits.
This is the essence of why the Republicans are so adamantly opposed to any health care reform that would give the individual some control of their own health. Health care is more than a bargaining chip for employers, it is a hostage holder. In most cases it is the Republican more specifically the Tea Party that represents employers. The Tea Party will do whatever to take down the ACA, including obstruction, lying and misrepresenting. This of course includes elected officials and the employers themselves.
So we get a piece of information from the CBO that is stated in a bit of a confusing manner. Trying to say that there will be less hours worked in a few years due to the ACA our corporate owned news media immediately misinterpreted the CBO statement. What the CBO meant and explained many times was that employees, now in control of their own health care, could choose voluntarily to cut back or leave employment. This does not fit the narrative that corporations and the Tea Party wants to project so they immediately put out their misinterpretation that jobs would be lost.
To admit the truth would be at the same time to admit that individuals could now control their own health care. Maybe employees could hop to another employer without worrying about losing health care, or just quit, or maybe just maybe start their own business. This last scenario would in the long run actually increase employment.
Holding employees hostage with health care has been a top tactic since the so-called Reagan revolution. Reagan did not lead a revolution. Instead he lead a retrenchment that put the rich more firmly in control than ever. Part of the strategy was to strangle information to the public via America’s corporate media. That has worked well, but the internet has provided another source for information. Still the right depends on their ability to control the framing of any issue using their hold on the corporate media.
Thus on the issue of health care, the right has put up their greatest fight ever. They have been able to stall and alter what I still believe will be the eventual answer: single-payer universal health care. They have delayed it so far and are once more throwing the bankroll at stopping it. But I believe their efforts will not only be futile but also fatal. Americans have gotten a whiff of what freedom to control their own health can be like. When they find out, they realize someone lied to them. One thing Americans don’t like is being lied to. So Americans will be anxious to know who lied to them, why they were lied to and what can they as controllers of the government really do.
That will be the revolution that is coming. Tea Partiers are on the wrong side of the dam trying to plug the leaks that are popping out all over. You and me? We are on the other side ready to drench them with truth. And when they get drenched they will realize they were never anything but stooges for those people up on the hill.
So after feeling all warm and fuzzy having completed my application on the phone with an employee of Coventry, we sat back and had probably the best Christmas we ever had. All I had to do was stay alive and on Jan. 1 I would achieve the American Dream – being able to see a doctor without having to sell our house!
Over the years I have, I think, been a model of the good citizen. I am involved in civic affairs, give blood, lots and lots of blood, and tutor kids. Shoot, I am a good guy. Well, as you know no good deed goes unpunished.
My nightmare started on Jan. 3rd. I received a cryptic email asking for information that I was sure was on the application. So I called the person back who had helped me with the application. He called up the app and assured me that data was there. So I called their call center. This is where things start falling apart.
I have never worked in a call center, but after a couple weeks, I get the impression of a hive of little cubicles where folks are basically supposed to “handle” customers. So after sitting through a 4 minute menu presentation followed by endless waiting for a live person 10 or 12 times, and maybe thanks to one rather nasty loss of temper on my part, I was able to at least get by this wall for a few moments.
I am not sure what my status is now. I have been told 3 or 4 times that I have insurance. However I really do not want to test it. So right now I must stay healthy no matter how sick I get.
During this trip I did find out that Coventry was bought out by Aetna and their computer systems are not talking. As a veteran of 3 or 4 of these type situations I know what that means – bad data and much clean-up.
Any lessons from my experience so far. Well you can lead a horse to water but you can’t make them drink. Translated, that means Thank You, Mr. President for making the insurance companies do what they are supposed to – cover people so they don’t lose their life saving because of an accident or illness. However, as a reasonable humans we all thought that the insurance companies would act as reasonable actors. But no one said they had to.
Through conversations I have found out I am hardly the only one and all of us over 60. Gee, 60 would be an age where the outgo for an insurance company might exceed the income, at least based on tables.
So I have postulated a theory based on only a small amount of data. This is the model that has made Fox News what it is today. Since this is an accepted method of making up news based on Fox I can only conclude that SOME SAY that the insurance companies may be, but not in all cases are, making it hard for those over 60 get signed up for health care. (sarcasm for the humor impaired, I hope)
And hey – someone have Fox call me. They want ACA stories. I bet they would love to hear one about incompetent insurance companies.
All the people waiting for the Patient Protection and Affordable Care Act to collapse under its own weight had better find something else to do. Almost four years in, there’s no way to hop in the DeLorean, go back in time and undo the good the law has already done.
Don’t get me wrong. I expect to hear more laments and entreaties about how wrong it was for President Obama to do it, and that government is taking over health care, yada, yada, yada. Please people. Get a grip. We went through all of these arguments during the Clinton administration. When the Republican idea of filibustering health care reform to death the way Bob Dole did died, so did the idea of repealing Obamacare. If Republicans gained control of the presidency and both chambers of the legislature, how would the repeal even work three years from now? Could they go back in time and undo the mammograms already provided, the colon screenings performed, or take away the happiness people who didn’t have health insurance experienced when they got it? I suppose one Back to the Future reference is sufficient: they won’t be able to go back in time, and some form of the law is here to stay.
The ship has sailed for Obamacare, and by that I mean we are in a period of waiting to know how it will work out. The website is working. The reforms set in place are working. The number of enrollments is increasing. What seems most important about new enrollments is answering the question, what kind of medical treatment will people require? Even though part of the new fee structure includes a premium for excess insurance to cover a bad claims experience, if everyone who comes into a plan needs expensive treatment, it will skew the costs. How will that work out? We won’t know until insurance companies review the data and actuarial experience and set 2015 rates. So we wait. For the close of open enrollment on March 31, and to see the claims experience during 2014.
Josh Mitchell of Talking Points Memo has written that as enrollments increase above ten million people (not a typo, read the article), so does conservative rage. Chill dudes. Greg Sargent of the Washington Post has suggested there are three stages of Obamacare acceptance. Get with the program.
What seems clear to me is that once people get health insurance two things will happen. First, life will return to a semblance of normal, and people will discover that having health insurance is far from a perfect situation. Conservatives will be quick to point this out, although we all know this experience is logical and predictable. Secondly, Obamacare will become the paradigm, generating new struggles to reduce government costs for Medicare, Medicaid, nutrition and other programs, while at the same time attempting to do right by the American people. We’re moving forward in the incredible storm and stress that is living in this country.
If you don’t like it, either move into a yurt, or contribute something positive to the discussion, one our country has been having since Harry Truman was president. A discussion that is likely to continue for the foreseeable future.
That’s why we’re having our next call this Thursday, December 19th, at 7:00 p.m. Central Time — RSVP right now to join in.
Here’s one of the topics we’ll be covering: In November, the Supreme Court agreed to hear the Hobby Lobby case, setting up an important decision on whether women and their families — not their bosses or CEOs — can make their own health care choices about contraception and preventive care.
To dive deep into all of this, and how Obamacare has expanded benefits for women, we’ll be joined tonight by Sarah Lipton-Lubet, policy counsel in the ACLU’s Washington legislative office.
This is a great time to jump in and hear about the great work coming out of the Stand with Women campaign — and what’s coming up next.
RSVP now for the call:
Thanks — and talk to you soon,
Women’s Issues Campaign Manager
Organizing for Action