Affordable Health Care... My ASS... Literally

06/04/2015 09:16 am ET | Updated Jun 02, 2016

I opted into the Affordable Care Act through Blue Cross / Blue Shield of Tennessee, once it became available. In 2013, I picked the Silver S Plan, which offered the best bang for the buck. The rate was affordable, the coverage, more than sufficient for my needs. Thankfully, I never used it during my first year of coverage, but it was there, just in case. It's why we buy insurance, isn't it?

Year two swings into view and I'm notified by mail that my rate for this plan will go up 60% for the next year due to unforeseen circumstances. I choked. Still, at my age some coverage is better than none. So I switched to a comparable plan in cost, but with a much higher deductible. It would work until it wouldn't, I mused, before eventually looking at the meager list of doctors who would welcome this reviled, excuse me, revised, but affordable healthcare plan. I choked again and reluctantly switched back to the broader S plan.

My first free wellness visit, remember the words first, free and wellness, happened 18 months after I first enrolled in the program. Noticing, through the nagging of my significant other, I was allowed one wellness visit a year, I decided to take advantage of its generosity and scheduled my first foray into the system that was designed to make healthcare affordable to all Americans.

Dr. D, we'll call him, was very thorough and accommodating, delving into my past medical history to determine I was a little overweight, but (aren't we all?)otherwise healthy and long past due for my first colonoscopy. "Have no fear," he said, "it won't hurt a bit. Besides, this screening is also covered by your insurance." Hot dang, I thought, finally I'm getting some return on my 18 months of premiums. Dr. D referred me to Dr. N, whose ass I put in his hands, quite literally.

Going through the motions, I asked numerous times if there would be any additional charges for this screening procedure. Through a question and answer session, I confessed "I may have a hemorrhoid or two," trying to cover all the bases, just in case. High protein, low carb diets will do that, I think. "Have no fear," Dr. N assured me, it should be covered, as long as I had the procedure done at the one specific hospital accepting my current plan. "What if you find something?" I asked. "We'll take care of it," Dr.N assured me, "no worries. It's not like I'd stop the procedure and call your provider in the middle of it. At least, I never have."

Confident we were on the same page, two weeks later my ass and I showed up at 11:30 in the morning on Friday the 13th, mind you, for my 'free' screening, colonoscopy. When I awoke, Dr. N visited me in perfect bedside manner, "You had one polyp, I removed it, plus three hemorrhoids which I banded." Relieved, I felt no pain, and a major sense of relief, until the bills started rolling in.

The first invoice I received was for my first wellness visit with Dr. D. Seems, he doesn't do wellness visits the first time he sees a patient. Who knew?

The second invoice was the balance of the lab work from my first office visit, which I readily admit, Blue Cross covered adequately.

The third, fourth and fifth invoices I received from Dr. N's office would choke a horse. I blew a gasket. After much wailing and gnashing of teeth, I managed to get the great nurses in Dr.N's office to confirm they submitted the correct codes for a screening colonoscopy, problem solved. Or was it?

The invoices continued to roll in. My Blue Cross rep insisted they would pay for the procedure as long as the correct codes were submitted. Dr. N's office assured me, they were. To my chagrin, it was his billing office, i.e. the coders, that refused to comply, noting that Dr.N performed specific procedures and therefore was due sufficiently more than the wellness policy would pay. Who am I to argue with that? I did, but no one was listening, period.

Over the last two months, I've received numerous invoices, with each one significantly less than the other. Dr. D even wrote a letter on my behalf to Blue Cross, informing them that I was sent specifically for a screening, which I'm very grateful for. At some point, I hoped beyond hope they would eventually wind down to zero. Once again, I was wrong.

Surrendering to the logic or the madness, whichever, I paid the latest one last week after two robo-call reminders. The newest invoice arrived this week with a higher amount than the one i just paid. Huh? Oh, and the pathology invoice for the polyp arrived two days ago. Rats, Blue Cross was not so generous this time.

Today, I learned on the news that Blue Cross of Tennessee is asking for a 36% increase in premiums for next year, needed just to break even. I give up. My total increase since the inception of this ACA debacle is over 96%. The doctors tell me they're not making money, the insurance company says they're not making money. My question is, who the Hell is?

Thinking outside the box, I have a solution. Let's give ACA to the government to manage at an affordable cost. They're the only entity I know that will keep prices reasonable, no matter what it costs. Way to go Amtrak, you rock!

In all seriousness, I've said all that to say this-America as a whole needs immediate relief from the rising costs, the hidden costs, the undeclared costs of healthcare. I don't know what the answer is. Do you? What I do know is, these hefty increases in premiums, along with totally unrealistic deductibles that people are subscribing to trying to make their premiums affordable, are not working. ACA in the beginning was a magnanimous idea that was sorely needed and destined to succeed at any cost. Then again, so was the EDSEL.