pameladean

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.

Pamela

So last year I blogged at length about a multi-day struggle with the MNSure website, hours spent on hold, and the kindness of the customer and tech support people when one finally got to them.

This year was much easier, but not without minor drama. I got through the application for financial assistance in one go and was promptly informed that we were eligible for a monthly subsidy. Then I went and looked at the plans. I knew that premiums had gone up, but hadn't really assimilated that plans had started to go floppy and were weird and difficult. I ignored co-insurance last year and just got a plan with co-pays and a reasonable deductible. This was through UCare, but unfortunately, I couldn't just renew that plan, because my clinic and pharmacy are no longer among their providers. Next year I might rethink this, but this year I simply refuse to change my clinic because a bunch of revolting corporations are trying to squeeze every penny out of what should be considered a public good rather than a business opportunity.

I spent about eight hours on the computer Friday; the application took less than half an hour, so the rest was expended comparing plans til my eyes started going around in my head, with pauses to rant at whoever happened to come by, whether in person or in email. It's just insane that a plan rated Gold that costs, before subsidies. more than a thousand dollars a month, should have 40% coinsurance. The deductibles are crazy too. I am also very, very tired of being required to predict the future, which is impossible for self-employed people with a patchwork of income, and then sternly warned that there are penalties for not telling the truth. There is no truth! It hasn't happened yet!

I finally, reluctantly, settled on a sucky plan for a price that made my heart sink but that didn't seem completely insane. It's twice what we were paying last year, after the subsidy. I told the website that I wanted to enroll in the plan. I got a rather plaintive page that said that something had gone wrong. I signed out and logged in again, and ended up in the same place I had landed last year: my application was listed as pending and there was no way out of the page where that information was; and yet, since I already had a completed application, there was also no other path to enrollment.

I decided to give them the weekend and see if things settled. In the meantime, for the second time this year, our main landline number died on us. In August this precipitated a nightmare in which CenturyLink was understaffed and couldn't send a technician for a week. When he got there, he didn't fix anything, and they'd given him a wrong version of my cell phone number, so he didn't call either. He also didn't ring the doorbell; he just left, and the website then informed us that our problem had been resolved. That eventually got dealt with by Raphael's explaining the situation in chat with tech support in a way that I don't have the personality to support. The tech people, abashed by Raphael, got hold of the local office manager, and she called and said that somebody would be out about two days later. This person had the right number and was reasonably competent. He said the line from the cross street was bad, and he fixed it. He got a bit muddled over the legacy wiring in the outside box, but David fixed that quite quickly.

This time, I got on the website to request a repair ticket, but they were having technical difficulties. I had to make an appointment in chat; to my relief, it was for two days hence rather than the next week. It was already dark when Raphael informed me that the landline was out, so in the morning I dutifully went out with a telephone and checked for dial tones. We have two lines but only give out one number, and the one everybody knew to call, naturally, was the one that had died on us. There were two dial tones, though one was scratchy. I went in and informed David of this situation, and he told me to cancel the repair appointment, since one will be charged $95 if CenturyLink comes out and discovers that the problem is not with their side of the divide. Over the weekend, while grading finals for the course he taught this semester and going to several parties, David took apart the inside wiring and traced the deadness of the line back to the wall. On Sunday morning he went outside and checked for dial tones. There was now just one. I got on the CenturyLink website, which was working now, and made a repair appointment for this morning, with a 10:15 am to 2:15 pm window. This is a little early for me, but I could manage it.

At 8:51 this morning, my cell phone rang. It was the technician; he was on his way. I lay down for a moment and suddenly the doorbell was ringing and the technician was here. He didn't, as it turned out, need me for anything, but I got dressed blearily, without showering, and went out just in case. Then I went back to bed in my clothes. Then I got up and fed the cats, since they were puzzled and excited by my having dressed and gone downstairs but not fed them. After they ate Saffron came and purred and snuggled with me, but several times the technician's equipment made warbling noises that she interpreted as possible prey outside the window; he also made some banging noises that required her to rush to the window, treading heavily on my stomach as she went. I did sleep for a bit eventually, waking at more or less my usual time at 11:30.

I picked up the phone in my office and checked to see if things were back to normal. One dial tone. After a brief period of despair, I went and asked David if he'd had time to put everything back together yet, and he hadn't. When he did, it all worked fine.

Buoyed up by this news and by a very large cup of tea, I checked the status of my application in its little cul-de-sac -- still Pending, still immured -- and called MNSure customer service. I got through to them handily, but after poking around, the nice lady decided that I needed tech support. This involved being on hold for about an hour and a half. They have the same music as last year, but have varied it with little skits where people fall and hurt themselves but won't let anybody call an ambulance because they don't have health insurance; or they go to the ER but leave because they can't afford treatment and maybe it will heal on its own. I sympathize with these, but the repetition is a bit wearing.

Eventually I got another pleasant, if somewhat brisker, woman who fixed my application in less than fifteen minutes. My application was no longer in a dead end. There was now a link to enroll in health care plans. Before I did, I double-checked that UCare, HealthPartners, and Blue-All-the-Things don't list my clinic and pharmacy. Then I double-checked all the Medica plans (they are plentiful as blackberries). I found another network that included my clinic as other than a chiropractic specialty, but the plans weren't really any better and my eyes were starting to go around again, so I just chose what I hoped was the best plan for our circumstances insofar as we even know what those are, and closed the deal.

This is still better than no health insurance. It's just stupidly worse than giving everybody decent health care and having done with all this nonsense.

Pamela

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.


Pamela