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I got signed up for insurance in October. It was a little annoying, but not worse than every time I've had to sign up for a new insurance plan in the past. I thought: easy-peasy. The website even said that my regular doctor was in network for my plan.
Come January, I started to use my plan as it was intended to be used. Two doctor visits, a raft of blood tests, some prescriptions. Then my doctor's receptionist called me in a panic and said that my doctor isn't actually in network. It was her impression that the physician's group to which he belongs had opted out of my plan. I had to pay them the full cost of the two visits. The physician's group told me that no, they had never been part of the plan (the Exclusive Provider Organization, or EPO), and my doctor had simply been mistaken. But Blue Shield's website had quite distinctly listed both the physician's group and my doctor in the EPO, remember.
Then Blue Shield sent me a letter dunning me for three hundred dollars because the blood test had been ordered by a doctor out of network (I have filed a grievance concerning this, on account of the fact that the website listed my doctor as being in network for the EPO, my doctor thought he was in the EPO, and of all the parties involved, I am the most innocent in the situation and also the one with the least resources).
I also had not been able to do anything with my physical therapy referral (a good thing, as it turns out) because no physical therapist I called would take appointments because they didn't know whether they were in network, even if I told them they were currently listed on the Blue Shield website (I can understand their apprehension).
I decided not to wait on my old doctor getting contracted in the EPO because maybe they wouldn't even be able to and in any case it might be months before they could do it. So I looked around and found that the giant medical corporation that provides most of the secular clinical care in the county is in network and has a satellite clinic four blocks from my house. (the only really full-sized hospital in the county is a Catholic one)I signed up, got a new patient appointment today, and had a lovely, lengthy visit, and the physical therapy office owned by Palo Alto Medical Foundation had called me to set up an appointment before I was done.
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.
Come January, I started to use my plan as it was intended to be used. Two doctor visits, a raft of blood tests, some prescriptions. Then my doctor's receptionist called me in a panic and said that my doctor isn't actually in network. It was her impression that the physician's group to which he belongs had opted out of my plan. I had to pay them the full cost of the two visits. The physician's group told me that no, they had never been part of the plan (the Exclusive Provider Organization, or EPO), and my doctor had simply been mistaken. But Blue Shield's website had quite distinctly listed both the physician's group and my doctor in the EPO, remember.
Then Blue Shield sent me a letter dunning me for three hundred dollars because the blood test had been ordered by a doctor out of network (I have filed a grievance concerning this, on account of the fact that the website listed my doctor as being in network for the EPO, my doctor thought he was in the EPO, and of all the parties involved, I am the most innocent in the situation and also the one with the least resources).
I also had not been able to do anything with my physical therapy referral (a good thing, as it turns out) because no physical therapist I called would take appointments because they didn't know whether they were in network, even if I told them they were currently listed on the Blue Shield website (I can understand their apprehension).
I decided not to wait on my old doctor getting contracted in the EPO because maybe they wouldn't even be able to and in any case it might be months before they could do it. So I looked around and found that the giant medical corporation that provides most of the secular clinical care in the county is in network and has a satellite clinic four blocks from my house. (the only really full-sized hospital in the county is a Catholic one)I signed up, got a new patient appointment today, and had a lovely, lengthy visit, and the physical therapy office owned by Palo Alto Medical Foundation had called me to set up an appointment before I was done.
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.
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I still want to link this over on Balloon Juice as an account of "How the system is working (or not)". But for that I did want to know if you are in Medi-cal, or instead have joined an Exchange plan, if you don't mind giving the information.
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Still have issues to work out. Several of them seem to stem from the fact that the insurance company invented a brand new type of plan and the physician's groups did not universally opt in, and there is still vast confusion about it.
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