why I ditched Covered California — for now

blueshield-check

We signed up for BlueShield through CoveredCA. Turned out, BlueShield had fed CoveredCA and us a crock of lies: almost none of our doctors signed up with the CoveredCA/Exchange version of BlueShield.

BS, as I like to call them, had advertised their doctor list using the previous year’s non-Exchange list. However, their Exchange reimbursement rates were so low that none of our individual doctors signed up. Not one. Only the big hospitals and biggest medical groups were able to negotiate reasonable (i.e. pre-Exchange) rates with BS. And, by the way, that’s only because of the Obamacare provision that forces the insurers to provide enough doctors for a given geographic area. If it weren’t for that provision, we’d have had no doctors at all in our area.

As an example, when I search for a dermatologist within 15 very crowded miles of my home, I find only one! [Actually, I found three, but two seem to have left the area or couldn’t apparently afford a phone answering service]

So even though we were paying for Platinum coverage, all of the individual doctors we saw from January through March were considered Out Of Network. We ended up paying the full doctor rate, and were reimbursed by BS at 50% of the rate that BlueShield would have paid the doctor if the doctor had signed up for BS.

Read that sentence again. When you sign up for insurance, they make it look like Out Of Network charges are covered at 50%. Not so. You and I only get reimbursed at 50% of what the insurer would have paid, not 50% of what you and I had to pay.

Take the image above, for example. The doctor bill that we paid was over $110, and that was AFTER we renegotiated with the person in the billing department! From the $110 that we actually paid the doctor, BlueShield cut us a check for a whopping $5.60. We ate the difference. Multiply that by all of the doctor visits we made from January through March. There were several. Strep throat, an eye infection, something that we thought was the flu but wasn’t, etc.

In this instance, my wife needed a medical test because of a potentially serious  problem (that luckily turned out to be easily treated because she caught it early). She was at the doctor’s office for over an hour, and saw a nurse practitioner plus the doctor. For this 1+ hour visit, BlueShield would have reimbursed the doctor’s office $11.20. Is it any wonder that the doctor didn’t agree to that reimbursement rate? Who would?

Do you want fries with that?

So I went back to my original dollar analysis for Covered California, and updated my spreadsheet (which you can use with Google apps or Excel) to again compare the options between different plans.

Now that it was February, I was able to re-contact all of our doctors to find out what plans they had actually signed up for. Guess what? The ONLY CoveredCA/Exchange plan that all of our individual doctors (and the medical groups and hospitals) had signed up for was HealthNet. They’d signed up for HealthNet both Exchange/CoveredCA and private (non-Exchange).

Why? Because HealthNet, at least for 2014, kept the reimbursement rates the same regardless of Exchange or private. So the doctors knew they’d get reimbursed the same as before. Hence they signed up.

So my original calculation, that HealthNet was the most expensive, turned out to be exactly backwards. With the exception of Kaiser HMO (which employs its own doctors and so completely controls everything), HealthNet was the cheapest real option, because it was the only option that actually offered us In-Network doctors.

Bah! So since it was pre-deadline, I switched us all over to HealthNet. Total cost for a family of four on the Platinum plan in the ultra-expensive Bay Area: over $2000 a month. Ack! But the math showed that this (or the Silver plan) were the cheapest. In our case, our usage pattern for medicines and doctors was moving very close to what I’d predicted, and the spreadsheet showed that the Platinum plan would end up being the cheapest.

Unfortunately, the CoveredCA site doesn’t make it easy to switch from one CoveredCA plan to another one within the year. I may have been able to do it given enough time and stress, but I was afraid that the terrible experience of signing up in the first place might screw us out of coverage altogether, so I signed us up for private covered through the HealthNet website. Took about a half-hour, and we were approved within a day or so. DONE.

Canceling BlueShield took nearly two hours just for them to answer the phone, and another 45 minutes on the phone with them. Everything about the BS experience was just that: BS. Website, the way they reimburse, the info you get. All BS.

Hopefully we made the right choice. It was certainly an expensive one. If my small business doesn’t show signs of life this year, I may be priced out of the private market and need to look for another corporate job just in order to get my family insured.

I remain grateful for Obamacare: without the changes in the law that prevent us from being excluded, we’d never get care at all for several of my family members without getting and keeping a job at a major corporation. But the prices of healthcare (which weren’t properly addressed by the law as it eventually came into being) are so out of whack, that the reality still only gives us decent coverage because we’re lucky enough to be able to afford it.

This year. For a while.

how to stop your alarm panel from beeping

alarm hates youThe accursed secondary ADT alarm panel in our bedroom started beeping again at 4:30 AM last night. Frankly, I don’t CARE why it’s beeping when it does it in the middle of the night. After all, if the house is on fire or someone is breaking in, the big sirens will go off. And if neither of those are happening, then whatever the alarm panel’s problem, it can wait until morning, dammit!

The last several times this has happened—and always in the middle of the night, mind you—here’s what the big emergencies were:

  • MY BACKUP BATTERY IS DEAD! IT’S DEAD, I TELL YOU! OH, MY GOD! WE’RE ALL GONNA DIE!
  • I FAILED TO MAKE MY EVERY-90-MINUTES PHONE CALL TO THE CENTRAL DISPATCH. WHAT IF I’M THE ONLY ALARM PANEL LEFT IN THE WHOLE WORLD?  OH, MY GOD! WE’RE ALL GONNA DIE!
  • I HAVE NO IDEA WHY I’M BEEPING, BUT I’M BEEPING! OH, MY GOD! WE’RE ALL GONNA DIE!

And so on.

There is supposed to be a setting that would prevent this sort of thing, but ADT can’t/won’t tell me the installer code to let me reprogram the panel. It’s a GTE/ITI Concord, and if you don’t know the programmer code, you’re hosed. Which is yet another reason I recently fired them and went with NextAlarm at less than half the price.

I s’pose I could pay an installer to come out and reprogram the thing, but since I NEVER want the panel in the bedroom to beep at me and wake everyone up, I decided to just silence it for once and all by cutting its vocal cords. I unsoldered the beeper and removed it. NOTE: you should think twice about doing this with your main alarm panel (in your kitchen, or hall, or wherever it is), since those beeps are quite helpful when you come and go from the house.

Here’s how I silenced it:

IMG_1785

  1. First, put your alarm into Test Mode, so if you accidentally set off an alarm, the SWAT team won’t burst down your door. If you have an old-school alarm company like ADT, just call them. If you’ve got something like NextAlarm, you can do this over the web.
  2. Take the panel off the wall. My panel just pulls up and out, so it’s dangling by a couple of wires. No need to snip any wires.
  3. Look at the back of the now-open panel, and you’ll see the circuit board. Mine was held in by some plastic tabs, and also by three tiny screws, which I unscrewed and set aside. Carefully pry the circuit board away from the plastic housing. Now the circuit board should be hanging free:IMG_1781
  4. Look at the back of the circuit board, and you’ll see a small black round thing about the size of your pinkie thumbnail. That little bugger is the piezoelectric buzzer that’s surprisingly loud for its diminutive size. Here’s a picture of it after I removed it:IMG_1783
  5. That buzzer has two pins that stick out from the bottom and go right through the circuit board, where they’re soldered on the front. Look on the front of the circuit board and you should be able to spot the little solder dots that correspond to those pins. I’ve circled them in yellow:closeup
  6. Apply a hot soldering iron carefully to those dots (one at a time of course) and you can unsolder them. If you have large enough hands, you can hold the circuit board in one hand and apply some sideways pressure against the buzzer to help it fall off. For me, the buzzer fell right off as soon as I heated up the second pin.IMG_1784
  7. Toss away that little buzzer! Reassemble the alarm panel: snap the board back into the plastic housing, and screw it back together. Pop it back on the wall. Test it to make sure everything’s working. You’ll hear nothing but blissful silence coming from the panel. Since this was my bedroom panel, and we have another one in the kitchen, I can still hear the other one faintly beeping as I test the system or arm it, so I know all is okay. Now take your alarm system back out of test mode, and you’re done!
  8. Tell your alarm panel what you think of its 4 AM beeping.IMG_1786