ritaxis: (hat)
I am low-energy, distractable, lazy, diffident, tentative, and easily discouraged to begin with. I began 2016 thinking I would ride the energy and optimism from my lovely new knees to Get Things Done, Get In Shape, and Get A Job.

I was doing pretty good until February, when I got the cancer diagnosis.

seriously this is just a long organ recital and for my own records, so don't read it )
So anyway, 2016 was for me like many others mostly a loss. I haven't mentioned much about the big world because others have more, and more eloquent, things to say about tt. I'm still alive, of course, and I still have a house. Also I have a pile of writing I'm sort of working on for several days at a time before I collapse in on myself for a few days again.
ritaxis: (hat)
I'm probably overthinking this.

So I got a bill from Blue Shield for over two hundred dollars for my first month of 2016. Considering that my original fee had been a dollar a month, and last year's had been $22 a month, it seemed out of line. Granted, percentage-wise it was less of an increase (a bit more than 2000% the first year and a bit less than 1000% the second year)...and of course my income has not risen at all and my other costs keep increasing too.

So I called to straighten it out, and eventually, after a couple of days of bad connections, frightening error messages, and lots of apologetic confusion from the stalwart souls who staff the front lines at the Blue Shield and Covered California call centers, it emerged that I didn't belong on Covered California because I don't make enough money. I was supposed to go to Medi_Cal instead.

California residents will understand my mixed feelings when I got this news. Medi-Cal is free, the coverage is fine...but doctors generally don't take Medi-Cal patients. I mean they flat-out don't, or they say they do "but we're not taking new patients just now." Plus, there's the issue that if I make any money at all, I'll be kicked off again and have to go back to the exchange and find a plan I can afford that will cover what I need.

First things first: according to the website, my primary doctor takes Medi-Cal. So if that works out, I'll be fine.

But let's return to my eligibilty. This freaks me out no end, because: Covered California uses line 37 of the tax return to determine eligibility, and Medi-Cal uses gross income. And if I understood all those people correctly the lower limit for Covered California this year is $16K+something. I can't confirm or correct this number looking around online: it seems to be a secret that you only learn if you dip below it. Meanwhile, according to the letter I got from Medi-Cal, if my income goes above $13,354 a month, I'm no longer eligibile. That's almost the same number: it might be exactly the same number.

However, line 37 on the tax return is the adjusted gross income and it is lower than the entire gross income. Why this matters to me is that my Covered California income is therefore under $10K a year, while my Medi-Cal income is about $20 a month less than the cap. If I get a job or sell a story will I have to change medical coverage again? I was thinking that since my legs work again I could be a substitute teacher. Will I have to change medical coverage during the school year and again in the summer? If I sell one story, I'll be over the limit for Medi-Cal that month but under the limit for Covered California for the year. I'm afraid to ask about it, actually. I considered dropping olut of the system but my barebones prescriptions (5 medicines, the rest are OTC) are four hundred dollars a month without coverage. I've been working towards dropping more drugs, but I can't drop them all.

Can we say it together? SOCIALIZE THE GODDAMN MEDICINE. Save your grandma!

Which reminds me of the thing I think is going on with the right wing: they really, really, really hate their mothers. Everything else derives from that.

On another front, it has rained sixteen out of twenty days here, but we're still running lower than average in rainfall totals and we're still at 67% full in the reservoirs here. It's worse in some areas. 
ritaxis: (hat)
I'm talking aboiut Blue Shield's behavior right now, but I don't know that the other companies are behavin better. So you already know that Blue Shield customers in California had their rates jump at the New Year (since the good people of California bought the idea that having the [elected] Insurance Commissioner be able to regulate health insurance rates is--somehow tyrranical? Somehow is bad for consumers? anyway, they voted against it). For example, the part I pay after my subsidy has increased 220%. I'm still not paying much, but we have no apparatus to keep it from increasing at the same rate year after year, do we?

What else happened after the New Year--not quite after open enrollment has ended (that'll be February 12), but contemplating changing my insurance while I'm in the middle of preparations for surgery (February 15) is not a happy thought, and I imagine a lot of other patients have similar issue to changing abruptly--is this:

Blue Shield has announced that as of December 31, 2014, they've ended their contract with Palo Alto Medical Foundation (Sutter Hospitals). They magnanimously conceded that they'll cover us through June 30, but after that we all have to get new doctors. PAMF has been sending us letters about how they're trying to re-open negotiations and how they're trying to get us covered through the year, and Blue Shield is not cooperating.

Nobody's ever said what Blue Shield and PAMF are disagreeing about in the negotiations.

My belief is that it has nothing to do with anything PAMF is doing, or anything they're asking for, or anything they're saying. I have believed it is a simple attempt to deny coverage to a large number of patients while still collecting their subsidy money.  Because in my part of California, there's not another large organized health provider which is not connected with a religious organization. The next available places are forty miles away over a narrow winding mountain road. The fact that a lot of people in my community drive that road to go to work every day makes this situation worse. But wait, I have another thought down the line.

Did I say that for the Affordable Care Act some wit invented the EPO--Exclusive Provider-- which means that if you go to a doctor, etc., that's not "in network," they don't pay reduced rates, they pay nothing? Which means if you don't find a doctor from the network, you're screwed, right? Remember what I said about PAMF being the only large organized health provider besides the Catholic Church in the Monterey Bay Area? There's a passle of tiny hospitals and physician's groups, but nothing like Kaiser down here. And we're short of medical providers of all kinds anyways because the only doctors who establish independent practice here are ones who will sacrifice making the normal doctor's living for a chance to go surfing in the morning. I'm serious: the fixed costs of doing medical business in this area are as high as they are in San Francisco, but Medicare (for example) pays the "rural" rates -- that is, the amount of money they would give to a doctor in the middle of the country.

My point, and I do have one: when we have to get new doctors in May and June, there will be none. Every doctor who actually is covered by Blue Shield at that time, if there are any left, will have no places for new patients.

I don't remember and I'm not in the mood to check to see whether I told you about the shenanigans I experienced at the beginning of this, where my old doctor was listed on the EPO website during signup time but it was revealed months later, after I (like many others) had accrued hundreds of dollars of costs, that in fact the Physician's Medical Group had not achieved a contract with Blue Shield, and eaqch doctor had to contract indivually and in the meantime... in the meantime, I had to pay for all the healthcare I had received at the outrageous uninsured rates that still pertain in this stupid stupid country.

So the thing I just realized is this: last year, Blue Shield used the new enrollees under Covered California as a lever to effectively break up the collective bargaining power of the Physicians Medical Group. This year, they're using us to attack PAMF.

I don't know what they're doing in the rest of California, and I don't know what they're doing in other ACA states, and I don't know what the other insurance companies are doing, but I know for sure it's not even a little bit benign.

The thing about being used as a weapon is that weapons get used up in the process. And that's what's happening in the marketplace.

So I'm getting all the healthcare I can before June, because after that I don't know if I can get any.

Edit: as the letter from PAMF points out, also:"Blue Shield sold health plan products during open-enrollment that featured the doctors and hospitals of Sutter Health; and then just days into the New Year abruptly announced plans to reassign members to non-Sutter doctors." That's what they did to Physicians Medical Group patients last year.
ritaxis: (hat)
longer and less interesting than you would wish for )

So, chaos, but now I have a doctor, who I haven't seen yet, but the Physician's Assistant and the other staff at the clinic were smart, efficient, friendly, and really, a joy to work with.

On another front, I'm celebrating St. Patrick's Day by trying to find versions of obscure songs to listen to. With mixed success.
ritaxis: (hat)
So I'm getting ready to sign up for affordable insurance.

The option that costs me a dollar a month after the subsidy is EPO: exclusive provider only, which means you have to choose from the list and you can't go off the list at all except for emergencies. The option that costs 77 dollars a month is Kaiser Permanente, which is an HMO (helath maintenance organization, with their own clinics and hospitals that you use)whose closest clinic is an hour's drive away over the hill. The option that costs me 79 dollars after the subsidy is a PPO (preferred provider organization), in which you pay more for providers off the list but they do cover something, but it is Anthem Blue Cross, which gives me the creeps because of past misbehavior. And then there's Health Net, which has the same coverage and is a PPO, but it costs 155 a month after the subsidy.

more research is clearly necessary.

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