DR. ROB LAMBERTS: Adventures in Caring and Acting Affordable

May 6, 2014

I’m back.  I’m recovering right now from trauma related to the Affordable Care Act.  I’m OK, but probably a few months until fully recovered.

Some would think that since I no longer accept money from insurance companies, the Affordable Care Act would have less of an effect on me.  Those folks may be right in how it directly impacts my practice (since I don’t know the actual impact on other doctors, it’s not easy to compare), but there has been a significant impact.  I’ve got plenty of ACA stories.

But that’s not what I am going to discuss in this post.

My personal adventures with this law are far more interesting from the other side of the insurance card: the health care consumer (AKA patient).  It has been quite a ride — one that has not yet reached its destination.

Chapter 1: December 9, 2013

Being the adventurous guy I am, I thought I’d give the website a whirl.  Expecting the worst, I set aside a lot of time for the experience.  It was actually quite a bit easier than advertised.  My family is as follows:

  • Me – Age 51, healthy
  • Wife – Around my age, but actual age disclosed only for legal reasons.
  • Child 1: Son, 21 years.  College grad but living at home for now.
  • Child 2: Daughter, 20 years.  In college
  • Child 3: Son, 18 years at time of application.  In college.  Birthday later in December.
  • Child 4: Daughter, 14 years.

I submitted the information about whether any of us smoke (no), any of us are pregnant (no), and how much money we earn (not much, as I am starting a new business).  I immediately got the following eligibility notice:

  • Me, Wife, and Kids 1 and 2 were eligible for insurance with a tax credit that would lower our cost to about $100/month.  Nice!
  • Child 4 was potentially eligible for “Peachcare,” the state run insurance for those with low income, that’s not low enough to qualify for Medicaid.
  • Child 3 had the following next to his name: “Based on your application, you don’t qualify to purchase health coverage through the Marketplace. In addition, you don’t qualify for a tax credit, cost-sharing reductions, COMPASS, or Georgia PeachCare for Kids.You still might be able to get health care at a lower cost. The health care law has expanded funding to community health centers, which provide primary care for millions of Americans. These centers provide services on a sliding scale based on your income. Learn more about getting care at a community health center on”

This made no sense.  I immediately assumed I had made some error in information input on Child 3 (like that he was pregnant or he owned some property in Utah), so I deleted this application and repeated the information.

Same result.  So what do they have against my kid?

Chapter 2: Later in December

A few days later I found the number on the website for phone assistance and gave it a ring.  My expectation of chaos and stressed-out government phone gnomes was proven wrong when I got a very nice and helpful worker on the phone.  This, in fact, was my experience each time I called the phone system (an experience, it turns out, that does not extend to the state level…more on that later).

The woman on the line looked at my information and listened to my explanation of what happened, ending up with a similar opinion about the result: confusion.  She agreed with my guess that child 3 was booted from eligibility for regular insurance because he was 18 at the time of application, and booted from the Peachcare queue because he was 19 when the insurance kicked in.  It’s the only thing that made sense to either of us.  So, she did what all good workers do when faced with a difficult process: she booted it to her superior, telling me that I’d hear from someone “soon” regarding this.

A week or so later, after not hearing from anyone, supervisory or otherwise, I called back the hotline.  I was again greeted with another helpful person, who again listened to my tale and looked at my info.  She saw nothing to indicate I was getting attention from supervisors, telling me to try resubmitting after my son’s birthday.  Mildly frustrated, I agreed to do that.

Nope.  That didn’t work either.  My application form my family had been submitted and had reached a “point of no return” status, and could only be changed by someone with the proper credentials, I was told by another very pleasant person on the hotline.  I asked how I could reach a person with such credentialing, and was forwarded to a supervisor.  I spent nearly an hour on the line with the supervisor, who really seemed to be trying to resolve my problem.  I was very happy with the time and attention my problem was given.

Here’s the final conclusion of this phone call:

  1. I should go ahead and get insurance for me, wife, and children 1 and 2
  2. I should go to the state website and get stuff submitted so I can get insurance on child 4.
  3. Child 3 should be also submitted to the state, but will be rejected.  Then I could re-apply for regular insurance and be accepted.

That’s what I did.

Chapter 3: January and February, 2014

The state website gave me some vague timeline about when I would be contacted regarding the application, along with a case number with which to check the status online.  I did that regularly, and it was always “in process.”  We never were contacted during that period.

I tried to call the state agency to check on the status, but was met with eternal repetition of Kenny-G, which (as they clearly realize) cannot be tolerated for more than 15 minutes in one sitting without significant trauma.

We did receive insurance cards for me, and my two older children.  Oddly, my wife’s card wasn’t in the mix (despite the fact that she was on the list of insured on the initial eligibility notice).  I figured she misplaced it.

Silly me.

We continued to be worried about the fact that two in our family were potentially uninsured, so I kept the mega-expensive policy we had prior to January, just in case.

Chapter 4: March, 2014

At the beginning of March we received a mysterious message on our voicemail saying that we were getting a notice saying that had determined our eligibility and that we were getting a notice and should disregard it.  Huh?

But then the message said that no further action was required on our part, and I was happy.  I am highly skilled at “no further action.”  That’s exactly what I did (or didn’t) do.

A week or so later we got the following notice in the mail:



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