Thursday, October 17, 2013

Adventures in Health Insurance Exchange Part I: Doctor, Doctor

The insurance exchanges are online and I need insurance.

A little background on me: I was a software architect at Optum (the IT arm of United Healthcare) building Health Information Exchange (HIE) systems until recently. I left to join a very small consulting company (there's 3 of us) and lot of exciting stuff is happening in health care: HIEs, ACOs, NwHIN, FHIR, Blue Button, all these amazing things coming into existence right now.

I'm not without coverage. I have a UNH plan, high deductible with HSA, which is fine. I like my doctors. I'm on COBRA which is $500 a month but I get $100 off for being in good health (rockin' all the vital signs - oatmeal and half marathons yo). Not a bad deal, in relative terms. The individual private plan is about the same but I've been waiting for the insurance exchange to come online and now I get to put it to the test.

Being a Silicon Valley kind of guy, I went to - I actually signed up months ago and the "window shopping" part of the site has been up for quite some time so I know my rates are going to be similar. Turns out that's just what they cost.

I have a few requirements for my next health insurance plan:

  1. I want to keep my doctors - all of them. PCP, eye doctor, dentist, everyone because I want to live as long as humanly possible and that involves watching the progression of my health very carefully as I age. I stand on the principle that continuity makes better care.
  2. I kind of like my health savings account (HSA), I'd like a plan with an HSA. You pour money in tax free and when it's time to pay that high deductible it doesn't feel nearly as painful as pulling that same amount of money out of a savings account. I also figure when I'm old and feeble I'll be paying the yearly max every year, so there's that.
  3. If they have high tech wellness tools, like a really killer mobile app, that's a plus.

At first, I didn't know if I could keep my doctor. A tool to search for providers was added October 7th, and with it I was able to find my care organization - Palo Alto Medical Foundation - but not my doctor. I had to go to PAMF's web site to see what plans they accept. PAMF was an early pioneer in this technology and their tools are very, very good. I not only saw what plans I could pick from the exchange, I saw this:

How about that. If I don't switch plans, there's a chance I won't be able to keep my doctor.

Partisan pundits have asked, "Will I get to keep my doctor under ObamaCare?" I think the real answer to that question is, "Were you ever able to keep your doctor?" I had to switch doctors every time I changed jobs, and sometimes just because my insurance company decided to change its "network" for no reason I ever knew. If I move to another city I'll find a new doctor, but as long as I live here, walking distance from PAMF, I'm not switching. I shouldn't have to.

With an ACA plan I can keep my doctor. In fact, I need to sign up now if I want to keep my doctor.

In a later post I'll describe my experience navigating the web site, along with a few others, and actually buying insurance. Spoiler alert: I'm a big, big fan of health IT systems and I'm inclined to like it, but I did run into one or two problems.

No comments: