I have entered the Insurance Twilight Zone!

Options
Siciliana
Siciliana Member Posts: 127
edited December 2016 in Employment, Insurance, and Other Financial Issues

I found out my diagnosis of BC on 12/21/16--just a few days before the deadline for signing up with the Affordable Care Act. The insurance I have had for the past year is Premera, but it is no longer available in my county for 2017. So that left only two options: Group Health and Bridgespan. I used a broker to help me select the best plan for my income and circumstances. Unfortunately, the plan I chose (Bridgespan) looks rather good on paper, but that is far from the reality. Even though the search function shows that numerous hospitals are "in network", I am unable to find any doctors who are in network at those same hospitals. Can't go to Seattle Cancer Care Alliance, not contracted. Can't go to University of Washington Medical Center (which is in network) because all of their cancer specialists are contracted with Seattle Cancer Care Alliance which is not contracted with Bridgespan. So what is a person to do? So I can find an in-network hospital, or I can find an in-network doctor, but can't find a combination where the in-network doctor has privileges at the in-network hospital. I can't have surgery without a surgeon.

In my depressed state after spending days on the phone trying to find some combination that will allow me to get treatment covered, I am visualizing a Scrooge-like entity, hunched over his computer, punching numbers into his calculator, devising the ultimate fail-safe system to keep his company from having to pay out.

This is the new reality, I guess. When my husband was going through his treatment for brain cancer seven years ago (a losing battle), at least we did not have to worry about finding a hospital that would treat him. We had many worries, but insurance was not one of them.

Please forgive my "poor me" attitude tonight. I realize there are others on this forum who have a much harder time of it than I have.



· Share on FacebookShare on Twitter

Comments

  • Zillsnot4me
    Zillsnot4me Member Posts: 2,687
    edited December 2016

    insurance is a nightmare for healthy people. You are still trying to wrap your head around your diagnosis. Most hospitals will have some kind of assistance. Good luck.

    · Share on FacebookShare on Twitter
  • Luckynumber47
    Luckynumber47 Member Posts: 397
    edited December 2016

    Is Swedish in your network? I received excellent care from Dr Hendershot ther

    · Share on FacebookShare on Twitter
  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited December 2016

    Siciliana, I'm afraid I don't know much about the kind of insurance you have, but it seems to me that there must be a way to contact the company and say, "Look, I bought this insurance, and I haven't been able to figure out where I can get treatment. Please tell me how to proceed." Be succinct, unemotional, and firm. They need to give you a workable solution. Otherwise, can you call your state's insurance commissioner for help? Another idea would be to ask the hospital social worker for help in solving this problem. Please tell us what happens. I'm sorry you have to deal with this on top of everything else.

    · Share on FacebookShare on Twitter
  • rainnyc
    rainnyc Member Posts: 1,289
    edited December 2016

    Siciliana, I am so sorry you have to go through this on top of your recent diagnosis. I'm also on an ACA plan, and it's definitely a challenge. A couple of things: while you're trying to find care providers on the Bridgespan plan, you might also continue to ask about providers on the Group Health plan. There is still time to switch: If you do so by January 15, that will get you February 1 coverage.

    As others have said, get on the phone with the plan. You can say, "I am a cancer patient, and I would like to ask for a care coordinator (sometimes called a nurse navigator)." This is someone the health plan hires for people with complex, chronic conditions, not only cancer but diabetes, for instance. Being able to get this person on the phone will help you eliminate long waits on the insurance company's main help line, and at the minimum may give you someone who can help find care providers.

    And yes, if you can't find a doctor who can see you, definitely call the hospital's insurance coordinator or patient advocate and explain the situation and get their help. Go up the chain of command. If it's not working, get in touch with your state's insurance commission. Be a very, very squeaky wheel....

    It really stinks that you have to do this. Good luck, and let us know how you're coming along with it!

    · Share on FacebookShare on Twitter
  • NoUGo-CA
    NoUGo-CA Member Posts: 46
    edited December 2016

    Hi Sicilliana,

    You could try asking Bridgespan for a Case Manager to help you figure this out.  If you've already received member info, log-in to the Bridgespan site and check the 'USE' dropdown.  Select 'Case Manager'. It explains what a Case Manager does and how to request one.

    I'm so sorry that you have to worry about all of this at this time.  You'll get it figured out and receive the care you need.

    Vicki

    · Share on FacebookShare on Twitter
  • Siciliana
    Siciliana Member Posts: 127
    edited December 2016

    Thanks, everyone! I finally found a breast cancer surgeon in Bellevue, affiliated with Overlake Medical Center, who is contracted with my insurance. I have an appointment scheduled for January 3rd. Feeling a little bit better right now. I love the idea of getting connected with a patient advocate.

    · Share on FacebookShare on Twitter

Categories