Friday, January 20, 2017

Obamacare - Threatening My American Dream

June 2016

My husband and I have been facing this struggle for 8 months, now, but we've been mostly quiet about it on social media and here.

For 11 1/2, almost 12 years of marriage, we've been working towards and dreaming of purchasing a home to raise our kids in.  So when you're faced with losing everything you've built up together (financially speaking), that's not something you necessarily want to plaster all over the Internet for the world to see.

It's extremely personal.  It's terrifying.  It's humiliating.

And while we all know the eternal truth that "money isn't everything" (and you could transfer this concept to "buying a house isn't everything"), we also know that there are strings attached to earning a living - REAL strings called TIME, that rule your life.  If you're strapped financially, it means time away from your kids so that you can provide for them.  It means they grow up before your very eyes, but you were too stressed and worried about about how to sort out the financial upheaval that you missed some of the joy along the way - maybe all of the joy along the way on the really bad days.  It means your trial is so big it that every where you turn,

all you can see are closed doors,

regrets,

and darkness.


You know that what truly matters is right in front of you, but because the situation that was thrust upon you is so much bigger than you know how to handle, you can't focus on what really matters.  You want to think about the ones you love and enjoy each moment with them, but you're being buried alive in the deepest pit you've ever been in.  All you have is a spoon to dig yourself out of the pit, but a dump truck just sent a fully loaded avalanche of soil on top of your head.  If you want to stay alive, you have to get out.  You want to get out right away, but there's no such thing as getting out of the pit overnight.  And while you're buried, you can't breath very well.  So that's why it's hard to focus on what really matters, because when you think you're going to die there, the only thing that seems to matter is getting out alive.


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My husband works for someone else, but gets paid on a 1099.  I teach private music lessons, and am self-employed.  When you are self-employed, you are responsible to figure out our own taxes and health insurance.

We look a leap of faith seven years ago when I quit working for the schools to be home more with my kids and would no longer receive tax with-holdings & insurance benefits.  But, you know what?  We've been okay - until last year when I was forced into using a bonafide Obamacare insurance plan from the Health Insurance Marketplace.

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NEVER DID I IMAGINE THAT OBAMACARE WOULD HAVE SUCH A PERSONALLY OVERWHELMING & NEGATIVE EFFECT ON THE DETAILS OF MY LIFE

THE SHORT STORY:


  • My Platinum Obamacare plan straight from the Health Insurance Marketplace was full of lies.  They acted in bad faith for the delivery & post-partum charges of my last child and it all came crashing down during the one point after 11 1/2 years of marriage where we finally had the hope an ability to begin the process of purchasing our very first home.

  • When you have money down on a home, your mortgage cannot close if you are a party in a lawsuit.

  • When you have money down on a new-build, you have an extremely long time to have your entire life and credit file scrutinized with a fine tooth comb, and the stress doesn't let up.

  • When the hospital is being mistreated by your insurance company, they can't wait for appeals, and they chase you for the money. If you don't pay them or can't pay them what they demand, they ruin your credit.  When they ruin your credit, you can't buy your home.

  • When you are self-employed and believe in capitalism, you have more hoops to jump through in order to even be able to make a living, let alone to be able to buy a home in this nation where socialism is trying to stomp out the last few remaining fighters who believe in liberty & free-enterprise.

  • When you have 4 kids, all you want to do is provide them a place where they can count on growing up and stability.

MY PERSONAL SOCIAL PROGRAM IDEOLOGY:

I am PROUD to be an American.  Perhaps I am more "proud" than I ought to be, as I have a major problem personally applying for or using government hand-outs.  In my mind, social programs are for people who need it.  I for one, don't WANT to need it. I will work my buns off, and run myself into the ground before I let myself need those things.  Part of that drive is also what fuels my ability to survive the rigors of being self-employed in a nation that passes law after law to stifle out the few remaining survivors who truly believe in capitalism.

THE BEFORE OBAMACARE BACK STORY:

My health insurance plan that I used during Baby #3, covered catastrophes, but not maternity.  So we paid for that child out of pocket.  We paid the hospital $4,000 for their 24 hour maternity package (and 24 hours means that you will definitely get kicked out of the hospital 24 hours after delivering...even if it's in the middle of the night - I left at midnight with my newborn) - BUT the package included medicine for the epidural.  Doctor's fees are completely separate, but I paid my OB his package pricing during the 9 months leading up to delivery, and I paid the anesthetist, pediatricians, and technicians separately.  By the way, if you pay for a baby out of pocket, everyone almost always has a discounted price for cash-pay patients who pay on the date of service or within 30 days.  Sometimes it's only a small percentage, but every little bit helps.  

With Baby #4, the method that worked for us before couldn't work now, because our premium payments for the same plan were skyrocketing, and even though it should have been grandfathered in despite all the changes enacted from the "Affordable" Healthcare Act, our options were no longer feasible - we couldn't pay the larger premiums for a plan without maternity and also be able to afford to save up the fees for the hospital in time, and because pregnancy was no longer considered a "pre-existing condition", we felt we would rather switch our plan to one that had some better insurance coverage and could give us peace of mind instead of paying the government fines for not having insurance on top of being a self-pay patient.  So I hunted around.  I found that the options and regulations of Obamacare have changed private insurance forever, making it more un-afforable than ever before, and it forced us to look into the Health Insurance Marketplace.

When you purchase health care insurance through the marketplace, if you are pregnant and your income falls into a particular range - not even the poverty level range - but a percentile sort of range above that, you qualify for free health insurance.  Cool, right?  Unless you're like me and feel like you don't need help, and would prefer to have the dignity of paying your own part of your health insurance premium, because you're a capable, hard-working American and that's what you do.  The Marketplace is designed to strip Americans of their pride, however, and if your application (estimated figures or true) falls into a category where you "qualify" for assistance, you are NOT ALLOWED the dignity of paying even a small portion.

So I did what any reasonably-insane, capitalism-loving, pridefully-hard-working American would do.  I made sure that my estimated A.G.I. was outside the range of qualifying for help.  After all, I was right on the edge with my previous estimations, I was hoping for a possible increase of business, and I also didn't want to imagine the horror of accepting a government handout because I imagined we'd be tracked and required to pay it back when taxes rolled in because it was possible we could end up making more than we had estimated.  Even if paying it back wasn't required (because the marketplace is so backup & disorganized  that I doubt they audit) I also didn't want my friends and neighbors or strangers in America paying for my health insurance through increased tax burdens when I knew full well that in my current situation I was capable of paying my own insurance premiums.

As we hunted the Marketplace, we first looked at the cheapest options with the least coverage in the Bronze categories.  But as I did the math, I realized that it would be better for us to go with this one particular Compass Plus PLATINUM plan - the monthly payments would be a stretch even with the $200/month tax credit to offset the cost, but in the end the deductible and out of pocket maximums had a cap that worked perfectly for our budget, and in the long run it made more financial sense to stretch ourselves every month with this plan to pay for the baby, so we switched plans.  Most of our general doctors, and all of our specialists were in the network.  So we moved forward.

Life was great, UNTIL a few months before my delivery, I accidentally found out that even though our doctors were all covered, the HOSPITAL ITSELF would be an out-of-network provider on my plan.  I was so confused and I couldn't believe it.  I was paying more than I ever dreamed of in my life on a monthly basis for this Platinum plan, and the hospital wasn't going to be covered?  But then I found a saving grace - there was a provision in my plan.  If you had a high-risk pregnancy, and that particular hospital was the only place your doctor delivered, and if you were in the 3rd trimester and couldn't switch, the hospital would be treated like they were an in-network provider and all would be well.  I filled out the forms by the deadline and was assured everything was good to go.  For some reason I had to call back and when I explained the situation, the worker explained to me that everything would not be good to go that way, and that I needed to request a "GAP Exemption".  I couldn't believe that had previously been hidden from me, and I resubmitted the paperwork, and Linda from coordination of care gave me a code.  I wrote it down, and she assured me that everything was good to go.  My doctor's office was also told we had done everything we needed to do in order to get the in-network treatment and Gap Exemption.  

Life was great again.

Finally my baby was born.  It was MARCH.  We paid our deductible, and I enjoyed my hospital stay - it was so nice to not be kicked out at midnight with a newborn.

FOUR MONTHS LATER, I got a bill from the hospital.  $18,660 was due.  I knew it was a mistake, so I resubmitted it with the insurance.  It got kicked back.  So we resubmitted it again.  It got kicked back, and we resubmitted it again - each time the people on the phone saw the notes and I gave them the codes, and they assured me it was all a mistake.  But then we started getting nastier notes.  I knew it couldn't be true, so I called United Health Care.

Now it was October.  I was on the phone for FIVE HOURS.

I finally got transferred...

ALL THE WAY BACK TO LINDA in Coordination of Care.

For the first time since February, I got word that United Health Care had changed their mind.  They had paid the hospital like an in-network provider (coincidentally, they paid about $4000...interesting...that's the cash-pay patient price), and on the phone that day, they said they would no longer be paying the GAP...the GAP is the DIFFERENCE between what the hospital charges and what the insurance allows...the GAP was the $18,660, and the hospital wanted the money - they were demanding $500/month for the next 3 years.

I don't know about you, but I don't have an extra $500/month just sitting around.  I'm already stretched to my max, and we don't live lavishly.  I was so scared.  Not to mention, I had been paying over $1000/month in premiums, plus the deductible, and now I was also being charged 18 grand?  I would have been better off if I had had NO INSURANCE AT ALL!  Come to find out, though, all of this came crashing down JUST BARELY BEFORE the deadline to file an appeal.  It was interesting, because I didn't get any of these notices until AFTER the point that I could have filed for help from something like ACCHHS.  And I also wasn't able to get to the bottom of this until the deadline to appeal was almost come and gone?  I had 2 weeks to pull all my documents together and write the letter.  I found an attorney who works with bad-faith insurance cases, and he helped me formulate a letter that wasn't too long, but I had all the documents I needed, and I knew the appeal would work out because of the documents I had to prove the promises I was made by my insurance company.  That was one of the most intense 2 weeks of my life.  I could hardly breathe through the stress, and I needed life to stop so I could focus and pull my case together, but it's all a waiting game, and life doesn't stop for anyone or anything.

The story gets worse.  Also, during October, we had found ourselves suddenly home-hunting because we realized that the home-builders were out between 7 and 9 months, and we knew our lease would be up at that time, so amid the insurance & hospital confusion, we were house hunting.  We found one we loved and for the 1st time in 11 1/2 years put earnest money down on our first home.  It was so exciting, and life changing to finally be at this point.

In November we got word back from the insurance.  They denied the appeal, and so the hospital sent us to a debt collecting agency.

We had more on the line than we ever had had in our entire life.... 



January 2017
(That's where I quit venting and crafting this post...I was so sick of the battle.)

For the record, we're still in the battle, because legal battles are snail speed slow.

And also for the record, we paid our tithing, and the Lord's promises are true - he rebuked the devourer for our sakes.  Our home closed, and the day after I got a call about one of the pieces of the puzzle changing to the next status against us...which status (involving just a change of paperwork that the exchange sent) could have ruined the home purchase if it had gone thru a day earlier because it affected our tax documents & we would have had nowhere to live for a couple months until it would have been straightened out.

I know that the reason my husband and I were able to achieve this American Dream of purchasing our first home was by the grace of God ALONE, despite the oppression of a Socialistic Government trying to take over the land of the free and the home of the brave.

Happy Inauguration Day - I am grateful that Obamacare is a thing of the past, and like President Trump said today, we are going to now look to the future.  I am relieved even though the mess isn't over, I feel some of the shackles of Socialism are lifting.