Monday, August 10, 2015

How the Affordable Care Act Failed Me


I am not a political person. I don't watch the news. When election time comes, I educate myself as much as is necessary to make an intelligent decision. I do vote. But overall, I don't have the energy to watch Fox News and CNN and then balance the two to try to come up with the truth of a situation.

Today, though, I will tell my story. And it sounds political. I will tell it because what happened to me is so incredibly unfair, and I feel like someone needs to know about it. Hopefully my voice will make a difference for someone else. It is a long story, but it is a story about life and it is a story that matters. It is also a story about death. But maybe it didn't have to be.

Several weeks ago, on a Saturday, I felt weird. I felt dizzy and nauseous. Something just felt off. I was at home sitting on the couch, and when I stood, I felt a strange tightening across my abdomen. I hadn't felt that since... well, I was pregnant with my son. I mumbled an excuse to my husband Jake for why I needed to make a trip to the grocery store, and I went. To buy pregnancy tests.

Positive. Two pink lines. I felt nervous and excited. I cried a little when I broke the news to Jake. We were going to have a baby. Such happy news after months of hard things.

I knew that I needed to see a doctor quickly, but it was Saturday, so that would have to wait until Monday. My first pregnancy ended in miscarriage at eleven weeks, so I knew I may need some intervention to sustain this pregnancy. My hope was that, come Monday, I would find a doctor, get some blood work done, and start taking progesterone supplements. The supplements had made a difference with my second pregnancy, so I was counting on them to help with this one.

Monday came, and I tried to find a doctor that took my Marketplace insurance. Obamacare. We had enrolled in March, but we had not had to use the insurance yet. The problem was, out of the 68 OB/GYNs in my area that were listed as providers, I could not find a doctor that actually was a provider. I called the insurance company. Everyone I spoke with seemed to know that their lists were not accurate, and each representative agreed to help me find a participating provider. I was told that someone would call me back when a provider was found. I called doctors. The insurance company called doctors. I called back to the insurance company on Tuesday. And Wednesday. Not one of the providers that had been called were still accepting my insurance. So I changed strategies. I called the Marketplace.

My purpose in calling was to see if I could change insurance plans. I needed a plan that was widely accepted. I needed to see a doctor. The longer I went without progesterone, the more nervous I became about the little life inside me. The Marketplace representative said I might qualify for special enrollment since I was pregnant. I might be able to change plans. She did a little bit of typing and checking on her end. What happened next is unbelievable to me, even still. She said that I qualified for Medicaid, and so she had to submit that application for me. She also said that she was terminating my insurance effective that day. I tried to tell her that I didn't want to apply for Medicaid. I wanted to keep my coverage, but I just needed a different plan. It didn't matter.

What if I need to go to the emergency room tomorrow?

Medicaid will cover it if you are eventually approved.

But what if I am not approved for Medicaid?

Basically, she said, I would be responsible for paying for it myself. She said that since I qualified for Medicaid, I could not keep my Marketplace plan. She had no choice but to drop my coverage, despite the fact that I had paid premiums for coverage through the end of month. By the end of that call, I had no insurance coverage, and I had been forced to apply for Medicaid.

I got in my car, and I drove to the Fort Worth Pregnancy Center. I needed care, and I needed someone to help me to get into a doctor quickly. I felt like time was running out. The people at the pregnancy center were kind and compassionate. They gave me a list of doctors who might take me as a self-pay patient since I no longer had insurance. I spent the afternoon making calls. Several doctors wouldn't see me because I was considered  a high risk patient. The last doctor I spoke to said that he would see me, but only with a $500 deposit, in addition to whatever charges I incurred from my first visit. He could not, however, see me that day. In the end, at the suggestion of a friend, I called and scheduled an appointment with a local midwife who agreed to run my blood work at cost. I scheduled another appointment with a nurse midwife, in case it turned out that I needed a prescription for the progesterone.

Friday's blood work looked good. Progesterone level needed to be a little higher. Monday's blood work showed the thing I had prayed against. My HCG levels had dropped. I was going to lose the pregnancy. By Tuesday evening, I was actively miscarrying. I was devastated. I am still devastated.

Wednesday I kept my appointment with the nurse midwife. She was compassionate and helpful. She listened to my story, and she performed an ultrasound to make sure that my body was handling the miscarriage like it should. She helped me put a plan in place in case I got another positive pregnancy test. The appointment cost me almost $200, and of course, I had no insurance or Medicaid to cover it. I scheduled another follow-up appointment that would cost another $100.

In the end, I was denied for Medicaid. Because I worked in the last 90 days, that income was used to determine eligibility. Apparently, the Medicaid qualifications that the Marketplace has are not the actual qualifications. I was dropped from my insurance and forced to apply for something for which I did not even qualify.

I know that it's possible that this pregnancy might have ended even if had the progesterone supplements that I needed. But at this point, I will never know. I needed medical care, and I did not have access to it, thanks to the lack of providers in my area. When I called to see if I could change plans, to increase my chances of receiving care for my baby, they took that coverage away from me. It just feels wrong that a plan that was supposed to ensure that all Americans have access to healthcare was the very thing that prevented me from getting the care that I needed in time.

I don't tell my story to start a fight. This isn't meant to fuel a conservative vs. liberal fire. Maybe there are thousands of Americans who have had wonderful success with Marketplace insurance. It's possible that there a hundreds of success stories, stories where Marketplace insurance saved the day and saved a life. If that's the case, good for them. But something has gone very wrong when a pregnant woman that needs urgent medical care can't get it.

This is my story. My situation. Marketplace insurance failed me. It failed my baby. And my baby matters.

8 comments:

  1. so sorry praying for you all the way in New Zealand <3

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  2. so sorry for your loss...praying for you and yours.

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  3. Oooooooh Julie....even though you and I both know better, it feels so pointless....this struggle, this valley, the hurt. I ache for your loss and am angry for you about this ludicrous treatment..wish I could give you a hug and buy you lunch at Mexican Villa! Love you friend.

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  4. Are there no Planned Parenthoods or Walk-In Urgent Care centers in your area? Even without insurance Planned Parenthood would have been able to provide just about everything you needed at little to no cost to you.

    If neither of those options are available in your area, why didn't you go to the hospital while you still had insurance? The dizziness, nausea, and abdominal pain you mentioned are all legitimate reasons to go to a hospital. Once they made sure you were okay right then and there the case managers in the ER would have set you up with your next OB/GYN appointment upon discharge.

    Also, didn't your marketplace insurance require you to have a primary care physician (PCP) upon enrolling? Did you reach out to your PCP's office at all? Your PCP would be able to give you a referral for an OB/GYN that should help get an appointment a lot sooner. Of course, there's a whole other set of problems where there aren't enough providers in general making appointments even more difficult to get, but that was a problem long before the ACA.

    I think it's awful that the ACA bureaucracy nonsense cost you your coverage, but you also have to realize that you may not have lost coverage if Texas had accepted the federal Medicaid expansion that was created specifically to prevent situations like yours. Governor Rick Perry put partisan politics ahead of your healthcare.

    http://www.npr.org/sections/health-shots/2015/05/29/410520561/texas-politicians-and-businesses-feud-over-medicaid-expansion

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    Replies
    1. Anonymous, I don't know you, but I know this is the very worst kind of response you could have made to this post. At a point when the writer is grieving a tremendous loss, you're going out of your way to tell her how she failed and what (you think) she could have done better. I don't necessarily disagree with any of the info you shared - I'm a NPR-listening, lefty Planned Parenthood supporter from way back - but I vehemently disagree with the way you chose to share it. "Why didn't you..." "Didn't you know...?" etc. is just victim-blaming and gross. Obviously, she did what she thought was best for herself and her child and it sounds like she worked her ass off in the process. Maybe next time, try, 'Here are some things I've learned that might be helpful if you're ever in this situation again..." And to you, Julie: know that people as far away as Montana are sorry for your loss and are praying for your continued healing.

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    2. Anonymous? If i was going to leave the moronic comment that you left, I'd want to be anonymous too. You need to stop. No one asked for your help or opinion. You are gross.

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  5. I am sorry to hear of your loss. Unfortunately we may hear more stories like yours. My wife and I had to drop our marketplace insurance because of high premiums, when I thought they were supposed to be lower. The marketplace seems confusing at best, at least for most of us.

    Hugh Mounsey @ U.S. HealthWorks Bellevue

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  6. This is a truly heartbreaking story. I hope you find some peace as you move through grieving your loss. You are very brave for sharing such a hard moment online. It is truly tragic that you were unable to find the care you needed due to bureaucracy and paperwork! I really hope your story can make a difference in someone's life.

    Jason Hayes @ DECORM

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