More (Bad) News About My 2017 Health Insurance

This story keeps getting better. I mean, worse.

If you remember my “everything I had to go through to get health insurance for 2017” post from last week, you might remember that I had to decide whether I wanted to continue with Premera even though my OB-GYN (the only doctor I visit regularly, for my annual Well Woman checkup) was no longer in-network.

Everything I Had to Go Through to Get Healthcare for 2017

I decided that I had very little control over whether I got to keep my OB-GYN; even if I did the work of figuring out which healthcare plan (if any) covered him, he could still retire, or move, or something could happen. Better to stick with Premera, since I’ve never had any really bad experiences and it’s also the major insurer in the area.

I didn’t think about checking to confirm which other doctors weren’t covered by my 2017 Premera plan, but it looks like there’s going to be a lot of them.

Here’s an excerpt from a letter I just received:

Over the last several months, Providence Health & Services and its partners, Swedish, PacMed and Kadlec have worked with Premera Blue Cross to sign a three-year contract for Premera Heritage Plus, an employer-sponsored health benefits plan. However, it is important that our patients know the following:

The agreement does not include Premera’s Heritage Prime plan, or Premera’s individual networks, Heritage Signature and LifeWise Connect, both of which are available on the Washington Health Benefit Exchange.

If you’re not a Seattle resident, you should understand that this is huge. I am effectively cut off from several of the major hospitals and medical facilities in the city.

So I went back and looked at my 2017 healthcare plan. If I were to visit an out-of-network provider, I would pay the full costs out-of-pocket, and my payment would neither decrease my $4,500 deductible nor my $7,150 annual out-of-pocket limit. There’s an exception for emergency services, which come with a $250 copay followed by payment out of my $4,500 deductible.

I also looked at which hospitals and medical services might still be available to me—which is not information that is very easily presented, I should tell you right now—and it looks like I’ll still be able to get medical care in Seattle, plus my local ZoomClinic is part of my plan, which should cover a lot of the care I anticipate needing (and help connect me to other healthcare services in my network as necessary).

So this isn’t a complete disaster.

But it’s still information I would have liked to have a month ago.

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