Why I’m leaving the healthcare exchange, for now (but hope to someday return).
I didn’t want to write this article. I still don’t. I want Healthcare.gov to succeed, despite its initial stumbles. But when yet another healthcare provider in a long list told my wife today that they aren’t accepting policies from the government exchange, I had to speak up.
Because signing up for healthcare coverage at healthcare.org isn’t the problem. Using it is.
To be clear, some of this is my fault. By choosing a “silver” rated policy on the exchange from Cigna (NYSE: CI), I assumed my investment in one of the largest insurers in the nation would shield me from cut-rate providers and ensure my family could continue to see the doctors we have seen for years. When I resigned from my corporate job in late 2013 to start my own marketing content firm, I consulted Cigna’s provider directory, saw that our family pediatrician and OBGYN and other specialists were accounted for, and chose one of their exchange plans.
I was excited. For years, I had heard how hard it was to find good insurance, as a self-employed individual. I wasn’t expecting any subsidies — although my wife stays at home with the kids, we’re lucky enough to have an income that disqualifies us. I just wanted an easy way to research and sign up for coverage, without worrying about preexisting conditions, lengthy and difficult comparison-shopping, and a ton of red tape.
We all know the signup snafu that ensued, and that’s not what this article is about. Suffice it to say, I managed to sign up after several months of paying for COBRA (at nearly $1600 / month) through my previous employer. Although our new premium of nearly $1100 a month would still be a significant financial liability, it saved us nearly $500 a month over COBRA, and didn’t look (on paper) to represent a serious change in quality of care.
Sure, our deductible was quite a bit higher. And no, we wouldn’t have an HSA anymore, from which we had enjoyed a nice tax savings. And without an employer contribution, nothing about the coverage would be more affordable — but these were all concessions I was willing to make for my new self-employed lifestyle and the ease (and purported long-term “do-good” benefits) of the healthcare exchange.
And then we tried to use it. The first time was at my general practitioner’s office, a major regional healthcare group. I had mistakenly asked the question “Do you accept Cigna?” on the phone while scheduling an appointment, to which they answered, “Yes.” Imagine my surprise at the check-in window when I presented my new insurance card, only to be told, “I’m sorry . . . we accept CIGNA, just not CIGNA LocalPlus.”
LocalPlus. Sounds great, right? Sounds like it should translate to “works in your community,” does it not? Yet the general practitioner was just my first of a long list of rejections. After finding a new GP that would take my policy, Walgreen’s — yes, the largest chain of pharmacies in the nation or world or galaxy, perhaps — turned me down, as well. That was my first indication of major trouble. When Walgreen’s refers you to CVS, something is amiss. Worm holes open that can never be closed.
Next up on our list of rejections? My wife’s OBGYN. “We DO take CIGNA . . . but we don’t accept CIGNA LocalPlus. In fact, there are only a couple healthcare exchange policies that we DO take,” the desk clerk explained. “We don’t take LocalPlus” is now firmly cemented as the standard response I expect from anyone I present my healthcare card to. Like the emergency care clinic inside CVS, who also did not accept my insurance, even though the CVS store they are located within, does.
And that’s why I am writing this. After being turned away by nearly all of our doctors (and Walgreen’s – WALGREEN’S, people!), I am starting to wonder what I am paying for. The right to seek out a substandard level of care and still pay full price? A continual reminder of what rejection feels like?
Since the plan we chose (and could afford) is already a high-deductible plan, it basically means most of our health care expenses until we meet our family deductible are out-of-pocket anyway. With out-of-network provider visits not contributing to our in-network deductible, it translates into over a thousand dollars a month (plus hundreds for out-of-network doctor visits) for absolutely no benefit in return.
I voted for President Obama, and indirectly, for the Affordable Care Act, because I do believe everyone deserves access to quality healthcare, no matter how little they earn. Many reading this may be tempted to cast off my complaints as spoiled or entitled – what’s the big deal if I my biggest inconveniences are having to find a new group of physicians and a new pharmacy?
On the surface, I would agree. My family is healthy and happy. We will find new doctors. We have healthcare, after all — it’s just lower of a lower quality than we are accustomed. We can pay out of pocket when we need to, barring something catastrophic, of course. I earn a decent wage, but not good enough to cover the cost of a heart operation or a lengthy hospitalization out of pocket.
But if you look deeper, you understand the implications. The Affordable Healthcare Act cannot succeed financially without people that pay full price. The idea is that subsidies can be granted to the less fortunate if enough of the fortunate also buy in.
Who will buy at full price if they know up front that their first act as a newly insured policyholder will be to get declined by every physician they have grown accustomed to seeing?
Truth be told, I feel a bit used by my insurance company, and possibly my providers. Whether intended or not, my family’s experience feels like insurers and providers are taking their dislike of recent healthcare legislation out on the consumer. It feels like finding out the car I just purchased (at full price) from the Ford dealership, with a Ford badge, is actually a Ford “LocalPlus” that can only drive on certain roads that are miles out of the way, crammed with traffic, and seldom maintained. It’s not what they advertised and sold, it’s what they didn’t advertise — the differences between an exchange-traded and private-market policy, that has left a bad taste in my mouth.
With hundreds of policies available on the exchange from dozens of providers, each its own tangle of legalese, intentionally ambiguous language, offsite links to a myriad of documents and directories, it is virtually impossible for the average consumer to compare apples to apples.
I won’t claim to understand the economics or politics of the healthcare industry at all, and yes, I am at fault for not consulting the specific provider directory for Cigna’s LocalPlus network. But in bringing their big brand names to the exchange, I assumed I would have access to the same providers that their non-exchange policies do. It cannot be a coincidence that many of our family doctors are considered in-network by every other Cigna policy except their health care exchange policies. As providers continue to opt-out of accepting exchange-sold policies, the national dialog is still focused on the initial difficulty of signing up, or the slow initial numbers to register.
Almost no media coverage of the Affordable Care Act has exposed this, though — a seemingly industry-wide refusal (or major hesitation) to accept the policies offered by our shiny new national healthcare exchange. Yes, you can point at a long list of providers that DO accept the coverage. But how much longer is the list of providers that don’t? And what good are lists, anyway, if almost none of the providers you have grown to trust and depend on for your family care make the cut?
Would I buy in again, knowing what I know now? Absolutely not. As of today, I am back to researching my options. I have no idea how difficult or costly it will be to restore the standard of health care my family is accustomed to, but I will be taking the steps, even if it means finding a catastrophic-only plan and self-paying for our medical care, or foregoing care altogether and reinvesting my premium payments on the open market.
Am I open to returning to Healthcare.gov in the future? Without question, as soon as it appears that the playing field has leveled, the grand standing has stopped, and it is far easier to evaluate and ultimately use the coverage you select. I still support the premise behind the policy, just not the way the government and healthcare industry have worked (or not worked) together to protect families like mine from spending big and yielding little. Until that improves, buying a Healthcare.gov policy like the one I did is just trading a hard-earned nickel for a wooden one, in my experience.