albanyweblog.com
Updated
March 1, 2014
Here is the phony, manufactured "news" story that falsely claims that The Wife was persecuted by the Affordable Care Act. This is typical of the Hearst Times Union of Albany NY and of all the rest of the unreliable corporate media. The truth? The Wife and I are paying less for more health benefits thanks to Obamacare. We'd do even better if we had a Single Payer system. Here's the original phony news article:
If you are coming to this page from outside the site, please check out the article that responds to this corporate propaganda item:
Another Phony Obamacare Horror Story
Albany woman's misadventures with Obamacare
One woman's experience shows setbacks, frustration with the new online market
CLAIRE HUGHES
Section: Main, Page: A1
Date: Monday, February 3, 2014Albany: Lynne Jackson's experience with Obamacare has been a journey through program snarls that state officials and the insurance industry continue to work to untangle.
The Albany resident found a solution to her latest and most pressing problem -- her inability to see the cancer specialist who has treated her for the last three years -- through a provision in her contract that she didn't know existed. She found out about it when an official from her new insurance carrier got in touch with her, after the Times Union and her assemblyman, John McDonald, D-Cohoes, began making inquiries on her behalf.
"I'm glad I have a big mouth," said Jackson, a 59-year-old social activist known for voicing her opinions, whether they be to protect the Albany Pine Bush ecosystem or support imprisoned local Muslim leader Yassin Aref.
Her insurance misadventures started last year.
A sole proprietor -- she runs her own computer consulting business and has no employees -- she was not allowed to keep her previous insurance plan because it was a group contract. Language in the federal Affordable Care Act, known as Obamacare, prohibited her from continuing to get group rates for insurance through a business group, such as a chamber of commerce. She had to find a new plan, at pricier individual rates.
So she went shopping on NY State of Health, the online insurance market established by the state in October to meet the requirements of the federal law. Though she is expert in using computers, she found it difficult to wend her way through the website, she said. There were dozens of options to sift through, and complicated decisions to make.
Jackson shopped carefully. Diagnosed with breast cancer in 2011, she is in remission. But her illness taught her about the need for good insurance coverage when you're really ill. Most important to her was having minimal out-of-pocket costs per doctor visit. At the end of her cancer treatments, for instance, she received radiation for six weeks -- 30 days of treatment, with a $35 co-pay each day, for a total of $1,050.
Health Republic Insurance of New York, a new entry in the local health insurance market, offered her the lowest out-of-pocket costs. The carrier is new -- a cooperative created through the health law as competition to long-established insurers. She checked -- or now, at least she thinks she did -- to make sure the insurer's network included the three doctors she cared most about: her oncologist, radiologist and surgeon.
She was taken aback this month when she went to her oncologist and found out he's not in Health Republic's network.
"I could swear that I checked," she said.
What's more, she found the insurance carrier had only one oncologist in Albany County in its network. A call back from McDonald's office revealed that it actually had two oncologists in Albany County, but that information had not been updated on the NY State of Health website. Still, neither oncologist had privileges at Albany Medical Center, where she'd been getting treatments. And she was going to lose the services of New York Oncology Hematology, which had coordinated her cancer care.
Jackson started complaining. Edward Anselm, chief medical officer at Health Republic, contacted her with a solution that was right in her policy. It was a provision for continuity of care, meaning this: if she was being treated for an ongoing condition, the carrier would reach out to the doctors already involved in her care and negotiate contracts on her behalf.
The provision is in all policies offered through NY State of Health, and applies to conditions that are life-threatening, or degenerative and disabling, for a transition period of up to 60 days. Health Republic may extend the period and maintain the continuity of care for longer, depending on individual circumstances.
"When members call the plan and ask, they will find there is substantial flexibility," Anselm said.
A Health Republic spokeswoman also said that the company is looking to expand its doctor networks, including in the Capital Region. The carrier met the state Health Department's network requirements, but understands that consumers want more provider options, she said.
Another solution for Jackson would have been to cancel the policy and choose a new one through NY State of Health before the end of open enrollment on March 31. That's an option for all plans purchased through the online market, within 10 days of receipt of the policy.
Though Jackson's tale may have a happy ending, two state senators said her experience is indicative of problems with the state health exchange. Similar problems to hers were detailed during more than four hours of testimony at a Jan. 13 hearing held jointly by the Senate Health and Insurance committees.
"That's a classic example of someone who is being very negatively impacted by Obamacare," Senate Insurance Committee Chairman James Seward, R-Milford, said of Jackson's experience.
The Senate is considering ways to allow sole proprietors to enroll in their former group-rate plans, Seward said, though anything state legislators fashion will need to comply with the federal law. Senate Health Committee Chairman Kemp Hannon, R-Long Island, said his committee is considering a proposal to require each carrier on NY State of Health to offer one plan with out-of-network coverage. Out-of-network coverage was eliminated from health plans for individuals through most of New York when the state health exchange launched.
But the problem of narrow doctor networks won't be solved by that proposal, he conceded. "If we're going to get the promise of Obamacare, we're going to have to get around these skinny networks," Hannon said. "This is certainly a Rubik's Cube in about 10 dimensions."
chughes@timesunion.com - 518-454-5417 - @hughesclaire