Uncovered California: Adventures in health care

Edit post

  • Published on September 29, 2016

Lisa Napoli

I arrived a few minutes early to this highly recommended GP/internist for my first complete physical in five years. The office was stylishly decorated, no obnoxious TV, and instead a lovely trickling fountain and soothing music — more like a yoga studio than an antiseptic doc shop. A kind attendant greeted me warmly. I’m gonna love this doctor, I thought!

I handed over my insurance card and received the requisite paperwork in return. Of course I’d cleared that they accepted Anthem before I arrived. I noticed a sign at the desk that proclaimed “WE NO LONGER ACCEPT COVERED CALIFORNIA” and felt bad for those who would be turned away. Covered California is a scarlet letter in the medical world. No doctor seems to accept it.

A few minutes later, the nice lady asked me to step behind the door. Wow, I thought, this doctor is so efficient I’m gliding right in to the appointment. When was the last time you didn’t have to kill time waiting at a doctor’s office. Well, no. The lady informs me, in a hushed voice to respect my privacy as if I’ve done something wrong, that my insurance isn’t accepted.

“But you said you took Anthem?” I insisted.

“But this is Covered California,” she countered, whispering again, because now I was really tainted goods.

“No it’s not, it’s Anthem,” I insisted, pointing to the logo. Anthem, that fabulous company that just announced premium increases of 20%, meaning come the new year my insurance is soon to be the cost of a monthly lease on a starter Mercedes instead of the monthly lease on a VW that it currently is.

A nurse came over and pointed to a tiny seal at the bottom of my insurance card.

“You have Bronze Pathway PPO,” he said. “That’s Covered California. We’ve billed them with this insurance before and they don’t pay. Your employer should have explained…”

“I don’t HAVE an employer. I pay for this myself. All I wanted was a physical for the first time in years…” Thank god I’m healthy, I thought.

They both looked at me, kindly, and sadly. The doctor (whom I recognized from the picture on her stylishly designed website) scurried out of one office, into another, averting my glance. I parried, not wanting to waste the trip:

“How much would it cost to see the doctor without insurance?”

“$300,” the nurse said, anticipating my next question. “Blood work could cost $300-$600 extra, depending on what you need.”

Deflated, I left the office, determined to use my pricey health insurance rather than forking over all this cash unnecessarily, trickling fountain or not. This is what I’d already did with the eye doctor, since it turned out to be cheaper to pay cash than get Anthem involved. Of course, calling Anthem is an impossible exercise in agitation. A few years ago, I was engaged in a protracted battle because they somehow never received my monthly digital payments, kept threatening to cancel my insurance, and then sent me a check for $12,000 (and THEN threatened me when I ripped the check up instead of “sending it back.” They only knew I received it because I managed to get through and clue them in to their error. Stupid, honest me, didn’t try to cash it. THAT would have got their attention!)

I steeled myself to be positive, and dialed the phone anyway, and when the call got dropped, twice, I resorted to the Internet. Thank god I’d saved my password, sparing myself the incessant feedback loop to reset it, though that one is easy to remember: ANTHEMSUX. A list of nearby doctors appeared in response to my search query. Doctor one: Oh, we don’t accept Bronze PPO. Me: But it says you do on their website. Them: Sorry, we keep asking them to take us off, but no luck. We even asked to be a Covered California provider, but they won’t respond.

Feeling slightly better that even doctors get ignored, I called a few more on the list and finally found one who was accepting new patients in a month or so. I could wait. Thank god this wasn’t an emergency! Hours of back and forth ensued where she pieced together what she needed to verify that yes the office did accept my particular brand of Anthem. Finally, she determined that they do, but because I had not met my $5000 deductible — thank god I was healthy! — it would not cover the visit.

So how much would the visit cost?

“Well, it won’t cost anything, up front. We’ll bill Anthem and then you’ll have to cover the visit, and the bloodwork.”

“But, what will Anthem charge me?,” I said, angry with the doublespeak. I repeated, “What is that going to cost me?”

“I’m not sure.”

“Let me ask a different way,” I said, thinking about the hundreds of dollars I save by paying cash at the eye doctor rather than having his office bill back the extortionate “rack rate” of an “insured” visit. “If I walk in off the street and want to pay you cash, no insurance, how much will it cost?”

“$170 for the visit. $100 for the bloodwork.”

Okay, sold, I said, and locked down a date on the calendar. Thank god I don’t have a regular job right now. How could I ever take care of business?

UPDATE: I got through to Anthem today. A nice person explained that many doctors don’t like the individual plans, because the rates they’re paid are lower than through group plans.

One clap, two clap, three clap, forty?

By clapping more or less, you can signal to us which stories really stand out.