pameladean: (Default)
I was planning to do a photo essay about a recent visit to the Eloise Butler Wildflower Garden, and still plan to do one, but right now I feel impelled to write about health insurance. Not in the way that you may think. This year, David and I have insurance through MNSure, thanks to the Affordable Care Act. I am really grateful for having had insurance, and tax subsidies to help pay for it, for the past four years. And I want to dedicate this account, with an extremely unpleasant expression involving crossed eyes and a stuck-out tongue, to former Senator Joe Leiberman, who fucked up the possibility of a much better system than what we ended up with.

About a month ago I had several nights when I couldn't sleep because things in general hurt. I kept thinking that I must be coming down with the flu, but I never did. Then instead of a general achiness I started having specific muscle pains that couldn't in any way be correlated with unusual or even usual exertion. They came and went in no pattern and with no cause. Then I started feeling a really strange sort of dizziness. I can get postural hypotension from my blood pressure medication, but this was much weirder than that and, like the aches, didn't really correlate with anything.

An acquaintance posted on Twitter that her statin had been causing dizziness and brain fog. Wait, I thought, muscle pain can come from statins. I read the patient information sheet and stopped taking my Lipitor. I ought, of course, to have called the clinic and left a message for my doctor, but I was busy. I don't even have high cholesterol. I just have a 14% chance of some kind of cardiac event over the next ten years, according to some calculation the state of Minnesota does, because of the hypertension, type 2 diabetes, proportion of good and bad cholesterol, and possibly a few other things that I've forgotten. On the basis of this calculation I was advised to take a statin and daily low-dose aspirin. So I figured stopping the statin for a little while wouldn't do any harm.

Within 48 hours the aches and dizziness had vanished. On Monday I tried to send email to my doctor, but there wasn't an email button under his name in the list of my "Care Team" on MyChart. I could have emailed my eye doctor, the nurse practitioner I've seen for a few minor ailments, or the diabetes nurse who showed me how to use a glucometer. But they hadn't written the prescription. I finally scheduled an appointment with my doctor, since I'm due for a bunch of lab work anyway; and in the space left to explain why you want an appointment, I explained about the side effects and stopping the statin.

The clinic called and asked me to call back, and when I did the nurse I talked to asked if I would be willing to see a different provider so they could get me an appointment sooner than Thursday the 18th; and I was willing, so she scheduled an appointment for this afternoon.

When I arrived I went to the registration desk, and the clerk told me with every evidence of sympathy that the clinic was not in network for my insurance plan and they would have to cancel the appointment unless I wanted to sign a consent form saying I would pay out of pocket. She also said that I was enrolled in a HealthPartners Medical Assistance plan, which I knew I wasn't. MNSure checks this for you when you give them your income information, and we aren't eligible for Medical Assistance. So I hoped that if I could get this part straightened out maybe they'd let me have my appointment. I had been pretty sure that the clinic was not in network for my plan -- it is in network for some specialties like chiropractic services and chemical and mental health, which initially fooled me into thinking it was generally all right for my plan; but it's not in network for primary care. I'd been able to get my medications from the pharmacy all right, and I really didn't want to change clinics, so I hadn't done anything about it. I said I'd pay out of pocket -- I know about what they charge for visits and this was a short one; and I wasn't actually worried about the statin, but it seemed to have sent the clinic staff into a tizzy that I had stopped taking it without consulting anybody -- and then I knew I'd really have to change clinics.

So I signed the form and went upstairs, in the nick of time for my appointment; but the poor clerk came running up the stairs and caught me. Her supervisor had "come by" and said that no, really, I couldn't have the appointment. They were legally required to bill the insurance company, and then the claim would be denied because the clinic was out of network, and "that would be a problem." I didn't see any point in inquiring further into this; I could see many possible reaons that they would prefer not to be billing plans that would not pay them.

But, she said, she would take me to the office of the financial counselors, who would help me change my plan so that I could stay at the clinic. I was pretty sure that this would work only if I really were on Medical Assistance, but I went with her and explained my situation to the counselor when they called my number. The counselor said that there had been some kind of confusion with HealthPartners assigning a lot of people to Medical Assistance who weren't on it, and she had fixed that part of things in my records, but the clinic was still, really, out of network for my plan.

I walked home -- at least it was a lovely spring day -- and called the nearest Park Nicollet clinic and got an appointment with the doctor of my choice -- from a list I'd made in January before I got stubborn and busy and didn't follow up with the change of clinics -- for Thursday, May 18th. I didn't laugh at the very nice woman on the phone who was helping me, but I laughed afterwards. I then had to call my dentist and move a hygiene appointment from that date to the following Monday.

I got an automated message from MyChart saying that my appointment of today had been cancelled. The reason given was "scheduling error."

I'm sure the new clinic will be fine, but Joe Leiberman can go jump in some really nasty polluted lake.

pameladean: (Libellula julia)
So I filed our taxes late again and am therefore only now narrowing down the not-very-appetizing choices remaining on MNSure for health insurance for David and me. I found a pretty good and a slightly better plan; the first is through Health Partners and the second through UCare. Both of them have a lot of complaints on the BBB site and scattered about here and there. My mother, who used to work for an insurance company and still has an interest in how they operate, is not very enthusiastic about Health Partners, though the anecdotal evidence she has is somewhat outdated. Health Partners seems to have inspired a lot more annoyance and dislike in the people it billed for premiums they had paid, whose doctors it made repeatedly re-authorize the same prescriptions, and so on. I have had a UCare plan before and, aside from having a very primitive website, they did not do anything egregious during the year I was their customer. But the Health Partners plan has a lower co-insurance and a lower co-pay. What to do, what to do? I'm leaning towards UCare, partly because they use the Fairview provider network.

A major annoyance in all this is that no plan available on the exchange includes HCMC in its network. I've been at HCMC since 2002 and I really don't want to leave, but we are eligible for quite a hefty subsidy on the exchange and really couldn't afford any health insurance if we had to pay all of it. But I am viewing all other provider networks with a very jaundiced eye. Anyway--

If anybody has experience with either provider that seems relevant to this choice, I'd love to hear it.

Thanks so much. One day I will make a post with actual content.

P.S. The upshot of the last problem I asked for advice about was that [ profile] lsanderson most kindly came over and took down all the tiny trees with a Sawsall and a green-wood blade. He did this on the last day before it snowed for the first time back in November. I failed to bundle up the branches in time for the last yard-waste pickup of the year and was still contemplating doing so and calling the city, as the city say sone may, to arrange for an out-of-the-ordinary yard-waste pickup. In the meantime I took [ profile] coffeeem's recommendation of A-Tree Service, and they dealt with the larger trees that had got tangled up in the powerl ines, and with the one branch of the Chinese elm that was hanging threateningly over the garage and rubbing on the tree's main trunk while it did so. The day, which involved Xcel energy's dropping the power lines and the power consequently being out for about five hours, felt quite traumatic at the time, but it all worked out well aside from the hole left in the bank account. As a very nice bonus, when they cleaned up all the branches they had cut themselves they also took all of Larry's. Thanks to all who made suggestions and recommendations.

pameladean: (Libellula julia)
I forgot to include this in the previous post. When one is diagnosed with diabetes, at least at an HCMC Clinic that uses MyChart, a huge raft of obligations springs up in one's list of Matters that Require your attention, all marked "overdue" even though you had no idea about any of this just the day before. I've been doggedly working my way through them (microalbumin test; dilated eye exam; diabetes education, which is one three-and-a-half-hour class and three two-hour classes; a foot exam with the dread word "monofilament" in it, which makes me think nervously of Sinclair monofilament, though in fact I have looked up the exam and it is no such thing). I was most worried about the eye exam, but put it off because most insurance plans within our reach, even with subsidies, do not cover routine eye care. I hate insurance companies. They should not be allowed within a million miles of anybody's well-being. Anyway, I had the eye exam last week and everything was fine; the diabetes has as yet had no effect on my eyes. They are a little the worse for wear after 63 years, but the ophthamologist said, "Your eyes look very healthy" in a tone of faint surprise.

The classes introduced HCMC's preferred dietary guidelines, which will drive me to distraction if anything does. "Diabetes," said the first instructor, "likes consistency." I hate routine. I hated it in kindergarten, I hated it in high school, I hated it when I had a day job, and I still hate it. Eating at the same times every day, keeping the same bedtime day in and day out, timing snacks, timing exercise, argh. My only comfort is that I have not been at this very long.

Anyway, any thought I had of controlling things by diet and exercise alone has been thoroughly squashed, so I'm taking metformin. After a month of 500 mg, it and my digestive system had come to a cautious truce, at which point, naturally, the medical profession decided to raise the dose. I complained at length both about having to take it twice a day and about the probability of more digestive side effects, so they gave me an extended-release version, which is taken only once a day and has fewer reports of nasty side effects. Not wanting either last Friday's hike or my weekend generally to be messed up, I collected the prescription last Thursday but only took the first larger dose this evening.

I've also spent quite some time down a research rabbit hole about possible ranitidine (Zantac) and metformin interactions, but concluded after squinting through a bunch of scientific papers and finding starkly contradictory statements on various websites for the use of laypeople, that nobody knows much about any of that and I should quit worrying over it. In addition to hating insurance companies, which I feel is quite a rational attitude to maintain, I also, with far less good reason, hate patient information sheets. I have hardly ever read a one of them that didn't send me into a tizzy for days. I don't think they strike the right balance between accuracy about the likelihood of the things they warn about, and specificity about the symptoms one should be on the lookout for. To me they all read like this: THIS REACTION IS VERY RARE BUT IT COULD KILL YOU! EVEN IF IT JUST SEEMS LIKE THE FLU, CALL YOUR DOCTOR! COMMON EVERYDAY MINOR SYMPTOMS COULD MEAN YOU ARE GOING TO DIE!

I think that's enough complaining for one entry.

pameladean: (Libellula julia)
On April 26th I went to the doctor for a regular checkup and lab work. My blood sugar came back elevated to the point where I was diagnosed with type 2 diabetes. This diagnosis triggered a huge number of Get this test, Get that exam, Here have a glucometer, No you don't have to start on metformin right away but you might need it so get ready, Take these four three-hour diabetes education classes, Talk with a diabetes education nurse (she was fabulous), Check your blood sugar first thing in the morning and two hours after beginning to eat your largest meal of the day, Hmmm given those numbers try exercising for 15 minutes an hour after eating dinner. I haven't seen a nutritionist yet but it's on the list.

I am not exactly surprised. Numbers have been creeping up for years despite periodic attempts to expel added sugars from my diet or at least be mindful of where they were and approach them with caution; both my grandfathers were diabetic. However, I am considerably more thrown for a loop than I would have expected.

In 2002 I was diagnosed with hypertension in the ER. Those numbers made everybody's eyes very large and caused them to rush around with heart monitors and ask me a lot of questions. Eventually they ruled out things that would kill me at once and sent me off with a prescription for a beta blocker and instructions to go find a primary care practitioner at the clinic. Nine months later, after trying about twenty drugs in various combinations, my PCP sent me off to a nephrologist to make sure my kidneys weren't turning the wrong kinds of cartwheels. In the regular clinic, my BP numbers made everybody get very quiet and look at me as if I were about to keel over. In the nephrologist's office, the nurse assigned to handle me addressed me as "young lady" (I was 49) and said, "We have patients with much worse numbers than that, and on more medications. We'll fix you up." They did, too; there was nothing wrong with my kidneys and they found a combination of meds that worked.

Similarly, while my blood sugar was sneaking up on the scary invisible line, everybody was very sober. Once it leapt over, suddenly my doctor was very cheery. "Oh, I've got patients with much worse numbers than that, and those are very hard to get down. You can get yours down."

I'm not sure if this is more reassuring or unnerving. Anyway, I've been sulking and dithering and sitting on the news, and I decided that it was time to stop that. Plenty of people live with diabetes. The new regimen and the knowledge that there are more changes to come are making it hard for me to work, but I will try to get over myself.

pameladean: (Libellula julia)
P: "I'm really sorry, sweetie, if I gave you my cold."
R: "I don't blame you, I blame evolution. Viruses are a fucking bad idea."
P: "Well, they're a good idea for VIRUSES, aren't they?"
R: "Get away from me with your situational ethics."

I have a really stellar camping trip with [ profile] arkuat to write up, but at the moment I'm alternating blowing my nose and getting ready for the MinnStf meeting we're hosting on Saturday. At least by then I won't be contagious and can make the vegetarian portion of the dinner offering without fear of supporting viruses against the human race.

pameladean: (Libellula julia)
But it was -- not an epic. Not a saga. Not exactly a comedy of errors, for which actually I am grateful, as those are generally far less entertaining to be in than to witness.

However, it was closer to a comedy of errors than to anything else; so, with that in mind, I present to you the following story.

Last year the MNSure website really didn't work right. Before I discovered this, I cheerfully clicked around and did stuff to see what would happen. What happened was an application of such profound borkedness that I had to call MNSure and wait on hold to annoying music for a period of time I then believed would be etched in my memory forever, but which in fact was not. I was eventually connected to a very pleasant and patient person who finally said that I seemed to have two applications running and they would have to be deleted and I would have to start over. In the meantime, I provided my back-of-the-envelope judgement of what our income was. I was, as it turned out, wrong, and we would probably have been eligible for tax subsidies, but it was a reasonable estimate for the amount of information that I had. We were at that time three years behind on filing our taxes (DON'T ASK), so I didn't have very good information. The helpful person said that I really should fill out the application but that if my numbers were right, we were not eligible for tax subsidies. He would see that the duplicate applications were deleted, if I could hold.

So I held and held and held and held until I had to hang up in order to preserve my sanity from the music. It's not that it was egregiously and obviously horrible, it's just that there are very few things that I can listen to for two hours. And if they had music that I could listen to over and over for that long, plenty of other people couldn't.

I never was able to start a new application, nor did I ever get through to MNSure on the phone again.

In the end, I used the MNSure website without logging in, to compare plans; chose one; and bought it at the website of the insurance company, PreferredOne. They had by far the cheapest plans, but there didn't seem to be major complaints lodged against them in any public venue I could discover, the coverage was as reasonable as that of other plans (which is to say, pretty crappy, but that is what happens when you engineer a health-insurance law to make the insurance companies happy), and the deductible wasn't too horrible to contemplate.

On the whole PreferredOne did all right for us, with one major exception: They do not pay for flu shots in a retail setting. I went to get my shot at Walgreens in mid-September, and discovered this. When I called the clinic, they said they'd be offering flu shots beginning the first week of October. When I called again that week, they said they didn't actually have the flu shots yet. I went back to Walgreens and explained the situation, intending that they not have to bother to look up my insurance again, since determining that PreferredOne had this arcane and anti-public-health policy had taken a while -- PreferredOne certainly didn't tell ME about it at any stage of things. The Walgreens clerk said, "Well, if your clinic doesn't have the vaccine, we can give it to you free," and so they did; so it all ended well enough, but I was extremely put out at this policy and had already decided to change insurance companies when Raphael informed me that PreferredOne had dropped out of MNSure. I got a letter from them not long after. The premium for the plan we were on had very nearly doubled. They suggested alternative plans with premiums closer to what we had been paying, but they all had enormous deductibles attached. Besides, having done All the Taxes, I knew that we were eligible for a tax subsidy.

I accordingly went to the MNSure site when open enrollment began, and was unable to log in or start an application. I called them and was on hold for about 45 minutes. The new pleasant and helpful person sorted me out fairly rapidly: I still had one application active from last year, and that would have to be closed out. She did this and walked me through the login and password reset, and it all worked.

At this point the first real instance of user error rears its ugly head, though I feel MNSure has to share some of the blame. I did not carefully read the Enrollment Tips, since I had, however fruitlessly, gone through the same process the year before. I put in all the information that I had. David and I are both self-employed at this point, and we have a bizarre patchwork of short-term contracts, rental income, royalty payments, consulting income, and one-time things like David's teaching at a local community college or having a print sale, or my selling an essay or the reprint rights to a short story. I put in what I had, hit "Save and Exit," went back with more information as I collected it, hitting "Save and Exit" each time; and finally went to put the last of the information in. I could not get back to my application. I looked at the Enrollment Tips, and discovered that to avoid common system errors, one should clear one's cookies and history, and one should complete the application in one sitting and not hit "Save and Exit." I feel very strongly that if the "Save and Exit" button causes trouble it should be disabled, or else there should be a gigantic red banner telling you not to use it under any circumstances, not a politely-worded Minnesotan suggestion that maybe, on the whole, you should not do that.

Anyway, I cleared my cookies and history and tried again. No good; though I got a different error this time.

I called MNSure. Only half an hour this time. A pleasant, helpful person who sounded very much like the last one, but whose name I once again did not catch, walked me through what happened and said, "I've never heard of that happening. I don't know what to do." I have heard these words or similar ones before, but mostly from David when something goes haywire with my computer or my smartphone. The nice person collected herself and went to consult other nice people. In the end, she said they'd get rid of the application, and I should do it over and do it all at once this time.

This was only mildly annoying, so I did it, and I was instantly informed that we were eligible for tax subsidies in X amount, and I could view insurance plans with that amount subtracted from the actual premium. So I did that until my eyes crossed. If one wants to know what "tier" one's medications fall into and what providers are in-network for any plan, one has to click through to the insurance company's website. I don't suppose, on sober reflection, that the insurance companies actually don't want you to have the information; but they don't make it very easy. Each plan has slightly different providers, so that, say, a Silver Best Choice Grandiose Fireworks plan might include my clinic, which I do not intend to leave; while a Gold Best Choice Grandiose Fireworks plan might not include it, but a Gold Okay Choice Magnanimous Flowery plan might. This is the case for all the insurance companies on the exchange and all of their myriad plans. And I imagine that the insurance companies' websites were being hammered by all the people checking the same information.

In any case, this was Thursday December 10, and the deadline for enrolling for insurance coverage beginning on January 1, when the old PreferredOne plan would expire, was December 15. So I decided to take a break, rest my brain and eyes, and consult David in case he had any opinions. Here is the second place that user error comes in; though, again, MNSure has to shoulder some of the blame. I had finished my application, I reasoned, so it was okay to hit "Save and Exit."

When I went back the next day and logged in, I landed on a page with two options. The first was "Enroll in health insurance without financial assistance." The second was a notification that my application's status was "Pending."

Here is the third instance of user error. Since I did not want to enroll in health insurance plans without financial assistance, and since I had caused a lot of trouble to myself last year by cheerfully clicking around to see what would happen, I did not try that button.

I called MNSure. Two hours on hold. I got a third pleasant and helpful person, who said that since I was having technical difficulties enrolling, they would do a manual enrollment for me. She verified some of my information again, asked what plan I wanted to choose, and said that she had done the first part of the manual enrollment, but that somebody would have to call me back to verify the information again. She said they would make the utmost effort to do this by the deadline, but there was no guarantee. She said it would be a good idea for me to check on the progress of the application by calling regularly.

I was glumly contemplating several days of waiting for a phone call from MNSure and being afraid to take a shower or go anywhere without cellphone service, when the current nice person called back to say that she had not actually completed the manual enrollment because the application was still listed as Pending, but somebody would do it as soon as the application was processed, and the rest was the mixture as before.

I logged in on Saturday, December 13. My application was now listed as "Processed," so I figured I had a plausible excuse to bug them. When faced with the MNSure menu of options on earlier calls, I had chosen the one for technical issues, but this time I chose "Other." That resulted in a wait of only twenty minutes. The final pleasant and helpful person said that he could certainly finish the manual enrollment, but now exactly what was it that happened when I logged in? I told him. He excused himself to consult other nice pleasant helpful people. When he returned, he told me that if I pressed the button for enrolling in health insurance plans without financial assistance, my application should pop up with our allowed subsidy amount in it, and I should be able to view plans and enroll in one.

I clicked on the button. He was right. Having ascertained this to his satisfaction, he bade me farewell, and I enrolled us in the chosen plan.

A lot of people are no better than I am with the particular oddities on the website; and many people do not have the time to sit on hold, or, for that matter, to do their application in one sitting. I really hope they straighten this out by next year. It seems a misuse of their very dedicated, nice, pleasant, helpful staff to have these ambiguities and weirdnesses in the website.



pameladean: (Default)

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