Story #3 – Unsustainable Situation

I have rheumatoid disease  – have had it since I was 14 years old and I am now 59. I also am a cancer survivor and the child of a colon cancer victim.  My biggest concerns are the ever increasing and ridiculously high costs of medications.  I am luck that I currently have great insurance and much of my cost of medications is covered.  But the huge cost of my medications is passed back to me and my coworkers in the ever increasing premiums.  This cannot be sustained.

Additionally I am concerned with losing the coverage of preexisting conditions.  I do not want to worry about not being covered if my job changes or I lose my job.  To me, this is blatant discrimination.  It is not my fault that I have a chronic disease and failing to cover this is treating me differently than others who are not in this same situation.
I have two sons who are under age 26 and in college and graduate school. One son has Rheumatoid Disease also. He works in a temp job with no insurance while he is finishing his master’s degree. My younger son is attending a local community college with no insurance provision.  How will they get coverage?
I am also concerned if costs increase for screenings and cancer check ups. Right now I am on the 5 year plan for colonoscopies and a yearly screen for lung cancer returning.  These screenings are vital to my health and survival.
I feel as long as we involve insurance companies in our healthcare coverage that we will always have problems. These companies need to make large profits and that is on the back of patients and the misery of being ill. This is not right and just.  This is also present with pharmaceutical  companies and their ability to set outrageously high and ever increasing prices for necessary medications.
Thanks for asking. I hope I have provided useful information.
C. C.

Story #2 – All in for Washington

After a long life of health and fitness a gene mutated and last year I had 2 massive heart attacks. I live wit just 1/3 of a heart now. A hiker, climber, kayaker I run out of breath walking around my apartment complex. There is no medical solution yet.
There’s a new drug for PCSK9, but Medicaid won’t pay for it, leaving me vulnerable to the final heart attack.  At 58 my life came to a crushing stop. All the years of taking care of my body…not worth anything.
Having good insurance can get me security of care. Get the drug needed to protect my heart. Pay for the right physical trainer to teach me how to use my body, push where I can.
I’m vocal about heart disease killing women. I want 10 good years to teach and train doctors to understand women’s hearts.
I’m all in for Washington!
– Anonymous

Story #1 – Family unable to find affordable healthcare

I don’t have a story of illness and high prescription costs or anything like that, but I am an average healthy person with a healthy husband and one year old child that is unable to find affordable healthcare.  What is actually most affordable for us is to go without insurance and pay out of pocket for any healthcare we need, including paying the tax penalty.

Even though we are healthy now, I am terrified of getting sick or anything happening that will land us in the hospital.  Our family falls into the well documented Family Affordability Gap.  Even though the lowest cost plan available to us exceeds the definition of affordability, there are no tax credits available for us.  Luckily, we were able to get my son covered with Washington’s Apple Health in case of catastrophe (which counts as income that we must pay taxes on) but the pediatrician we chose and have loved since his birth is not covered under their plan and we continue to pay out of pocket for his regular visits.

When our son was born, we were covered with Blue Cross Blue Shield of TX under my husband’s employer and the pediatrician/family doctor we chose was in their network.  I tried to have a lower cost birth house/midwife pregnancy but was told I must have a c section.  We spent two days in the hospital and despite giving all of our doctor’s information and stating that we did not need any additional pediatricians, we were visited by two pediatricians in our room who did absolutely nothing with the baby.  Brief 30 second to 1 minute visits, as well as several other specialists that were in and out at all hours.  (our baby was completely healthy and did not need any of this) We didn’t learn until later that these doctors and specialists that had no purpose being in our room weren’t even included in the hospital treatment, they all billed separately from their respective offices.  Needless to say, BCBS did not cover any of it and we were stuck with thousands of dollars in bills from people who breezed through and marked that they saw us.  We tried disputing but were threatened with collection agencies.  Furthermore, the way BCBS allocated the different out of pocket fees meant that even though our bills far exceeded the deductible, they still found a way to avoid covering the overage.

Months after our son was born, several visits into our pediatrician check ups (just when we were almost caught up on all the balance billing and surprise bills from dr offices we never visited) we received notice that BCBS was not covering anything because our son was not on the plan.  As new parents, we had no idea that there was a very small window directly after birth to add him to our plan.  They covered us throughout the pregnancy, then after the birth, and we continued to use our insurance card, it just seemed intuitive that our child was now on our plan.  Maybe we should have known, but this was just never told to us by anyone we encountered along the way, it certainly could have been included in any of the multiple repeat mailings we received from BCBS.  Or we could have known if they had started rejecting the bills when there was still time to sign him up.  This is when we were able to sign him up for Apple Health but the pediatrician we had been seeing is not in the network so we had to pay out of pocket for the visits anyway.

In October, my husband changed jobs and we were relieved that we were almost in the clear and open enrollment was around the corner.  My husband and I carefully looked at the options in coverage through his employer and the open exchange.  After reading over and rereading and contemplating all the options during open enrollment, we decided on a plan that was more expensive than the minimum available (by about $30 a month) but appeared to cover everything for nearly $500 a month.  (for reference, “affordability” for us is a plan that is less than $387 per month, the lowest available to us was about $470) No copay, no charge for most routine services like check ups, labs, etc.  Sounded ideal for what we needed.  The chart we reviewed on the open exchange had “no charge” listed in the column to the right of almost all the services.  This seemed ideal and after searching and searching through all the different plans, we decided on that Group Health plan.  It made sense to us to pay a little more for a plan that covered whatever we might need in full than to pay for a plan that would never be of use to us because we rarely need medical attention.

Two months in, we started getting notices that Group Health had changed to Kaiser. I started looking around the website trying to find that chart we saw or anything that would explain our benefits because my husband and I both wanted to get routine checkups and some blood work (what I would consider preventative care).  Even signed in with my account I was unable to find anything.  I sent an email asking for the information that was never answered.  Life is busy, I simply don’t have the time to dedicate to chasing this down and I let it go for a couple weeks.

Now, three months in, I revisited and looked to see if maybe the website was updated.  I was still unable to find any information about my coverage so I emailed again.  This time I got a response and was surprised to see that the chart I was sent had “after deductible, member pays nothing” written in every column.  This was not what I signed up for and I panicked trying to read the fine print.  With a deductible over 7k per person, 14k per family, I never would have chosen a plan that had us paying out of pocket up until that number when we never spend that much on healthcare in a year anyway.  After searching the internet to find the chart I originally saw when we purchased the plan, I found it.  Every column says “no charge”, just as I remembered. 

Now, of course, I see fine print that says the chart is explaining charges AFTER the deductible is met.  I’m not certain that fine print was there when we purchased but even if it was, the chart is totally misleading, borderline scam.  I feel that we were forced to purchase something that will never benefit us and we cannot afford.  I plan to cancel and be without insurance until the next open enrollment because I don’t know what else to do.  I am attaching screen shots of the two charts.  The black and white one was sent to me after purchasing and multiple requests, the blue colored one is what we saw before purchasing (possibly without the fine print).

I’ve been a single payer advocate for years and I want to do whatever I can to facilitate this initiative.

Thanks for your time,

M. C., Olympia