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Healthcare

The Many Ways My Bad and Expensive Health Insurance Has Screwed Me Over

Burn in hell Oscar!

Health department employees in black and white from archived photographs from the City of Minneapolis
Photo via mplsarchives/Flickr; Remix by Samantha Grasso

I am not a superstitious person, but I do believe in the significance of uncanny timing.

Just now, minutes ago, as I was working up the courage to open the CMS window and write the draft of this blog, I got a 1-800 call from an unknown number. I answered it, as I do with most of these robocalls, and was greeted by a kind voice named “ANNE,” reminding me that I’ve yet to re-elect my Obamacare insurance plan. According to “ANNE,” I have until Dec. 15 to do so.

And so, I have taken this kind ring from the Department of Health and Human Services as Some Sort Of Sign to finally deal with this. I implore you, our dear readers at Discourse Blog, to help me figure out what to do with my insurance plan, because my options suck.

I’ve had Obamacare — or “marketplace” — insurance for the last two years, since I (and the other writers of this blog) got laid off in 2019. Specifically, I’ve had an expensive bronze-ish health plan with Oscar.

The plan, the details of which I will get into down below, is expensive. It’s more than I’ve ever wanted to pay, or ever thought I would need to pay, for insurance. But back in December 2019, I elected it because I went in thinking I would only have to pay for it for a little while.

But to be as vaguely specific as possible, between the pandemic’s effects on, uhh, an entire country’s oil-based economy, and my own decision to spend more time working on Discourse Blog, I still didn’t have employer-based insurance by the end of 2020. And so when it came time to elect my marketplace insurance for 2021, I wasn’t in any position to refuse it.

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But now after two years of having Oscar, and one round of reevaluating my marketplace options, I am less than certain that paying more than (pause for dramatic effect) $360/month has been worth it for the coverage I’ve gotten.

I’ve been able to afford it on my contract work, coupled with the financial support we get from our dear subscribers, but a significant part of this insurance plan’s affordability came from how little I spent during the first year of the pandemic. I also felt desperate to get a plan that my therapist would take.

But even if it would have been cheaper to pay to see my therapist out of pocket than to pay for this insurance plan, I also justified the price point because it would allow me to go to the ER or stay at a hospital without accruing a (more) crushing amount of medical debt. In my 2021 plan, it would only (“only,” lol) cost me $1,150 to visit the ER, and $3,000 for room and board at a hospital. My out-of-pocket max is somewhere around $8,000, meaning I’d only be about $12,500 in the hole in the event of a very serious life-threatening emergency. I’ve felt OK paying this much since I could afford it, and that it meant I could hopefully avoid any of those real-life American horror stories where hospitals charge people hundreds of thousands for even the most basic of medical care.

I am sure there is a psychological component to why I feel the need to pay so much when maybe I don’t. Stereotypically, my fear of medical debt stems from the financial stress I grew up under. Just the other week, I got into it with my dad because he couldn’t remember taking me to the ER when I was 11 and had chickenpox. If he had taken me, he rationalized, my parents would have gotten a tremendous medical bill for it, and he never remembered one ever arriving. He remembered the chickenpox, yes, but medical debt is a recognizable scar of its own kind.

And maybe I’d feel less nervous — more prone to tell myself that I’m young and healthy and don’t need expensive insurance — if I wasn’t married to someone I want to stay alive for. But what little faith I had in my body’s ability to keep me safe vaporized through the pandemic. Nothing is a given.

And still, taking all of these things into account — my therapy, my ability to afford this expensive plan, my avoidance of medical debt — I am still not completely sold on the idea that this is the health insurance I need in 2022. Because over the last two years, I’ve had a less-than-optimal experience with Oscar, to the point that I am asking, what the hell am I paying $360/month for?

First, there is what I’m not getting with my Oscar plan — a health savings account, and also eye insurance (something that I am very much in need of, as I’ve been paying out-of-pocket for astigmatism contacts for the past two years). This is, to my knowledge, not an Oscar-specific problem, but just the way that marketplace insurance works. You have to buy plans that have these benefits built in, and, surprise surprise, that’s pretty difficult. HSA cards only come with high-deductible plans, unfortunately, while eye insurance isn’t a la carte like marketplace dental insurance. I wasn’t going to stress out about the eye insurance too much, given that I’ve done well with cheap contacts website rebates. And then my latest pair of glasses that I got four years ago broke in the spring, so I paid for an exam for an updated prescription out of pocket, too.

More importantly, though, there have been times when it seemed that, when I really needed to use my insurance, it wasn’t exactly coming through for me. To preface this, I must explain that Oscar provides free urgent care calls with a doctor and free virtual appointments with a nurse practitioner. Crucially, these people are employed directly by Oscar (it’s a health insurance company and a healthcare provider, because there’s no conflict there!) and you can only book an appointment with them through Oscar. It’s easier than getting an appointment with a primary care doctor, but not typically the most helpful.

Take the first time I actually tried to use Oscar for help with a new health problem, which wasn’t specifically Oscar’s fault, but seemed like it. I tried to get a virtual appointment with a new doctor for these ice pick headaches I’d been getting. Sometimes they were migraines, sometimes they were dull pains, but most times they were these pangs of lightning that shot right into my skull for just a few seconds, and then disappeared immediately. I got a prescription for caffeine pills from the Oscar on-call doctor, who called me over the phone within 30 minutes of me requesting an urgent care appointment. And then I scheduled an appointment for a month later with a local doctor over a video call (this is life on the open insurance market during a pandemic.)

When we finally met, it took her over half an hour to meet with me, and when she finally entered the chat room, I happened to have my camera and microphone turned off, and she left within seconds, presumably thinking that I had logged out. The headaches were so bad at that point that I burst into tears and called her scheduler to see if she’d get back on the video chat with me. I felt helpless, thinking my potential shot at relief would have to be postponed for another month. The doctor ended up giving me a call and getting me a referral for a specialist, along with other medication. I couldn’t make an appointment until the referral went through, but each time I followed up with the specialist’s office, they said they hadn’t gotten it, and irritatedly told me that they’d reach out to me when they did. I never went to the specialist, and stopped getting the ice pick headaches, though the migraines still persist.

Another time, a time that definitely seemed like Oscar’s fault, I had gone to my longtime OBGYN for a routine exam and some tests, and ended up with an unexpected bill for over $100. When I called the office, they said Oscar had denied the claim. When I called Oscar, they said the office hadn’t sent the claim, and needed to try to resend it. This, again, happened a few more times, until I just paid the bill out of frustration a few months later.

Which leads me to my latest and most upsetting (dra-ma-tic, I know!) interaction with Oscar, from a few weeks ago when I tried to get a referral for a dermatologist. The thing about Oscar’s referrals is that they are, to my understanding, a magic key to one free appointment from the office you’re referred to. So, instead of shelling out the $100 to see a dermatologist outright, for something as non-life-threatening as persistent acne, I scheduled an appointment with an NP in the hopes that they would refer me. Of course, I now cynically think that the whole point of Oscar advocating for its policy holders to book virtual appointments with its NPs and on-call doctors is to avoid an insurance claim from even an in-network medical office, under the guise of making healthcare more accessible. (Looking at a record of my insurance claims over the past year, none of the virtual appointments I’ve had through Oscar come up.) But at the time I was optimistic.

So I scheduled the appointment with the NP. I told her my problem with my acne, my skincare routine, how it won’t go away. And instead of giving me a referral, she looked through her list of prescriptions and decided to prescribe me Adapalene with Benzoyl Peroxide. It’s like Differin, she said, which is what she remembered using when she was a teenager. She went back into her prescriptions list to look up the directions — apply once a day. If it doesn’t work in a few weeks, she said, schedule another appointment with me and I’ll get you a referral. OK, I thought, maybe this acne cream will work! And if it doesn’t, I’ll get a referral anyway.

It took less than a week from the time I picked up the prescription for it to chemically burn my face off. Not literally, but over the course of five or six days, following the NP’s directions and the directions on the prescription, I managed to completely strip my face’s protective barrier, making it sensitive to even water. I should have paid attention to the signs earlier — my pillowcase was bleached, and my skin was dry. But it wasn’t until I was removing makeup and washing my face on the sixth night that I realized, holy shit, this stuff has fucked up my face.

I was in Colorado with two friends and woke one of them up to the sound of me yelling after I had put a handful of CeraVe night moisturizer onto my face, thinking it would help the burning brought on by washing my face with water and a CeraVe cleanser (this blog is not sponsored by CeraVe, but for those of you familiar with these products, you know they’re known for how easy they are on sensitive skin!). After I wiped off the moisturizer, washed the area with water, and let the burning dissipate, my skin got so taut I looked like I was wearing a facial mask. I went to bed with my face burning, convinced when I woke up I’d be able to at least wear moisturizer again.

For the next week, I only washed my face and sealed it with petroleum jelly, the only thing that didn’t make my face feel like it was on fire. Back home, I made another virtual appointment with the next available NP, explained to her what happened to my face, and begged her for a referral, which she kindly agreed to.

Of course, there is a part of me that wants to think that maybe it was just one particular NP who didn’t know what she was doing, and that this wasn’t directly Oscar’s fault — even the second NP’s help proves that. But I also wonder if I could have avoided this incident altogether if I hadn’t been so won over by Oscar’s “$0 virtual care” visits that it pushes on policyholders, and had just done the traditional thing that people use insurance for, which is booking a doctor in its network. Again, I am left asking myself, why am I paying $360/month if this is the level of care that Oscar itself advises I go with?

There is a light at the end of this face story. My appointment is for the first week of January, a little over two months after the Adapalene incident, and I’ve already checked with Oscar to make sure I won’t need another referral since the appointment will take place in a new coverage year.

Which is, of course, only something I will need if I stay with Oscar and its expensive bronze plan. The most obvious alternative would be to join my husband’s employer plan, but it would cost us $200 more than what I’m already paying Oscar. (And ICYMI, his employer-based health plan is not the saving grace it should be.) The less-obvious-but-still-obvious alternative would be to find a salaried job that offers insurance, but I don’t think I need to explain the hoops I’d have to jump through to make that happen.

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And so I’m left to my devices, but my devices — aside from the recommendations from you, dear readers — kind of suck. Really, I’m stalling to see what kind of plans are available to me for this next year, partially because it takes so much time filling out the intake information for the marketplace, but also because I’ve gone through this whole process twice, doing the calculus on what makes the most sense to pay up front given what I’m getting in return, and twice I’ve felt screwed over regardless of the effort I’ve put in.

I already know this plan is rising another $10/month next year, after jumping up $20/month this year, so I’m already feeling screwed. And from what I can remember, this year will be much of the same: either get a low deductible, high premium plan that may save your ass but still doesn’t seem to pay for itself, or get a high deductible, high premium plan or a high deductible, low premium plan that covers your ass, but not enough should disaster strike. You’re damned whichever way.

Which I know is a loaded complaint coming from me, because again, I am someone who is able to afford the premium insurance that could make the difference between surviving a life-threatening accident or not, let alone getting to walk away from it with only a few thousand dollars of debt instead of tens of thousands. I guess I’m tired of trying to reason my way into paying so much for health insurance, when it’s getting harder for me to rationalize these specific benefits with this specific provider.

And so I turn to you, dear readers of Discourse Blog, to ask, nay, beg you to tell me what I should consider doing with my health insurance in 2022, in lieu of moving to a country with universal healthcare. Are you on a marketplace plan (in Texas, ahem) that you recommend? Have you gone with some private insurer that seems to be serving you better? Do you have discount prescription cards handy? Are you, too, worrying over what you should do for your health insurance over the next year? Please, share with me your secrets — the future of my face (and, of course, my health and ability to live a long and medical debt-free-ish life) depends on it.