It took me four years, but I am only beginning to understand my health insurance policy. This is a health maintenance organization, which means that I need to consult my primary care physician to get a referral for most specialized services.
I know all this because it was explained to me by an exasperated bureau chief, who set up the kind of voice usually reserved for truculent 5-year-old girls. She phoned two weeks ago to blame me for getting the wrong type of referral for an appointment. I did not know that there was a bad guy.
Apparently, my recommendation was to mention the fact that it was a HIP plan (the Greater New York Health Insurance Plan is one of two companies merged to form EmblemHealth, my current insurer) to proceed. I did not report it when I provided my police number and, somewhere in the future, my reference was found in the buffers.
This delicate exchange was followed quickly by a second call from another office manager (at a second doctor) calling me over the phone to explain that although I saw the good doctor last month for my knee, it turned out that I was completely wrong location.
I did not know that there could be a bad location. But it turned out that the Brooklyn office near my home was not the right one; the downtown office, 35 minutes away from the subway, was the one covered by my insurance.
When I contacted EmblemHealth to explain the difference in location, a representative sent me an e-mail: "Providers, including doctors and other practitioners, have the choice to participate with us in some of their sites or in all their sites. "
The pure and disconcerting complexity of all this
But I welcomed the telephone explanations of the heads of offices. During my career as a foreign correspondent, I have generally found it prudent to listen to locals with advice and acronyms – especially with regard to navigation problems of Byzantine complexity, such as the tribal structure. nomadic shepherds from North Darfur or blood vendettas from MS-13 gangs in San Pedro Sula, Honduras, or even get by in the sky train at John F. Kennedy Airport in New York.
The only problem is that on this occasion, the essential explanations were somewhat redundant, following an email sent a month earlier by my insurance company who informed me that it ended my police at the end of the year.
There are many, many more, I still do not know
I spent the end of December trying to understand as much as possible the health insurance market in New York – and I learned that there were many, many more than I did not know about American health policy yet. Crossing the offers of different companies, weighing the franchise in relation to the maximum, differentiating HMOs from EPOs (exclusive service providers) does not make sense if you have not already spent your whole life in the system.
I shudder to think of what it was before Obamacare, when we could not even be sure that the basics were covered without a Mr after the name, a magnifying glass for the small print and a few weeks without anything in the newspaper .
Nevertheless, since I became a freelancer in the United States, the New York State health market, created under Obamacare, and its prices were blazing.
The email at the end of this first year was a shock. My insurer told me that my premium was increasing by 20%. The problem was the Affordable Care Act, according to my insurer of the time, and an unanticipated number of people presenting with pre-existing conditions.
Two years later, it was the same but different. With Donald Trump ending the "individual mandate", too few healthy people have signed up. "When only the sickest people buy health insurance," said another condescending explanation that I seem to attract, "it costs more." About 30% more in the case of EmblemHealth HIP plans, according to an email sent to customers during the summer. Or it would have been the case if the state of New York had not told the company to give consumers a break, limiting the increases to a single figure, and if my policy was not abolished anyway, according to the email that I had received in the fall.
Much like when the British rail system stopped due to the wrong kind of snow, the US health care system is apparently beset by the wrong kind of patients: the sick.
Medicare for all seems to be a possibility
So, what is the solution? Medicare for all, as advocated by progressives, seems to be a possibility. Maybe it could work, as in Britain. Of course, there is a tradeoff in terms of choice, speed and availability of the most expensive drugs, but the good side is a universal system in which everyone is treated the same when it goes to see his doctor. There is no chance that your doctor is "off the grid".
This disoriented patient is at least grateful that part of Obamacare remains intact – the metal valuations that make it easy to compare gold, silver or bronze policies (but also reinforce the sense that I am a loser in life as I dive right into the cheapest category).
This was perhaps the biggest Obama master stroke. Could he have known that his successor would be a passionate of precious metals, eager to see them all, from lifts to health insurance?
Of course, I'm not the first to complain about the complexity of the system. And EmblemHealth says it's constantly working to demystify the system. "We want members to be aware of the costs associated with their care, so early next year we will provide a simple, clear and straightforward explanation of what the clinician has billed, the price of the plan and the costs that the person is responsible for, "said the spokeswoman.
In any case, with the time that has elapsed until the deadline for registration, I did what I always do when I am confused by the wide choice. I went for easy bronze and I chose the second cheapest option.
Then, and only then, I wondered if my current doctor was covered.