The real face of ObamaCare paid me a visit last week; let’s call her Melody.
Melody, 27, works as a real-estate broker; the job doesn’t provide for her health insurance. Her old insurance is no longer offered, because it doesn’t comply with ObamaCare requirements on preventive services, among other issues. In January, she logged onto the state health exchange and signed up for ObamaCare.
Like many healthy young people, she chose a “bronze” plan, with an annual $5,800 deductible and a monthly premium of $357. She figured a more expensive “silver” or “gold” plan wasn’t worth it, since she’d never need to rely on the lower deductible of those plans.
Last month, she came to see me for a routine follow-up visit and discovered that though her insurance plan was active, I wasn’t covered by it, because her Blue Cross HMO hadn’t chosen to include me or my hospital in its network. I charged her just $100 to see me, but this amount wasn’t covered by her plan and didn’t even count toward her whopping deductible because I was out-of-network.
During that visit, I discovered that she had mild hyperthyroidism (overactive thyroid). The most likely cause of this in a young woman is an autoimmune condition known as Hashimoto’s thyroiditis.
This is a relatively benign disease that didn’t require immediate treatment, but to confirm this diagnosis, I needed to do a blood test for thyroid antibodies, which she said she couldn’t afford right away. I also needed to order a thyroid ultrasound to check for thyroid nodules, which she also said was too much to pay for.
These tests would count toward her deductible, but she was forced to shoulder 100 percent of the cost until she’d spent the whole $5,800 of the deductible out of her own pocket.
We both came to the realization that her ObamaCare insurance was useless — that it was actually hurting her by providing the illusion of coverage.
I felt very uncomfortable with this patient visit, because I wanted to help Melody but couldn’t. She wasn’t too happy, either; she opted to change to a Silver plan (which does have me in-network), which meant a $2,300 deductible and a monthly premium of $450.
She still didn’t have enough money set aside to pay for her thyroid tests, but at least when she does come up with the money, she’ll be closer to working her way through the deductible.
I wanted her to see an in-network endocrinologist, but she said she didn’t want to pay his several-hundred-dollar consultation fee.
Pre-ObamaCare, her old insurance (not in New York, but not unlike policies others of my patients have had here) would’ve covered the ultrasound and the lab tests, and all she’d have to contribute was a $35 co-pay toward her office visits.
With her new insurance, even when her “silver” plan kicks in, Melody will be paying over $5,000 per year for a health-insurance policy that provides her with no health care whatsoever beyond paying for her birth-control pills.
It’s a very small consolation that at least the $100 she pays me per visit to prescribe her pills will now count toward her deductible.
How does Melody’s experience fit with President Obama’s promises?
Well, she couldn’t keep her insurance. And she pays far more for the new plan but doesn’t get to keep the same health care. True, she gets to keep her doctor, but this doctor’s hands are tied in terms of what he can do to help her.
Dr. Marc Siegel is a professor of medicine at NYU Langone Medical Center and a Fox News medical correspondent.