I have significant pre-existing conditions that could have potentially caused me problems in getting a new policy if it were not for the ACA. Among them are chronic back pain which requires ongoing physical therapy and vigilant pain management, and sleep apnea — for which I am now able to get equipment to help alleviate my problems with insomnia. I also just recently discovered a new medical condition which would require attention as soon as possible.
I began the online application process in mid-October and resumed in November. The gap was due to the New York marketplace site's snags and resulting updates. Accordingly, I used the time to do more research so that I could be better equipped to finalize my application. One obstacle was a lack of clarity in the financial portion of the application and discerning the meaning of subsidies and their impact on my future finances and responsibilities for premium payments.
Another roadblock I faced during the application period was the ongoing confusion among providers in New York as to who would be accepting "marketplace" carriers and plans. This group included primary care physicians, specialists, and hospitals. Although I had been assured by one insurance carrier to just "tell providers you'll have a normal ID card which won't indicate you purchased the plan on the marketplace", policies contained some form of ACA affiliation. I had wanted to keep my current PCP but he belonged to a medical group whose team of doctors, associated with New York University hospital, was advised by an oversight firm to not accept any plans under "Obamacare" (the term used by billing and medical personnel in sardonically referring to the ACA).
Finally, I needed a plan which I could afford, given my current income situation, but which would also cover my pre-existing conditions and prescriptions.
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I applied due diligence in overcoming obstacles in the application process. Through the marketplace helpline and insurance agents, I was shepherded through the application's various stages and requisite financial information. I initially received a determination of eligibility and tentatively enrolled for a plan. I concurrently spent several weeks in online research, phone calls, and visits to business offices to determine what plans were being accepted.
Because primary care physicians' offices often gave contradictory information on whether or not they were opting in to various insurances, I subsequently reversed my order of priorities and made sure that my tentative choice for a plan accepted the hospital (New York University) and various specialists I wanted to retain. My preferred hospital did not accept the plan I had been enrolled in, so I needed to return to the marketplace website and change the carrier to another which would be accepted by the hospital.
After repeating the application process, another determination was made that I was eligible for a plan which (1) reduced my premiums through federal subsidies; (2) had a zero deductible; (3) $1,000 out-of-pocket; and (4) affordable co-pays for office visits and prescriptions. I was also fortunate to be connected to a knowledgeable service operator with my new insurance carrier who advised me to pay my portion of the premium as soon as I could in order for the system to churn out a member and provider ID by Jan. 1. I paid my premium before Christmas eve. From there, after exhaustive efforts to search for primary care physicians on my own, I relied on NYU's physician's referral service to render a list of several doctors who accepted my plan. I chose a doctor and made an appointment for the second week of January to have a much needed examination. I now have a primary care physician of my choice, and options to change if the need arises.
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Was my diligence and perseverance worthwhile? Absolutely. I am happy in knowing that persistence and patience landed me an affordable health-insurance policy, which includes my pre-existing conditions. My premium is lower than what I paid last year with another carrier and I have a significantly better plan. When my income changes, I expect my portion of the premium will increase as the federal subsidies decrease. And that's how it should be. I have found that taking charge of my health care has become almost a part-time job. However, I encourage others to be as diligent in their own quests for affordable health-care plans, tailored to their specific needs. I imagine they will be as grateful as I am today.
I believe that President Obama has taken a lot of unnecessary flack for how the ACA was rolled out. It is my experience — and I'm sure others in entrepreneurial, policy-making, and event production industries would concur — that any undertaking of this magnitude would have inherent glitches and confusion as it was designed, planned and executed. The president has always had his detractors, and his detractors seem to want to stall any and every item in an agenda he was elected on twice.
I do not blame the president for the complications that led to the messy rollout.
I do blame the rampant and incessant negativity which is pervasive and does nothing to contribute to the common good. The proof of this historic legislation's success is evident in the rising numbers of success stories, like mine — which sometimes don't get enough airplay amidthe clamor of (to quote Spiro Agnew) the "nattering nabobs of negativism."
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In life, we face complications and adversity and we deal with them. We use tools to troubleshoot. This empowers individuals to think for themselves and carve out a niche in this great society. As the old cliché goes: "Nothing comes on a silver platter" and as John Houseman so astutely reminded us in those old Smith Barney commercials: "you have to earn it." If it has not been put in place already, I might address any remaining complications by appointing an "overlord" of sorts with a troubleshooting team to address the myriad of issues and confusing information that remains out there. At the risk of promoting myself (remember, I'm unemployed), I'm happy to be of service!
President Obama, you have earned a very special place in history for your efforts in bettering the lives of many Americans for generations to come, and I thank you.
— By Martin Gewirtz
Want to be part of our first-person series on Obamacare? Send an email with a short description of yourself and your experience to our commentary editor, Cindy Perman, at cindy.perman@nbcuni.com.
