I’ve long since given up on going out on a Friday night. If there’s a special event, like a friend’s birthday, then I’ll make the effort when I can, but otherwise, I just stay in. I hope that changes one day, but for now, paying bills is the same to me on Friday as on a Wednesday.
So I was going through my bills and other paperwork tonight, and I came across my new health insurance handbook. It arrived in the mail earlier this week and I hadn’t gotten to it. Unlike most people, I actually read these things. Plus, I went to my PCP’s office today to show them my new insurance card and arrange a referral for my rheumatologist and they said I didn’t need a referral, so I wanted to make sure for myself.
I started flipping through the handbook, figuring I’d do a thorough reading later, but then it really caught my attention. You see, I’ve always had employer-provided HMO plans. With these plans, PCPs (primary care physicians) must give referrals for all specialists, and I pay premiums and co-pays for everything. I’ve been lucky to have plans that didn’t have deductibles or co-insurance. It was a very restrictive system, but it was the only one I knew.
That’s why I was shocked to find out about my new plan! Now, I haven’t used any of these services yet, so I can’t be sure if they’ll work out the way they’re supposed to. And I don’t know how long I’ll have this plan. For one thing, I appealed my denial of medicaid, so I could end up with that instead of this. And of course that doesn’t compare to the uncertainty of the long term disability insurance mess. If I get the insurance coverage when we appeal, then I’ll get my old health insurance back. I’d rather keep this new insurance, I think, but I definitely need to win that appeal so that I have an income.
I was accepted for this new plan despite my pre-existing health problems because Massachusetts rocks, and it was given to me without having to pay premiums because I have no income and Massachusetts rocks some more. Believe me, I know how lucky I am! But I was still shocked to read the details of this plan. I can see specialists WITHOUT A REFERRAL!!!! I feel like I’m dreaming. This means that I don’t have to worry about whether or not my PCP agrees with my decision to see a certain doctor! My big issue now is that I need to find a new endocrinologist, since my last one dumped me for being the cause of too much paperwork and too many expensive tests. I’ve been worried about finding someone who practices what I think is best approach based on the research I’ve done. Then, once I find them, my PCP would have to approve…. but not anymore! I figure if I can see someone soon, then even when/if I get my old insurance back, my PCP would be more likely to go along with it because I’d already have seen the new doc (or she’d be pissed, in which case I’d find a new PCP.)
Even more amazing, there are no co-pays for visits, and the co-pays for meds are incredibly low. Now again, this is a plan for people who have no income, so I know this isn’t what everyone gets. Still, it’s amazing to me that they did it right! They are offering free coverage to people who can’t afford to pay, so that we don’t get really sick and end up costing even more money to them later.
It’s amazing, almost unheard of, but I think I’ve finally encountered a health-related, government-related system that isn’t broken! I sure hope it turns out to be as good as it seems, because right now, it seems too good to be true.
I’m sure all of you readers in other countries are wondering what all the fuss is about. I just can’t even tell you. Click on the “Healthcare” category in the sidebar on the right (you might have to scroll up or down) and you’ll start to understand just a little bit. It’s really lousy here in the U.S when it comes to health insurance. Most of it is linked to employers, and many people choose jobs based less on their passions, the work, or the job potential than on the health insurance that’s provided. I really hope this ray of sunshine lasts for me, and that the new Affordable Care Act helps things!