As I hinted at my previous Adventures In Obamacare post, healthcare.gov, the government one stop shopping center for insurance quotes still sucks.  My current insurance company’s web site (BCBSIL) sucks less.  I have always HATED their website.  It’s designed well for people shopping for insurance but incredibly poorly for actual members.  For instance, it’s nigh impossible to figure out how to make a payment online.  Also, instead of giving you a list of doctors in your plan, they send you to another site where you have to enter in your plan information all over again which is confusing because the name of your plan can be different from the list of plans you can choose.

Since I can’t compare plans on the government site, I will compare my options with Blue Cross which is who I’ll likely go through in the end.  I am assuming that various other insurance companies’ offerings will be similar.

Blue Cross offers 18 different plans in Illinois.  The prices listed below are for me, a 40 year old male.  They range in cost from their bare bones Bronze plan which would cost me $152.24/month to a Gold plan that costs $383.14/month.  Due to the weird pricings that go into deductibles and coinsurance and copays, the one Platinum plan that they offer comes in at $357.13/month.

I will compare only three plans for the sake of brevity.  They will be the three that I briefly mentioned in my previous blog post.  They are: the cheapest plan (Blue Choice Bronze PPO 006) at $152.24/month, the one closest to what I pay now (Blue PPO Bronze 006) at $225.40/month, and the one closest to my current benefits (Blue PPO Bronze 005) at $227.69.  A chart of the comparisons will follow at the end of the post.  But to begin, Blue Cross screwed up when they sent my letter.  I currently pay $303/month which is not close at all to the one they say is closest to what I pay now.  The issue there was I just switched to a higher deductible plan ($5,000) and I paid less than the $303 for the first cycle because of the pricing differences when switching plans.  Somehow, Blue Cross quoted me that lower price per month instead of my actual price per month.

As far as coverage is concerned, all three plans are exactly the same.  The cheapest one is a Blue Choice PPO plan and the other two are Blue PPO plans.  As far as I can tell, the Blue Choice PPO plans offer a smaller network of doctors to choose from than the Blue PPO plans.  For that added ability to choose, they charge $73.16/month.  That’s a 48% premium.  It’s funny that the Blue Choice plans actually have less choice.  They are obviously steering people towards those plans based on that name.  I’m sure they’re somewhat more profitable than the others.

Besides the added ability to choose, the Blue Choice Bronze PPO 006 and the Blue PPO 006 plans are exactly the same.  They all have a $6000 deductile which is $1000 more than my current deductible and require no copay.  Despite the fact that they both state a 100% coinsurance, they both have an out-of-pocket maximum of $6000 so coinsurance shouldn’t ever actually come in to the equation.  So really, the coinsurance should read “not applicable” but I guess programming wise it may be easier to just say 100%.  The Blue PPO Bronze 005 plan costs just $2 more than the similarly named 006 plan but coinsurance actually comes into play here with only a $5000 deductible and a $6250 maximum out-of-pocket cost with a coinsurance rate of 80%.

The bottom line is I can get similar coverage under the Obamacare plan for 33% less than what I currently pay.  If I am willing to accept a $1000 larger deductible and a smaller network, I can cut my insurance premium in half.  Not bad.  Not bad at all. As an added bonus, with the savings, I will likely add dental insurance which I have not had in the past.

My next Adventures In Obamacare post will be when I can actually get on the exchange and compare other companies.

The pooch-screw that is healthcare.gov continues.  The website continues to have lots of problems and delays.  I am still waiting for the website to officially declare me a human.  But that’s not what this post is about.

I received a letter from my current insurance company (Blue Cross and Blue Shield of Illinois) informing me that my current plan is being cancelled because it does not meet the minimum requirements of the Affordable Care Act (ACA).  This was highly surprising to me given how comprehensive my coverage was supposed to be.  What’s frustrating is that the letter is not very descriptive of what exactly was missing in my plan that the ACA requires.  As best as I can tell, the only thing missing from my coverage that the ACA requires is pediatric dental care.  One would think that it would be a much simpler matter to just add pediatric dental care to my plan instead of having everyone on my plan switch to something else.  But maybe it’s not.

The interesting thing is the options that Blue Cross gave me as alternatives.  They gave me three alternatives.  All of them were considered Bronze level coverage according to the letter.  The three options were: 1) a base Bronze plan, 2) a Bronze plan that was closest to what I pay now for my current plan, and 3) a Bronze plan that was closest to the coverage of my current plan.  The base Bronze plan was noticeably, but not significantly cheaper than the other two plans.  The Bronze plan that was closest to what I pay now was, shock of all shocks, right at what I pay now.  The Bronze plan closest to my current coverage was only a few dollars more per month than my current plan.

I was shocked at a few things.  First, that my current coverage fits neatly into a Bronze plan.  I was fully expecting to find that my coverage was Gold level or higher.  Second, I can get an ACA plan that offers greater coverage than what I’m paying now for only a few dollars more a month.  Score!

I have yet to dig into the nitty gritty details of the three plans Blue Cross offered me.  I’ll write another post about them later.  Horrible website issues aside, Obamacare is looking pretty good so far for yours truly.

Correction: The small business requirement applies to businesses over 50 full time employees, not 30.  This requirement has been delayed until January 1st, 2015. The 30 is the number of hours an employee has to work to be considered a full time employee.

I am one of the approximately 20% of the population that can take advantage of the new health exchanges that came into being to much fanfare and gnashing of teeth on October 1st.  This is my story.

As an owner of a small business well under the 30 50 employee level which Obamacare mandates companies offer insurance, I purchase health insurance for myself on the open market.  If I so chose, I could continue on my current health plan which I am assuming would equate to a platinum type plan on the health exchange.  But that would be no fun.  I currently pay about $250 a month for a fairly comprehensive $5,000 deductible plan.  Let’s see how the health exchanges stack up.

I live in Illinois.  Our state has decided to allow the federal government to control the health exchange signup procedure for anyone living in Illinois.  This means that I go to www.healthcare.gov to sign up on the exchange.  I attempted to do so on October 1st when the exchanges first opened and was met with a page telling me that the site was really busy and, if I just waited there in the virtual line, they will redirect me to the signup page as soon as possible.  After an indeterminate amount of time, I decided to try again some other time.  News reports were that people were waiting up to 3 hours to get past that screen.  Since I had until January 1st, I decided to let them shake out the bugs and the onrush and try again later.

Today, October 5th, is later.  I was once again met with the virtual please wait here message.  This time, though, I was ushered in to the ‘Create An Account’ page after only a minute or so of playing mindless Flash games.  Creating an account is fairly painless.  The website itself is fairly snazzy.  There are some bugs and I seemed to have to reenter the same information quite a few times, but eventually I was able to create an account and do the usual e-mail verification to get the account activated.

After that, you need to be able to verify your identity.  The website contracts with Experian to verify your identity, but Experian was unable to do so for me.  This is not an unusual occurrence for me.  I blame the hyphen in my name and bad coding.  As an alternative way of verifying my identity, I was able to scan and attach a copy of my driver’s license and let them verify me that way.  Unfortunately, this takes human intervention.  So now I wait.

Without proving that it’s me, I can’t yet choose a health plan.  Given that it’s the weekend, I don’t expect the verification to happen until Monday at the earliest.  I’ll post more about my adventures once I am me.

The New Yorker has an interesting article regarding medical residents, hours worked, and health outcomes.  Residents used to work ridiculous hours.  We’re talking 30 hour shifts.  That is beyond ridiculous considering that even a little sleep deprivation has been shown to impair cognitive abilities as much as being drunk (which the author of the article both admits and seems to poo-poo as something non-doctors always say).  The shift time was reduced in 2011 to “only” 16 hours.  This resulted in an increase in the amount of handoffs which is what they call it when a doctor has to leave and hands off care to a new doctor.  What they’ve seen is an increase of mistakes related to handoffs not being handled correctly.

To recap, 30 hour shifts lead to doctors making mistakes with their patients.  16 hour shifts lead to handoffs causing mistakes with their patients.  Unless I missed something, the end result appears to be a wash.  Just as many mistakes are being made either way.  But then the author starts talking about how people feel and I just want to roll my eyes.  Doctors feel like they’re not getting a complete education.  Both doctors and nurses feel like the health outcomes are worse.  Ugh.

From my point of view, the 16 hour shift is still infinitely superior to the 30 hour shift even though results so far appear to be the same.  I would argue that part of the problem is that shifts should be even shorter.  16 hours is still an incredibly long time and doctors are expected to create handoff notes before they leave which is the time when they are most likely to cause mistakes due to sleep deprivation.  The only difference is it’s a fresh doctor that’s making mistakes because of the sleep deprived notes of the previous doctor.

The funny thing about the article is there’s no mention of doing something simple like changing the handoff procedures.  To me it’s obvious that’s what needs to be analyzed and changed.  I can’t find a link to it now, but there was a study done about ER patients with heart problems and they studied various hospitals, some of which used a physical checklist of things for the doctor to do and some which just had the doctors just perform like they normally do.  The hospitals with the checklists had a ridiculously higher quality of outcomes than the non-checklist hospitals.  The handoff procedure just screams for something similar to a checklist to be created and used religiously.  To me, the obvious addition is a simple question.  Why?  If the doctor wants to stop a medicine they must both write that they are doing so and the reason why they are doing so with pointers to the tests/observations that made them do so.  They should do this at the time they are performing the action and not wait until the handoff.

The end result should be that no handoff is necessary.  Yes, it’s still good and important for doctors to talk to each other, but relying on it is a recipe for disaster as much as working 30 hours is.