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Help please! Very confused EnglishGirl.

Hi guys. Some of you might not know. I'm English living in Texas USA. I'm having a very confusing insurance problem, will someone please explain?

We've always been covered by my husbands company insurance plans. This year he's a contractor (all year) & neither the company that employs him or the company he's placed at have offered insurance coverage. We needed new insurance so we went to 'The Marketplace' & went for United Health Care. We had that for years when he worked for a big telecommunications company. It's expensive ($2,000 a month) but low deductible, medication prices etc.

We checked that my docs take it & thought all was fine. I went to my docs appointment & was told that because it's through 'The Marketplace' they don't take it! He's part of a big physicians group in Texas so this isn't a good sign. I paid out of pocket (he only charged me $70 so I can handle that for a year) THEN CVS told me they don't take it because of the marketplace stuff!! (Walgreens do)

I'm very confused & very worried now. I've got 2 young kids. What about emergency care? I know I can phone every hospital & emergency place around but....ugh!! If I say "Do you take United Health Care" they'll all say 'of course! They're huge here!' but when I tell them it's 'Marketplace'....?????

This has just happened so I don't know about my other specialists.

How can I get different insurance without going to the marketplace? Can I just call United & ask to be a normal customer?? We were given the impression that it would cost us a fortune if we didn't go through the marketplace. Is $2,000 (in rounding down cant remember exact amount) a month for a family cheap? It seems really expensive to me but in England it's free so I just don't have experience of insurance companies.

I don't know if it's just coincidence (could be because April brought changes) but this is the first time I've EVER had trouble filling my meds or getting in to see docs. Have we made a HUGE mistake in how we got our insurance?

PLEASE will someone knowledgable talk me through this. I'm going through one of those "End of my tether" times & every little thing feels monumental!! Ugh!!
Osteoarthritis & DDD.


  • So.....this gets even more annoying. I can't see an answer to this. My husband is looking for a different job, with benefits. We've been told there's no other way to change our insurance plan??? It's wait until the next year cycle or have a big "Change of life" like new job, divorce etc. if anyone knows a way I can change my insurance NOW please tell me.

    I've recently had a new MRI & it's confirmed some scary new symptoms. Phoning everywhere I finally found a surgeon who would take this marketplace insurance. My doc referred me. I went to my appointment on Monday only to wait around for nearly 2 hours because there was "Confusion with my paperwork". In the end I was told it wasn't a valid referral because it needed to come from an in-network doctor that I had a "Considerable history of care with". I hobbled out & drove home in tears!

    My docs aren't in-network! The computer system says that they are but they are only in-network for United Healthcare & NOT United Healthcare Marketplace insurance. Ugh!

    I can't afford to pay out of pocket. If I'd saved the premiums I'd already paid for a useless insurance I might!!! Has anyone ever experienced this? Am I just stuffed? The insurance rep advised me to find new in-network docs & start establishing a history of care so they can refer me. I don't want to change docs. I love my docs. They're charging me the absolute minimum cash appointments while I sort this out. My PM is writing my prescriptions without appointments so it's free. The closest in-network PM I can find is nearly 2 hours drive away. He has horrible reviews. I can't drive that far. My husband doesn't get paid leave. It's just a nightmare!

    At this point I don't expect anyone to have a solution for me. I'm frightened & REALLY want to talk to a surgeon. This seems crazy!

    Good news is a new Kroger has opened near me & they take my insurance!! That's great (when they have my meds!) ugh!!

    I'm just venting at this point but if anyone can help please tell me what I can do.
    Osteoarthritis & DDD.
  • dilaurodilauro ConnecticutPosts: 9,859
    I only wish I had some good words
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 07/04/2015 - 8:20 AM
    Thank you Ron.

    Just incase someone's in the same boat with a 'weird' insurance....I HAVE called every emergency facility in the area & have a list of places we can get to for any kind of emergency with my family. There aren't many but I've got a couple of options for each thing. It's best to be prepared! Even a little thing (both my kids have needed stitches in the past) can turn into a nightmare if you're facing a huge bill because of insurance. Only one of the big hospitals is 'in network' for us & the kids.

    For prescriptions - no independents or big pharmacy chains (except Walgreens) take it but to my surprise the big supermarket pharmacies seem to take any kind of insurance. (Kroger charges 3x as much for my oxy though!!! What's that about?)
    Osteoarthritis & DDD.
  • I think private practices can select what insurances to accept and what to refuse But hospitals they can't refuse any kind of insurance,i think it's a federal and state law. Check it,I had something similar a year and half ago we ended up without helth insurance,l got injured not working and my insurance covered us like 6 months after that but at the same time my wife was in the middle of treatments fighting breast cancer....you know what problems i had to find coverage?? No insurance will take us because of pre existing conditions so we ended up in market place until recently we were covered by medicare.not every doctor accepts it but not all them.Get a list from your insurance for participating practicioners so you know who accepts it and who doesn't.... Hope to be helpful, i'm sure you'll find way..!
    June 2013 Car Accident,i suffer blunt abdominal trauma and had surgery.
    june 21 2013 ACDF C 5-6,6-7
    August 27 2013 rotator cuff surgery
    june 3 2015 abdominal incisional hernia.All kind of pain killers,opiates,epidurals and disable for life.
  • Thank you Nick. I'm so sorry to hear about your problems. Coming from England with a free health service I never even started to imagine how complicated the insurance system can be. Ugh!! The crazy thing is ALL of my docs are on my insurance list but it's wrong!! Ugh!! Hopefully my husband will find a new position with benefits & this nightmare will end. Thanks again for the advise ;-)
    Osteoarthritis & DDD.
  • nicky74nnicky74 Posts: 19
    edited 07/04/2015 - 5:03 PM
    If your primary doc is in the network and he can gets you a referral for dr.abc and his refusing it call and report him he can't do that as long you have that referral issued in his name,i had something similar to that and i had my son (young lawyer) called Emblem Health and solved the problem. If he doesn't accept YOUR plan you won't be able to get referral for him. ....impossible. It's very confusing situation and they taking advantage,if the can get you pay cash why they going to take the amount insurance alows them.... Stand up and call insurance even there's a state offices you can complain THEY ARE USING US!
    Hope is going to work for you too
    June 2013 Car Accident,i suffer blunt abdominal trauma and had surgery.
    june 21 2013 ACDF C 5-6,6-7
    August 27 2013 rotator cuff surgery
    june 3 2015 abdominal incisional hernia.All kind of pain killers,opiates,epidurals and disable for life.
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