State Of The Union: Medical Care in MA

What a wild ride I've been on with navigating the healthcare world during these past two years and even more so, since May of this year. On May 23, my older daughter turned 26, which meant that she could no longer be on my insurance policy. Now the fun - or shall we say, not so fun began! I have had the same insurance for a number of years because the coverage was good, alternative services such as food sensitivity and some alternative GI tests were also covered. The price was reasonable for someone self-employed with a family. Then as 2014 started, these tests were no longer covered, compounded medications and supplements were also taken off the list. The starting of the demise of inclusive services. When May 23 arrived, my daughter had already done her homework about choosing a plan, being sure the company paperwork was submitted and on that day our entire family policy was cancelled. I knew first because when I went to renew prescriptions, I was told I had no insurance. The process began. I could not be found in the database by name, date of birth or social security, and yet, I had been with this company for years. My daughter's policy was now my old number and she had wrong data attached to her brand new policy. I started with customer service, but after one month of no return calls, I asked to speak with a supervisor. We made a little headway, then he was gone for extended holiday and no-one took over my case. Start all over again! The next person promised to keep me updated weekly on progress, but that never happened. I was informed that we may have problems for the entire year. During this time, I overpaid bills to doctors, pharmacies etc. I had requested my monthly statements since I was not receiving them. I worked on this while in my "hotel room", as I called it at the Newton Wellesley Hospital, dealing with my own poor health. Once home, I called to request updates on issues that never were solved, thus decided to write the president and CEO. He never returned a call or letter, thus I sent the same letter a second time, certified, return receipt requested. He received it alright, but never responded. I had stated in my letter that I hoped to work out these issues without having to contact the insurance commissioner's office and my state rep and thus decided to follow up with a call. I was transferred to the ombudsman's office and we talked. I requested what seemed reasonable to have 3 months waived from premiums given the money, time and stress that was spent on this fiasco for myself and my daughter. Again, I received no follow up from the ombudsman, until finally an email stating that the issues would be resolved in 3-4 weeks and that the company would not honor my request regarding some restitution. It is now mid-October, almost the end of the year! The very next day, I received a demand letter to pay over $6000 in premiums or my policy would be cancelled in 15 days. While in shock, I chose to contact the insurance commissioner's office, to contact my state rep and he has been very cooperative with me to assist me during this time. While all of this has been going on, I had labs done at the Brigham 2 weeks prior to my doctor visit and when we met, he had not received them, nor could they be found on the site. I called, only to be connected to answering machines, then disconnected. After attempting this for a number of times, I called the operator expressing that I needed to speak with a person in the lab, not an extension, because my labs were lost! Upon speaking with the lab person, she realized that the labs were faxed to a phone and not a fax. She told me that it would be done right away. A day goes by and no labs at my doc's office. I start the process yet again and when I explain that the lab had mistakenly faxed to the phone and that I needed these reports, she told me "when I have time". With my jaw at my feet, I told her that this was unacceptable, that it was now three weeks with lost labs and I that I am dealing with cancer, she still stated "when I have time, by the end of the day." She was not compassionate, sounded irritated and did not apologize for any mistake on their end. I asked to speak with a supervisor and she stated to be the supervisor! Wow - well this is a long and detailed blog, BUT, the upshot is that the state of healthcare here in MA is not so pretty. I feel lucky enough to know how to address some issues being a provider myself and feel very concerned for people who just don't know how to deal with the system - a system that is very broken at the moment. While I still do not know the outcome of the Harvard Pilgrim fiasco and have dealt with less than compassionate lab folks at the Brigham, I do know that there are ways to not be in a place of victim-hood: Gather your data Be assertive and persistent Look outside the box for assistance - governing agencies, state representatives If we all begin to assert our displeasure, we may begin to make some momentum in creating a healthcare system that does work for the people. Rah-rah! Julie