The following article is an opinion piece and reflects the views of only the author and not those of AllOnGeorgia.
What do you do when the private health insurance companies no longer serve your county?
This is a question I was forced to ask myself last fall when Blue Cross Blue Shield of Georgia, the only remaining private insurance company in the county, announced it would no longer serve the Bulloch County region.
My next question: What do you do when the private health insurance companies no longer serve Bulloch County and no one notices?
The exit went largely unnoticed because Statesboro, being home to Georgia Southern University, employs thousands of people who usually opt-in through the state, plus we have a number of municipal, county, state, and federal programs, all of whom are eligible for health insurance in a different pool that private sector folks never dabble in. Add in the percentage of the population that’s on Medicaid or Medicare, which is sizable, and don’t forget about all the students whose health insurance plans are tied to their permanent residences wherever it is they came from. Now you’re left with a handful of uninsured people and another bunch of self-employed folks who collectively asked themselves, “Where do I buy health insurance now?” on October 15th.
I’m a simple kind of patient. I’m a healthy 30-year-old female without children, who rarely gets sick, and whose only recurring medical condition is that I get kidney stones. I drink lots of water, choke down herbs, and frequently try to fend off a flare up with a “Not today, Satan!” but nevertheless, I deal with these several times a year. My sole purpose for health insurance is for my kidney doctor and emergency room visits.
So, when I learned that the private entities wouldn’t be offering insurance in my county, despite offering it in neighboring counties and blocking me out solely based on my zip code, I briefly regretted complaining about the high deductibles and costly monthly premiums before focusing my attention to my options.
Before we go any further….If had a dollar for every time someone suggested joining a cost sharing program, I wouldn’t need insurance and I wouldn’t be complaining about the broken system. But seriously, the Medishare and healthshare programs are a wonderful opportunity and the libertarian in me secretly shouts for joy whenever someone leaves the insurance market for the a medishare program, but I’m not eligible for the programs. These programs will cover new medical problems, but not pre-existing conditions for which you’ve had an incident within the last 12 months. I get stones multiple times per year.
Back to the options. Well, option. Sole option. Ambetter by Peach State. This is a plan on the Health Insurance Marketplace under the Affordable Care Act.
When I say my dog’s veterinary coverage is more comprehensive than Ambetter, I mean it. No doctor I have ever visited in Bulloch County is an approved provider. The blood laboratories aren’t included, and worst of all, East Georgia Regional Medical Center, the hospital IN BULLOCH COUNTY, is not covered. The closest hospital approved is Optim Medical Center in Screven and their emergency room services are limited. Sometimes, they don’t even have a doctor on the premises. After that, the closest hospital is in Savannah. Someone call the chopper because no one can drive themselves 55 miles on the highway when you’re dealing with kidney stone pain.
Without any other options, I went ahead and purchased a middle grade ‘gold plan’ (which offers more of the brass-level quality than it does gold) so I could handle catastrophic incidents with a moderate deductible. I did this assuming that out-of-network services would, like most private insurance companies do, be negotiated down in price if I had to see a provider out of my network.
Fast forward to early January when I have a kidney stone flare up and I learn at a number of doctor’s offices, hospitals, and laboratories that I can’t get cash prices because I have insurance. At this point, I realize I’m better suited to not have insurance.
When I contacted one of my doctors and explained the situation, that I understood that the office did not accept my insurance, but I was in a position to pay cash for doctor’s office visits, I was quickly told that they’re not accepting patients who only pay cash, and because I have insurance, they would not be able to classify me as a cash paying patient. That’s right – even if I showed up with the exact dollar amount of my visit, they would turn me away.
There’s a lot of confusion about state and federal laws and whether or not doctors offices and hospitals can ‘ignore’ if you have health insurance and still offer you different prices, or set up payment plans. This is a problem on its own, separate from the shoddy insurance system.
But their suggestion was for me to drop my health insurance, get Medicaid, and come back.
What in the actual……?
So, what we now have, for those not employed by some level of government, is a segment of the population in Bulloch County that cannot get a certain level of services in, can no longer be a patient of service providers in Statesboro, and must leave the county to be treated. An entire segment of the population who would be better served by not having insurance at all. What kind of twisted system has this all evolved into? Despite all of the changes in Washington D.C., despite the court rulings, and the manipulation at the state level, competition is not alive and well in the health insurance and health care industries.
Leaving the county for healthcare services when you live in a relatively larger metropolis like Statesboro is an outrageous thing to comprehend when you think about how smaller counties with smaller populations and fewer resources – looking at you Candler, Evans, and Tattnall – haven’t been forced into similar situations. Why is it not getting more attention that people are having to spend their money elsewhere?
The small government conservative libertarian knows deep down that the further out of the way that government gets from this issue, the better off we’ll all be…but this tangled web that’s been woven is here to stay for now.
What’s happening in Bulloch County that we’re running off private insurance companies? How did we get to this point? I know I’m not the only one facing this issue and I know the problem isn’t exclusive to Bulloch County, but it’s like a portion of the population –who is willing to pay for their services — is being boxed into a corner of shoddy health care. I’d like to know why. And I’d like to know what can be done to fix it.