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A Former Teacher Engages Reality

[By Jeffrey M. Hartman]                   

In late 2014, I did something many teachers never have to consider doing. I sought my own health insurance. After leaving my teaching career, I opted to work for myself. My plan was to live off my savings while getting started. This meant I was going to have to buy insurance rather than rely on a school to provide it. The misadventure that unfolded provided unsurprising but unsettling insights.

Bubble-Boy

I lived in a bubble during my teaching career. The comforts my job afforded me affected my perspective. How did people in other fields work so late each day? Why did anyone agree to work during the summer? I had a salary that kept me more than comfortable and health insurance that most people would have envied. Although I frequently reminded myself how fortunate I was, I still took too much of my situation for granted. When I decided to up and leave, reality poured into my bubble.

Great Coverage

Health insurance had never concerned me. Working in schools my entire adult life, I didn’t fret over having coverage. It was a given; an amount taken out of each check. If anything, I felt guilty for having such great coverage. I rarely used it. I happened to be a healthy person and I infrequently visited my doctor. Being so cavalier about my coverage while other people suffered without it made me feel like some kind of heel. My wife used it occasionally, so it wasn’t completely wasted.

A Career Abandoned

By abandoning my career, I forced myself to face a sudden and real need for coverage. I’ll admit resenting the need to have something I wasn’t likely to use, but I accepted the situation and proceeded. I had left other teaching jobs. After each departure, I replaced the job quickly, moving to a better job each time. This was another example of my chosen field distorting reality. Not many people enjoy that kind of mobility. Benefits had come along with each new job. With no intention of taking a new job last fall and no immediate income from working for myself, I was on deck to try HealthCare.gov.

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Enter HealthCare.gov

Prior to any of this, most of my experience in dealing with health insurance involved my mother. I helped her get Supplemental Security Income and Medical Assistance. The process was arduous, but after an appeal, she got what she needed. More recently, I assisted my grandmother in connecting with a home health care aide through her insurance. This was tricky as well, but perseverance paid off. Having to deal with these systems gave me a notion of what to expect when navigating a massive health insurance bureaucracy.

Experienced as I was, working through HealthCare.gov tested my patience. The site achieved infamy in early 2014 following its beleaguered launch. I expected the site administrators to have fixed most of the bugs for the second year. Perhaps they had. What I found was convoluted, nonetheless. I managed, but not without incident.

Registration

The first hiccup came during registration. I followed the directions on the screen and provided the requested information, but the site couldn’t verify my identification. I’d never had a problem like this registering for anything else. It prompted me to upload registration documents, but I found no way to do this. I called customer service and a helpful but disaffected person verified my identification simply by asking for my address and Social Security number.

I completed the application and was eager to see my results. Before I registered, I had investigated what coverage might be available. I expected to be eligible for one of several seemingly suitable plans. Upon seeing my results, I was shocked to find my wife and I only qualified for Medicaid. Nothing else was available. I knew Medicaid had a resource limit in my state. I also knew my savings were approximately thirty times that limit. The site never asked about resources. It only asked for income, which was zero at the time. My wife’s income didn’t put us over the Medicaid income limit, but this was irrelevant.

I realized my situation was an anomaly. Most people don’t go from my former income to nothing by choice while not having any solid replacement. At the time, I was paying a high premium for continuing coverage from my former employer. I was determined to get something less costly through the Marketplace for the start of 2015. My state was going to deny me Medicaid. I had to appeal.

Non-Appeals

I couldn’t find a way to appeal online, at least not in my state. I had to mail the completed appeal form. After several weeks, I got no response. The deadline approached for having coverage by the first of the year. I called customer service. The representative told me I’d have to apply for Medicaid and get rejected before appealing. This was going to take too long. I called my state Department of Health and Welfare. A representative confirmed I’d be denied. He urged me to call HealthCare.gov again and simply state I’d been denied instead of going through the process. I did. I handled the appeal over the phone. An hour later, I had new insurance. I had even paid my first premium, which definitely stung.

Over the next month, HealthCare.gov sent me three letters and called me twice to remind me my identification had yet to be verified and my appeal had been denied. I politely informed them I had handled each issue. No one I spoke with could tell that I had, nor could they tell I’d selected and paid for coverage, even though I had.

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New Coverage

Dealing with the new coverage was almost comical. I’d selected the same provider I had while teaching, but a different plan. My wife and I selected the same physicians we had seen for years. Despite our history with each, making appointments or filling prescriptions required us to provide detailed proof of our existence and needs through phone calls, faxes, and emails. This was necessary for the first several interactions. Inquiries and referrals were much more tedious than what we had known. Over four months, the provider sent us a total of ten new insurance cards. All the inefficiency with both systems prompted some reflection.

One could expect such confusion within large systems. However, I’ve thought of what difficulty others users might face. I’d like to think I’m relatively literate, tech-savvy, and patient. I have family members who would have been stumped after the first few screens of the on-line HealthCare.gov site. The parents of some of the students I taught would have had similar difficulty. People in such situations might have the greatest need for coverage. The complicated and buggy nature of Healthcare.gov requires a small army of customer service operators to help befuddled applicants through problems. I shiver thinking about the resources spent maintaining this backup system in lieu of having a more functional interface, but I guess this creates jobs. Similarly, my actual provider requires a maddening degree of redundancy that might strain the coping skills of needy clients. I wonder how many people just give up when pursing complicated but necessary claims.

Assessment

Perhaps by 2016 HealthCare.gov will be streamlined and smart enough to not confound its users. My provider might be as streamlined and smart as it’s going to get. I’ve rarely seen such bloated systems. Maybe I’ve been ignorant to what other people endure. Having outstanding coverage handed to me while teaching and being healthy my whole life kept me out of touch. My new experiences were mild inconveniences, but I fear how similar complications could stifle those really needing help. I suppose I’ve emerged from my bubble.

More:

• Will you receive a tax credit to help you purchase health insurance?
• Site HACKED – HealthCare.Gov
• Introducing Child Stats.Gov

ABOUT

Jeffrey M. Hartman is a former teacher who blogs at http://jeffreymhartman.com/

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

• PRACTICES: www.BusinessofMedicalPractice.com
• HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
• CLINICS: http://www.crcpress.com/product/isbn/9781439879900
• ADVISORS: www.CertifiedMedicalPlanner.org
• FINANCE: Financial Planning for Physicians and Advisors
• INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
• Dictionary of Health Economics and Finance
• Dictionary of Health Information Technology and Security
• Dictionary of Health Insurance and Managed Care

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