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Healthy Athlete Premium Raised 44% for Bare Bones Plan

Heather Johnson, Oakland CA

I am 43, an athlete, healthy, with no medical problems. I don’t use my insurance much and live on a pretty tight budget. Despite the fact that I almost never use my health insurance, my premiums with Blue Shield have jumped 44% from $180 in 2013 to $260 now for a bare bones plan offering a very narrow network. My deductible, which was $0 under Blue Cross a couple of years ago, is now $4,500. Such a high deductible is almost like not having health insurance for me. On the rare occasion that I do need care, I go through so much hassle I'm tempted to just take the tax penalty and go without health insurance.

Up until 2013 I had a good plan with Blue Cross that had no deductible. Then they raised their rates forcing me to switch to a Blue Shield PPO with a $6,000 deductible costing $180 per month. In January 2014, I was told by Blue Shield that they were discontinuing my policy and I had to enroll in an EPO, like it or lump it. My rate increased $80 per month to about $260. The “Bronze” EPO that I selected has a lower $4,500 deductible but I later learned that EPOs only let you use doctors and hospitals in their very narrow EPO network and that I had to pay 100% of the cost of treatments that would have been covered under my PPO.

In 2013, I was riding my bike and was hit by a car. Dealing with Blue Shield to get treatment was a nightmare. In January 2014, I finally scraped up the funds for what I thought was my share of the cost for physical therapy and chose Sports Orthopedic Specialists, based on a referral from someone I trust and because it was an in-network provider.

But Blue Shield denied coverage, claiming the company was out of network. It was impossible to call Blue Shield to resolve anything. Hold times are an hour minimum. I lost many hours from my job just waiting on hold to talk to someone. Then more hours lost trying to get them to give me straight answer. Customer Service Representatives “promised” to call me back and never did.

The provider confirmed with Blue Shield on the phone, via tax ID #, that they are, "in network." Turns out the provider was under Blue Shield’s PPO network, but not with the new EPO, which I was switched to only two weeks before my first physical therapy visit. The provider’s staff was not even aware of this difference. I ended up paying 100% of the costs myself, nearly $600 out of my own pocket for their services.

Why do I have insurance? They raised my rates so that I can barely afford the most basic policy and then severely limit the “in network” care that I can receive. For me, paying $260 per month for something I almost never use, plus having to pay $4,500 before coverage kicks in, and 100% of out-of-network care is like not having insurance at all. Switching to another provider means a mess of paperwork. So like I said, I'm tempted to just take the tax penalty and go without health insurance, especially if the rates increase again.