Health Insurance is Not Health Care

I have spent the last two months trying to obtain the health care my doctor is recommending.  Now, note that I am saying health care as opposed to health insurance.  They are not synonymous.  The media uses the terms interchangeably as though obtaining health insurance automatically means you will have health care.  It is not so.

I went without health insurance for 20 years.  I have now had health insurance for 1 year.  Other than getting some preventative tests done and a flu shot (which I will do without from now on), there hasn't been much difference.  At least not in my health care.  I am still the person who is responsible for each decision, for 90% of the research, for finding the best prices, calling to check prices, and taking care of myself.   

Don't misunderstand me, I think it is commendable that we, as a nation, have attempted to provide health care coverage for everyone.  I also believe that we have an extremely screwed up health care system.  I had to search and search for a doctor I liked and trusted.   Great.  We established a relationship. 

When she referred me for further treatment 2 months ago, I ran into a wall.  The plan I have didn't have any doctors to provide the treatment in my network.  Actually that is not true.  They did have some, it's just the 6 they had are all in the same clinic and that is the one I went to the first time I had this procedure. 

It was a disaster and not done properly.  Hence the need for a second procedure.  It makes no sense to go back to the place where things were mishandled the first time, so no doctor, no procedure.  I decided that even though the procedure would have been completely covered this calendar year (my deductible is met), I would wait until next year and just pay for the procedure. 

Apparently, in Texas the plans that are through the exchange are treated and accepted much differently than the plans not through the exchange.  Many doctors, medical groups, and hospitals have decided not to accept those networks.  There are only 9 companies that service the area I live in through the exchange and I live in a big city.  I cannot imagine the poor selection in other areas.

So I started the hunt for an insurance plan that has the doctor my doctor referred me to in the network.  After 2 weeks of research and comparing plans, I called the insurance company to ask a few questions.  They informed me I had better check with my doctor because the provider list is not kept up-to-date through the exchanges.  Great.

I checked with my doctor and lo and behold they are not in that network.  Back to square one.  I spent 2 days on the computer and came up with a list of 9 plans, 3 each from 3 different companies.  I called the companies to ask specific questions about the procedure I need since the website doesn't spell out how things will be classified or charged.  I got answers to my questions, ruled out one company completely and narrowed my list to 3 plans. 

Then I called my doctor and found out yes, they are in those networks.  I have one more doctor to check with and I am waiting for a call back on that.  Presuming they are in network, I have to decide between X deductible and Y out-of-pocket max.  And then consider D and F costs for the procedure, facility, and doctor.  Oh yeah, and then drug costs.  Of course, none of this is transparent.   I have no idea what the "contracted" price of any drug, procedure or doctor is with any given company.

I have to guess at what will best meet my needs without solid information.  I accept that I cannot know what medicines, treatments, or tests I might need next year, but if I had concrete prices to compare I could at least make a decision based in something besides guesswork.  That is not how our system works. 

I don't want to skip ahead in my life 6 years but I do wish I were eligible for Medicare.  It seems so much simpler.  Just sign up and that's it.  The prices are clear, the plan is universal.  Because we are an aging nation, it is accepted by most doctors. 

It should not be this complicated and difficult to have affordable health care.   It is too confusing, too opaque, and too skewed to the advantage of the insurance company.   I am willing and have proven able to take care of myself, to do my homework, to ask questions and be involved in my care, and I would appreciate if our health care system would cooperate in my effort.