• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Galen Institute

A not-for-profit health and tax policy research organization.

  • Home
  • About Us
    • Mission and History
    • Officers and Trustees
    • Scholars and Staff
    • Who was Galen?
  • Activities
    • Core Activities
    • State Leaders Calls
    • Commentary and Oped Tutorial
    • Our Book
    • Galen Guides
  • Donate
  • Contact Us
  • Major Papers
  • Broadcast Interviews

Elisabeth Rosenthal: Insured, but Not Covered

POSTED BY Galen Institute on February 9, 2015.

The New York Times, February 8, 2015

When Karen Pineman of Manhattan received notice that her longtime health insurance policy didn’t comply with the Affordable Care Act’s requirements, she gamely set about shopping for a new policy through the public marketplace. After all, she’d supported President Obama and the act as a matter of principle.

Ms. Pineman, who is self-employed, accepted that she’d have to pay higher premiums for a plan with a narrower provider network and no out-of-network coverage. She accepted that she’d have to pay out of pocket to see her primary care physician, who didn’t participate. She even accepted having co-pays of nearly $1,800 to have a cast put on her ankle in an emergency room after she broke it while playing tennis.

But her frustration bubbled over when she tried to arrange a follow-up visit with an orthopedist in her Empire Blue Cross/Blue Shield network: The nearest doctor available who treated ankle problems was in Stamford, Conn. When she called to protest, her insurer said that Stamford was 14 miles from her home and 15 was considered a reasonable travel distance. “It was ridiculous — didn’t they notice it was in another state?” said Ms. Pineman, 46, who was on crutches.

She instead paid $350 to see a nearby orthopedist and bought a boot on Amazon as he suggested. She has since forked over hundreds of dollars more for a physical therapist that insurance didn’t cover, even though that provider was in-network.

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources — such as separate deductibles for network and non-network care, or payments for drugs on an insurer’s ever-changing list of drugs that require high co-pays or are not covered at all.

Continued…

Filed Under: Uncategorized

Primary Sidebar

NEW – OF INTEREST

Health Care Choices 20/20:

A Vision for the Future


See the latest interview of Grace-Marie Turner on C-SPAN

SEARCH

LATEST NEWSLETTER ISSUES

SUBSCRIBE

Social Media

Like Us On Facebook

Twitter: @galeninstitute

 

Copyright Galen Institute, Inc © 2021; · Log in