Essays / Prose

Signing up for was easy. But using my coverage wasn’t.

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 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 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 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 policy like the one I did is just trading a hard-earned nickel for a wooden one, in my experience.

Cindy Crawford’s rare, rare melons

I’m at McDonald’s eating an egg, cheese, and bacon biscuit because I am weak and human and dammit if it doesn’t taste amazing. Besides, I’ve been strong before, when I was twenty five and I gave up smoking and drinking and sugar and fast food. Today, I will eat. There is a time for guilt, and it is always later.

Cindy Crawford is on one of the TV’s selling skin cream made from melons that her crackpot French doctor claims are immortal. Cindy walks us through her amazing discovery that the fountain of youth is actually a small field of “rare melons” (jokes abound) in the South of France, with a rustic barn house and no armed security anywhere in site.  This is what my friend Xavier has been hiding from me all these years, I think. He lives in Provence and he must be eating these melons every day in the middle of that very field, rubbing the fruit all over his wife and children’s faces and they will live forever with smooth, radiant skin. Cindy goes on to show how time lapse photography proves beyond doubt that these melons ages slower than your garden variety melon, which is great, except we are not melons.  I keep my credit card in my pocket.

Cindy Crawford's rare melons

Cindy Crawford’s rare melons

The Loudest Man Ever is here, too. I’ve seen him here before, he sits at the counter height table with The Homeless Man Who May or May Not Actually Be Homeless and his travel companion, The Quaker Girl With Large Buttocks, who is likely not actually a Quaker but does, in fact, have a very large buttocks. What strikes me about The Loudest Man Ever is that he is a very, very stupid man, but what he lacks in any measurable sign of intelligence he makes up for in sheer volume and excitement. Who in their right mind would choose to be smart and sad when you can be completely dumb and happy?

Here’s the most exciting news: The Loudest Man Ever has won a Quarter Pounder with Cheese from his McDonald’s Monopoly coupons! This is undoubtedly a sign, this is surely his luckiest day ever! He’s been saving it for tonight, when he will redeem the game piece and eat the burger just before he boards the casino bus. It costs twenty dollars to ride but you get the money back in casino credit when you arrive in Oklahoma, because there are no casinos in Texas. He highlights the route: South San Antonio to North San Antonio, San Marcos, Buda, South Austin, North Austin, Georgetown and maybe even Waco, he can’t remember.  Oklahoma by midnight, chips in hand by 12:15. Back on the bus at 9:30 a.m. sharp, lunch in Waco, home by mid-afternoon. I consider telling him that 12:15 a.m. is tomorrow — if today is his luckiest day ever, it will be thinning out by the time he crosses the state line. But he is happy, and I have sandwich in my mouth. I sip my Coke instead, listen.

“Keeping the poor people poor,” is all the Homeless Man Who May or May Not Be Homeless has to say about that.

Except The Loudest Man Ever says not all the people on the bus are poor, some of them pull up to the bus station in Cadillacs and everything. He doesn’t know that there are poor people with Cadillacs. He would not understand, or the news would change him, destroy his hope or his luck or both, and who would do that? Because you can make good money in Oklahoma, the Loudest Man Ever proclaims to nobody and everybody all at once. Hell, one guy even had four or five vouchers in his hand at the end of the night, and each one of them had to be worth at least fifty bucks.

Stuff my mom never bought me – and neither did Rachel’s

Rachel at blogumutha and I lived parallel lives as kids. We were deprived of orthodontic devices, which explains my extreme self consciousness about my smile and the fact that she actually owns a grill (like Lil Wayne, not George Foreman.) I’m really not lying. She works in enterprise software at a big publicly traded corporation in a big girl job and she has a grill and probably has her own golden pimp cup. We both also yearned from the deepest depths of our pubescent souls for a Hypercolor t-shirt.

Very few kids at my middle school were wealthy, though there certainly were a few. Jason Zimmersham (name changed to protect, well, the poor) was not one of them, broke ass fool. But even that fool had a Hypercolor t-shirt. In retrospect, though, I think he may have spent his entire school clothing allowance on it, because it is the only shirt I remember him in. Ever. For grades eight through twelve. After a certain number of washes, the hypercolor stopped working and all you had left was a tie-dyed t-shirt, which was uncool. In case you don’t remember, Hypercolor was also kinda gross – they shouldn’t have treated the armpits of the boys t-shirts, because dudes would work up a sweat and the whole shirt would be one color and the armpits a different one entirely. Sucka’s paid good money to have a visual representation of pittin’ out.

Okay, now I’m starting to freak out, because Rachel is a girlio and I am a dude and I kinda wanted almost everything on her list, too (that rabbit coat is looking all sorts of lush). Well, maybe not Glamour Shots. But yeah, kinda. If I could have pulled off putting on a gold lamé jacket and a feather boa and a dab of blush and made all my ugly go away and not been beaten to death by the northwest Houston jimbo’s I grew up with, I definitely would have. I’m progressive. I like glitter. I kiss my dad on the lips.

Rachel never had Kaepas, but I did, chump. Two years after they were in style. My mom bought them at Weiner’s, which is where clothes go to die after Marshall’s won’t take them. You would see someone else you knew from your class at Weiner’s, and the race was on to spread the rumor that the other kid shopped at Weiner’s. Weiner’s smelled like . . . . no, that joke is too obvious. It smelled like desperation and layaway and future therapy bills. It smelled like suburban childhood during the oil crisis. It smelled like Reagan, K-Mart po-boys, and pleather shoes. Michael Jackson Moonwalker Court Shoes, because nothing says hoop it up like a little Jacko on your hooves.

Watch this Weiner’s commercial and imagine me dancing along in front of the TV, because I probably did in the 80′s:

The best thing about Kaepas were the interchangeable triangles in different colors that came with them. I promptly lost most of them and broke off entire fingernails trying to swap out the remaining few. Instructions: Using your entire fingernail as a lever. . .

I also had the male equivalent of the Blossom hat, which was the Joey McIntyre NKOTB hat. I wore it everywhere, which might not be so bad, except that I think I also wore a bolo tie. Seriously, with turquoise and everything.

So what didn’t I have? I’m so glad you asked, just in time for Christmas. Because I still want these things, I’m not even lying.

1.) A GT Performer BMX bicycle

If I had one of these I would be a CEO right now, or at least in prison.

Straight up and down, this is the culmination of everything I have ever wanted and never had. Kids that rode these were capable of awesome things, like vandalizing cars senselessly and growing their bangs out over one eye like a cartoon dog. WANT.

Instead, at the height of BMX fever, my mom and dad bought me a red Schwinn ten speed bicycle with ram’s horn handlebars. And a speedometer. While other little boys were breaking faces on half pipes, pumping other kids to school on their pegs, I was running time challenge sprints up and down the street. I had a built in waterbottle cage and an air pump. Take that, Matt Hoffa.

2.) Z. Cavaricci pants – with two belts.

Two swatches. Two belts. Zero friends.

Mom, the reason I can’t take care of you and dad in the old folks home is painful and difficult to discuss. But it really comes down to that lie you told me about not being able to afford a week’s worth of Z. Cavaricci’s for me in the sixth grade. $500 dollars for 5 pairs of little tiny boy pants seems perfectly reasonable. You get 10 belts! They practically come with a girlfriend, too! And instructions on how to make out with her at the skating rink. You still stand behind your decision? Rot in adult diapers, mom. I hope you and the bathrobe you stole from the senile lady’s room next door are happy together. Tell dad next time I win a box of Kleenex’s at old people bingo, I’m not letting him fold them obsessively into small treasures like he does with his liver spotted grandpa hands.

3.) A pierced left ear

Everybody knows you’re gay if you pierce the right one, duh. Until you do, and you aren’t. Or you are, and you like it.

Eventually, this fantasy turned into getting a suicide chain like Rachel Bolan from Skid Row. Because who wouldn’t let their 7th grader connect their nose to their ear with a rip cord?

What? What do you mean I didn’t get the job?

4.) An electric guitar from the Sear’s catalog

If they had a double necked one shaped like a skull, I would have bought it.

This was not a short-lived want. Every year, Sears put out the “Dream Book,” which was their Christmas edition of the Sears Catalog. Every year, I asked for an electric guitar – preferably either the one with the built in amplifier, the one without a headstock, or the one with the Eddie Van Halen paint job – and every year I got a completely different instrument instead. It started with a harmonica. Then, an autoharp. I’m not kidding – an autoharp. I had one of those. I played it and sang along with it and tried to figure out if you could mic it and play badass solos. You cannot.

Finally, I got the closest thing I would ever get to an electric guitar. Mom and dad pinched pennies and saved dimes and bought me – wait for it – a key-tar. I am actually dead serious when I say this is the closest I ever came, ever, in my entire life, to being cool. Think about that a bit, if you will.

I asked for an electric guitar. I got a keytar.


5.) British Knights (BKs)

I don’t want these anymore, I can safely say.

I never wanted a pair of shoes more than I wanted a pair of British Knights. I remember standing at Foot Locker debating between the hi- and the low tops, knowing I would get the no-tops since I was broke. Actually, I can say with 100% honesty that I DID get the original version of these (at Weiner’s):

Are these cool again? Maybe I’ll get another pair. Mom?

I’m just going to end the list here. I’ve gone off and stirred up a bunch of feelings of inferiority and jealousy and my insurance won’t cover another therapy session this week and I’m afraid the hotline won’t take my calls about Air Jordan’s and Girbaud jeans anymore, as if they aren’t a “clinical” enough emergency. Shyeah, right, as if.

How I crowdsourced my wardrobe decisions to my social media network

In middle school, despite a raging astigmatism, I decided glasses were for dorks and begged my mom to get me contact lenses – for my birthday. Seriously. This was just a year or so after I asked for (and received) a full motion waterbed for Christmas, which my parents probably bought me knowing darned well and good that it would serve as an auditory alarm (swoosh!) and nauseating (Dramamine!) deterrent from the celebrated high school past time of climbing in bed with girls. I realize now that this is all evidence that something was off from the get go with me. Freaking waterbed.

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In which Joshua gets a pedicure

“It’s like Kegels, but for toes.”

Wifey has really stumpy toes, like swollen potted sausages. Mine are long and graceful, like a piano player if his hands were cut off by a displeased king and his toes lengthened freakishly quickly to compensate for his disability. As I type this, I am flexing and spreading and wiggling my toes in every configuration my brain will allow, testing my dexterity to see if I might actually be able to hammer out a tune or two on my pianoforte with them. It’s like kegels, but for toes.

stumpy toes in a pool

These are not my toes. These are stumpier, like my wife’s.

I envision myself with both hands clutching the sides of the bench to support myself as I lift both feet onto the keyboard and use my big toes to tap out the bass line to Chopsticks. The last part of my vision involves completing the song and then dismounting from the keyboard by using the piano bench as something of a pommel horse, flailing my legs about in a short tribute to the summer Olympics (which are exactly my second favorite Olympics).

BUT ANYWAY. On a long weekend trip to Portland, wifey convinces me that we should get pedicures together. We’ve done his and hers massages before and enjoyed it immensely, and since she loves pedicures – considers them luxurious and relaxing and a high form of pampering – I figure why not, it certainly can’t hurt, can it? Read More…

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