Adventures in healthcare

To the Editor:

My VHAP coverage was slated to end on December 31, 2013. I received a notice from Economic Services (DCF) in early December stating that because of problems on the state's insurance exchange web site, a decision had been made to extend VHAP coverage through March 31, 2014. Instead of taking the extension though, I elected to take the plunge and sign up for Affordable Healthcare.

I talked with Rose at Vermont Health Connect (VHC) on December 8th. After researching and comparing plans, I decided to go with the BlueCross/BlueShield Standard Silver Plan. I received an invoice on December 24th and I mailed my premium in on December 26th. I received my new insurance card on January 13th. I called BC/BS Vermont on January 14th to name a primary care physician. While talking with the BC/BS rep, I discovered I had been signed up for the wrong plan. I had wanted the plan with the $100 prescription deductible. Instead, I was signed up for a plan with a $1,250 deductible. The deductible has to be paid before the co-pay ($12) kicks in. BC/BS told me there was nothing they could do. They referred me back to Vermont Health Connect.

I am on social security and don't have an extra $1,250 lying around so I began to panic. How am I going to get my meds? Joe at VHC acknowledged they had made a mistake and said they would fix it. I made numerous phone calls over the next two weeks, but nothing had been done. I was finally told on Monday, February 3rd, that there was a glitch in the software and they didn't know when it would be fixed.

I have Type 2 diabetes. By this time I was on my last insulin pen - enough for seven days, and I had less than a week's worth of another diabetes medication. I kept asking the navigator at VHC what I was supposed to do. She was sympathetic, but said there was nothing they could do until the software problem was fixed. By now it had been four weeks.

I called Bernie Sanders' office, but since this is a state and not a federal matter, there was nothing they could do. They gave me the name of an insurance navigator who, in turn, gave me the phone number for the Vermont Healthcare Advocate (formerly ombudsman). Lauren called me back within 30 minutes. I explained the situation and she took over from there. She really was my advocate with both VHC and BC/BS.

It took a couple of days, but Lauren called me yesterday, February 6th, to tell me Blue Cross had agreed to change my coverage to the correct plan after they had verified the mistake made by VHC.

Because I had never received a February invoice from VHC I was worried my coverage would be cancelled, so today I sent in a $135 payment. But now I won't have enough money to pay for my meds until next Wednesday. I figured I would be okay for a day or two without insulin.

When I got home today there was a message from someone at Vermont Health Access letting me know I had been reinstated in Green Mountain Care (VHAP). I had been told earlier in the week it couldn't be done. Yesterday I had no coverage; today I have coverage under two different plans. I verified this with VHC and told them not to touch anything. I will use my VHAP coverage until they get the VHC mess straightened out. I don't care if I have to resubmit an application. I am just grateful to have prescription coverage again. And, I can now call and make the doctor's appointment I had to cancel.

Please do not mistake this as a diatribe against the Democratic Party or President Obama. I voted for Obama, and I voted for Pete Shumlin. I just wanted to share my experience with the VHC web site.

Thank you to Lauren and the Healthcare Advocate's office. Without them I would still not have prescription coverage. And thank you to VHAP. I pick up my prescriptions tomorrow morning. And, most especially, thanks to God. He always comes through.

Leslie Cherrington

St. Johnsbury, Vt.

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