I was in medical school. I understand how to advocate for myself and for my health when I'm in these appointments. I can talk with lingo that physicians understand and I often can identify immediately when there's something going on in my body that needs medical attention. I have my medications memorized--both generic and brand names plus formulary/non-formulary status according to my insurance-- and their doses.
Now I'm in public health. I have a pretty solid grasp of insurance. I understand the marketplace--I've never needed to use it myself, but I can navigate it easily. I know what I want/need out of an insurance plan. I understand how deductibles, co-pays, co-insurance, and max-out-of-pocket all relate. I can tell you better than most insurance representatives precisely what is covered by my plan and how much I pay in co-pays at general, specialist, urgent care and emergency room visits. I have my plan ID number memorized and I can tell you how much each of my many medications costs after insurance.
But through no fault of my own, I recently learned that I haven't been on health insurance for almost a month.
You see, I got a new job starting in August that paid for my insurance. It turned out to be a better plan than the one I was on with my family, so I started the process to drop my old insurance and was automatically enrolled in the new plan through UNMC. I wrote a letter to Nebraska Medicine per the protocol with Blue Cross Blue Shield to ask that my deductible met so far this year be rolled over to my new plan (they often do this if you switch midyear, but you have to write a formal letter and go through the process).
So far, so good. The plug was pulled on my family's plan at the end of August. I hadn't heard yet from the student health plan provided by UNMC, but that's okay cause they weren't going to send a physical insurance card until late September, as far as they told me, no news was good news.
Turns out, I didn't have any insurance...which I didn't find out until after I had gone through many X-rays and a specialist visit. The office couldn't figure it out and didn't want to deal with it so they sent me away. I had to physically visit the student health coordinator (1st unnecessary visit to deal with problem) and call about 10 people between 3 insurance companies to find out that "there was something 'hanky' with [my] application, so we put it in a separate pile of people we can't easily enroll" (direct quote from someone at the enrollment insurance company) (1st instance where I spend hours on the phone dealing with the problem). I asked this kind lady if anyone was going to bother following up with any of these "hanky" applications in insurance enrollment limbo, but she said that's it's not their protocol to do so--at this point I'm SERIOUSLY concerned for anyone else at UNMC that maybe had a "hanky" application...you do not have health insurance and you have no idea.
Eventually, I got enrolled in the plan (that was supposed to start 8/24/15...it's now one month later and the only reason I got enrolled was because I called to get it figured out), but they still can't send me a card to present at a physician. I begged for the policy and ID# so I could just freaking go to the doctor.
I show up at the physician's office and they are not super happy to not have a physical card to copy and put in their records, but I promise to bring it to them just as soon as I get it in the mail (2nd unnecessary visit). Then they ask me why I don't have a referral to see this physician. Which makes absolutely NO sense. I've seen this guy for 3 years now. I don't need a referral to see someone I'm established with. Apparently I do with this new insurance so I called to get the referral (2nd unnecessary phone call to receive referral to physician I am an established patient with...now will need to do this for every appointment with this physician and all others in the Nebraska Medicine system I see).
Appointment goes wonderfully and I head to another appointment to get a PPD skin test placed (to test for TB...a requirement of all UNMC students and faculty each year...which I know because I've been at UNMC for 1,000 years, but no one actually reminded me about it--it's a good thing I've got this health literacy down, eh?). I show up and the nurse has no idea why I'm there, even though I made the appointment on Monday. In person. Eventually we get there.
Knowing what a hot mess this whole process has been, I go to verify my enrollment into the insurance plan AND that it correctly got into the electronic health record (3rd unnecessary visit). The student health coordinator cannot ascertain that herself so she must call the student health enrollment person (3rd unnecessary phone call). The enrollment person is out for 10 days, so no one on the UNMC side can verify that I have been enrolled completely--this after 10 minutes of calling 4 different departments and an insurance company.
While I'm there, I ask about the referral nonsense. She verifies that I need a referral to every physician I see, each time I see them. I ask to get referrals created for the appointments I already have scheduled, which she grants. She asks for a list of my physicians. I give her the list of 5 (just at Nebraska Medicine--these are people I've been seeing as an established patient for 3 years), she panics and leaves to talk to the student health provider. I have only see this student health provider once for a flu test--she's not my primary care person and she wasn't on staff when I had my initial referrals 3 years ago, but she is CC'd on every single note and healthcare visit that I've ever had at Nebraska Medicine and she has access to my chart. This APRN requires that I have an appointment with her before she will give me any referrals to any other physician--you know, the ones that actually know me and I'm established with (4th unnecessary appointment--of course this cannot be done in conjunction with reading my PPD/TB spot, so I will have to pay 2 copays to get this done). Okay fine, I'll see you on Friday.
Now back to the insurance thing...officially I didn't have insurance when I had the first appointment that tipped me off to this whole debacle (well, I did but it wasn't in any system, so it doesn't count as far as they are concerned). This means that I will get sent the whole bill from that appointment which I will need to take into both the student health enrollment person and the Nebraska Medicine accounting/billing department, so that they can re-bill through the insurance (5th and 6th unnecessary visits) and send me an accurate bill. I would imagine that this will require at least one phone call also (4th unnecessary phone call).
I have probably spent 5 hours on this since Monday alone and the process is far from over.
It is lucky that I have the health literacy and education that I do to know what to say and how to advocate for myself and my healthcare with the right people. Most people don't have that. I can usually get a good idea of who to call right away, so I can avoid the long hours on hold or being transferred between departments. Most people don't even know where to start. It is also lucky that I have the time/am able to make the time to deal with this problem. Most people don't have that time during business hours.
The system has failed me over and over and over again this week. It's not the first time and it certainly will not be the last. And there is absolutely NOTHING I can do about it to make it better. There's not even really any one specific person or department I can write to or call to complain (thus, I complain to you, dear readers).
But this needs to be talked about. This systematic breakdown is not new. It's no fault of the Affordable Care Act. It's no fault of the individual physicians and other healthcare providers that I see. It's no fault of the student health coordinator, she's just doing her job. It's the fault of the system. We need further reform and transparency of the system itself. This is especially true for those with low health literacy who have no idea how to navigate the system and for chronic care patients who are juggling lots of balls in the air, but have no one advocating for and with them to not get screwed and drop everything.
My best advice to you, is to know your body. Know your health insurance. Know how to advocate for yourself. And don't back down because people will pawn you off as not being "their problem". The system is broken, don't just follow it blindly into the rabbit hole.
Or else you could unknowingly end up without health insurance for a month.
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