Another difference #ACA makes!
2010-12: With my Cobra ending, in GA I stay covered via obscure HIPPA protections. My only choice: Celtic Insurance owned by Centene Corp. For my Humira drug, Celtic makes me pay tens thousands up front as pay first & manually snail mail claims 1/
2010-12: With my Cobra ending, in GA I stay covered via obscure HIPPA protections. My only choice: Celtic Insurance owned by Centene Corp. For my Humira drug, Celtic makes me pay tens thousands up front as pay first & manually snail mail claims 1/
To make matters worse, this insurance takes up to 9 months to reimburse me as I float tens of thousands dollars via savings or credit cards. Other times, insurance says submit my bills (as claims) from CVS Specialty Pharmacy instead, but then CVS hounds me for unpaid bills! 2/
While all this is happening, insurance has no transparency in their online portal or snail mail of the processing, status, or even the existence of my claims! I'm completely in the dark, I have to call & call & call this insurance's customer service representatives for info 3/
Oh yeah, there's also a drug coupon (co-pay card) from the Humira manufacturer (Abbott) to cover my out-of-pocket from my deductible. This usually happens at the time of transaction. Instead, I'm the one manually submitting these to the drug company after insurance pays. 4/
Oh remember that I mentioned insurance was taking like up to nine months to pay? Well, the drug manufacturer really needed those within a 120 day window. So it took like THREE YEARS (2013) to straighten that out and get a $13K check all at once of MY MONEY! 5/
That $13K check even held up a mortgage application in process (for my condo I still live in today) because the mortgage company wanted to know who/why I suddenly had this large deposit. 6/
Remember insurance eventually let me mail bills as claims? Well since insurance was taking so long, I'd get hounded routinely by phone from CVS for unpaid bills. It got so bad I once yelled at CVS threatening self-harm asking them if they wanted me to jump off my balcony! 7/
One other winkle, when I got Celtic insurance initially they did allow CVS to submit the claims & work with the drug coupon card. Because it was this special individual market insurance product it worked kinda clumsy, but it did work. But then insurance changed the game on me 8/
Another detail because this will tie the while story nicely, back in the early 2010s if I was out of Humira refills, I'd have to leave a message on a recording with the doctor's office, which could in and off itself take several days to get a response, 9/
So understand everything I've just recounted for you, I was basically turned into my own claims specialist, spending hundreds of hours in phone calls, paperwork, snail mails, extreme aggravation, faxes (when insurance couldn't "find" claims I'd submitted months earlier) 10/
Hell not only was I turned into my own health insurance speciality pharmacy drug claims specialist, I didn't even have transparency of the status of my claims!!! And besides being uncompensated for all this work, I raked up tons of interest for what I floated on credit cards! 11/
OK now that I just described my account of dealing with insurance (in the individual market) with a chronic condition (I have Crohn's Disease) in the pre-ACA/Health Reform world, are you ready for me to describe a 2019 account of this whole process? OK, here we go ... 12/
OK, since last year I've been here in Georgia on Ambetter Insurance. Ambetter is owned by Centene Corporation. Remember I mentioned Centene at the beginning? Yeah, because they own the Celtic Insurance (I had), and they own Ambetter. It's the same insurance company! 13/
Yesterday I call Ambetter's pharmacy benefit manager Encompass RX to get my first refill of Humira this year. We verify my drug co-pay card is still on file & valid (it is). I'm out of refills and they need to electronically transmit to my dr's office for a new prescription 14/
Ten minutes later I get a call back that they got the refill from my doctor, my co-pay is $5 dollars, and it's being shipped out to me! As much as I was distraught with that SAME insurance company at the time, I have nothing but praise in my experience with Ambetter today! 15/
In fact since 2014 I've had three insurances within the Georgia insurance "marketplace" (Obamacare): Humana, Blue Cross, and Ambetter. I've found Ambetter has actually worked the most seamlessly of them all within my experience with the ACA! 16/
My guess is maybe Centene/Ambetter in possibly lacking the legacy of a lot "practices" (best practices or otherwise) in the pre-ACA world has made them more adaptive than others in the post-ACA world. IDK. I do know when others retrenched as ACA had challenges, they expanded. 17/
Regardless, I've found all ACA marketplace coverage to be on-par if not superior to any job based pre-ACA health insurance I've ever had, and that includes working for Fortune 100. 18/
I believe contrasting my previous horror story to now, even the ten minute turnaround on a refill of a specialty drug, are proof positive of the positive impacts of the regulatory structure the ACA has had on the insurance, provider, pharmaceutical, and medical industry. 19/
And to the challenges that many have experienced with the ACA I absolutely acknowledge that. But remember much of the problems are the result of Republican obstruction and sabotage of the original law in the first place! 20/
I say build on this progress! Protect pre-existing conditions, expand #Medicaid everywhere including Puerto Rico (and rollback back draconian HHS waivers), get a robust #PublicOption in the marketplaces, evaluate #SinglePayer but remember the GOAL is #UniversalHealthCare!!! 21/21
