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The Billfold

I Want to Love My ACA Health Insurance but It’s so Frustrating

I don’t know if this is the ACA’s fault or my insurer’s fault.

Photo credit: WerbeFabrik, CC0 Public Domain.

So let’s recap all of the things we currently know about my health insurance plan.

First, for the second year in a row, premiums have risen significantly:

[In 2017], my Bronze plan’s monthly premium will increase by 19 percent to $293.08, and I’ll have two deductibles: $4,500 for medical, and $1,500 for pharmacy. My out-of-pocket maximum will jump up to $7,150.

Second, although my insurer hasn’t changed, the doctor I’ve been seeing for the past three years is no longer in my network:

I learned that my former OB-GYN is no longer in my network, which I kind of already knew because I got this letter from the medical provider saying they were no longer in my network, but then I got another letter from the medical provider inviting me to make an appointment, and I went on to my health insurer’s website and it claimed the OB-GYN was in my network, so I called the medical provider and confirmed that they really, really weren’t in my network. (When I asked why my health insurer’s website claimed they were, they told me the health insurer’s “find your doctor” database probably hadn’t been updated yet.)

Third, I just learned that I couldn’t even use the walk-in clinic down the street without a referral from the primary care provider that was assigned to me with my new health insurance plan.

Here’s what happened:

Two weeks ago, as you probably remember if you’ve been following Do 1 Thing Thursdays, I started trying to set up an OB-GYN appointment so I can get my annual Well Woman checkup and my birth control prescription refill.

After confirming that the OB-GYN I’d been using for the past three years was no longer in my network, I walked into the walk-in clinic (where I got my physical and my T-DAP last year, so I’m already a patient on file) and asked if they still took my insurance, if they did Well Women appointments, and if they could refill birth control prescriptions.

Yes, they told me. We take your insurance, and we can give you a wellness exam, which is a little different from a Well Woman exam, but it’ll still let you refill your prescription.

So I made an appointment, adjusted my work schedule to have the afternoon free, and went to get the thing done.

That’s when the clinic people told me that my insurance would only cover the wellness exam if I had a referral from my primary care provider.

“You need a referral? For a walk-in clinic?” I asked.

I tried to get a little more clarity; like, if I needed pinkeye medication or a flu shot, would I still need a referral? They couldn’t say. They did tell me that I could contact my insurer and make them my primary care provider, which… I went onto my insurer’s website to check the list of eligible PCPs and neither the clinic nor the individual doctors that work there were an option.

So I called the office of the PCP whom my insurance had assigned to me and set up a Well Woman appointment for next week, which means taking more time away from work and making up the hours. The person doing the intake kept asking me if I wanted to change my PCP, since I hadn’t been seen by this doctor before, and I was all “if this is the person assigned to me, might as well meet them!”

After all, I might get pinkeye in the future and need a referral. (I am definitely going to ask about the walk-in clinic thing when I have my appointment.)

The point of all this is that as much as I want to love the Affordable Care Act, and as much good as it has done for many people I know, it’s still so frustrating. This might be less the ACA’s fault and more my insurer’s fault, or maybe the medical provider that pulled out of my network’s fault. I don’t know.

Yes, I know that my Well Woman exam will be free (or assumedly free, unless they decide to run additional tests) and that my birth control prescription will be free—but in the past two years my Bronze plan premiums have gone from $219.38 to $293.08 per month, so “free” feels a little relative.

I want to end by sharing this comic from The Nib, about life pre-ACA:

Nomi Kane explains that in 2009, she got laid off and eventually ended up in “a state high-risk pool, the same kind Republicans say will be available to Americans with pre-existing conditions under the proposed American Health Care Act.”

Her premiums, that year, totaled $4,000.

My current premiums, in an Affordable Care Act Bronze plan, come to $3,516.96.

I’m guessing that premiums in an AHCA high-risk pool will be even higher—but it’s astounding to think that insurance costs have risen so much that my Bronze plan is now as expensive as a state high-risk insurance pool was eight years ago.



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Nicole Dieker

Nicole Dieker

Freelance writer at Vox, Bankrate, Haven Life, & more. Author of The Biographies of Ordinary People.