It hasn't gone well. The website for United Healthcare was probably built and maintained by the company that originally did healthcare.gov. This site just doesn't work. No matter what I typed in, it returned zero results. I couldn't even find my cardiologist on it (although I have been assured more than once that he is indeed in the network). I finally found one orthopedic surgeon. However, I knew that doctor. He fixed the pain in my neck 12 years ago, but he doesn't do knees. I decided to call his office on the assumption that if one doctor in the practice is "in network" some of the others will be, as well.
When I got through to the knee doctor's scheduler, she wasn't at all sure about the insurance plan. She promised to investigate and call back. She got back to me this past Tuesday. It seems that the doctor who does the knee replacement surgery is NOT in the network. Furthermore she told me that the three doctors who are in this particular network (out of about a dozen in the practice) were "hand picked" by United Healthcare to be in this network. Other doctors were not permitted to "opt in" and if a doctor chose to "opt out", he or she would be opted out of EVERY United Healthcare plan. Interesting stuff.
But in speaking with her and giving her the numbers on my card I made another interesting discovery. I had been assigned to a PCP (primary care physician). She also told me she thought I had to have a referral from my PCP in order to see a specialist.
I once again tried the provider website and the "find a doctor" feature still didn't work. However, I was able to confirm on their website that my plan did require me to have a referral from the PCP before seeing a specialist. I also learned that if I did not have a referral or if I chose a doctor outside the network, that I would be responsible for the ENTIRE cost of any treatments and office visits. Wow! That's serious. There is absolutely no margin for error here.
I decided that the first thing I needed to do was make an appointment with the PCP. The website did explain the reason for the referral system. Boils down to "no one knows your healthcare needs like your primary care doctor." What a load of bollocks! I've lived in this body for 60+ years and I know it better than anybody. But I am now in the position of asking a doctor I've never met to refer me to a doctor (my cardiologist) I've been seeing for the past nine years, or my OB-Gyn whom I've been with for 25 years. What a monumental waste of everyone's time! Well, maybe not everyone - the PCP does get a fee for his services.
Anyway, I called the PCP shown on my ID card and was told that there was no Dr. Westbrook at that number. They also indicated that they'd been fielding a number of calls for the non-existent Dr. Westbrook. I called the customer service number and after waiting an hour on hold, I got through to someone who attempted to change the doctor. I asked that she confirm that the doctor did in fact exist before she switched me. Problem was that it was lunch time and she was getting either no answer or the "we're out to lunch" recording. I told her she could confirm it and call me back when lunch was over. She told me she wouldn't be able to do that because of high call volumes. She gave me the names and numbers of two doctors and left me to confirm their existence. Guess what? One number was no longer a working number and the other one belonged to a nurse practitioner, who knew the doctor in question, but wasn't associated with him. I had apparently signed up for a plan with no "real" doctors.
After another hour on hold, I was given the names of three doctors and was able to confirm that at least one of them existed and was taking new patients as long as they weren't on Medicare. But in all the excitement I'd forgotten to find out about the orthopedic doctors. Another call, another hour long wait on hold and I was sent a twelve page list. I went through the list to eliminate the doctors who were more than 50 miles away. Then I went through it again to see which doctors did knees. That brought the list down to eight doctors. I also wanted to make sure these doctors did knee replacement because that's the worst case scenario and I really wanted to avoid being referred more than once. By Wednesday evening I was only able to confirm that one doctor on the list actually did knee replacements. I would have to wait until Thursday morning to see if there were two. Still, two is not much choice.
I called United Healthcare's customer service number again. Only a 30 minute wait this time. But I really wasn't happy that two days of research had produced only one name. The call center rep made the mistake of telling me that not all doctors had opted in to the plan. Bad mistake - remember what the woman in the doctor's office told me about United Healthcare hand picking who was on the plan? The customer service rep said "that just isn't true". Girl, you work in a call center answering a phone. No one informs you about policy. Why on earth would I believe you over someone who works with a multitude of insurance carriers for multiple doctors? Short story - if there is only one doctor in my area then I must use that doctor. All I can say is he'd better not screw it up because I will come after the doctor and the insurance company that didn't allow me any choice. I asked if I could be moved to a different plan, one that had more than one doctor. She told me it didn't matter whether the plan was Bronze, Silver, Gold, or Platinum - the doctors were all the same for "marketplace" customers.
So it would seem that the insurance companies have managed to pervert the intentions of the Affordable Care Act. (Yes, it's affordable, but you'll have trouble finding a primary care doctor and you'll only have one specialist to choose from.)
The next call was to my insurance agent. "Get me out of here!"
"It will cost you twice as much."
I don't care. I don't want this. I want some choices. And I don't want to work so hard. I went to the PCP doctor yesterday and his first two referral choices were NOT the guy on the plan. If I hadn't known who is on my plan, I would have been stuck paying the entire bill. Although the one guy on the plan hasn't phoned me back to make an appointment, so we'll have to see. But if I stay on this plan, and it's determined I'll need surgery, I guess it will be my job to co-ordinate the facility and the anesthesiologist to make sure they're in the plan. And right now, my fear is that they won't be.
No comments:
Post a Comment