Navigating Health Insurance in Washington?
May 13, 2015 1:10 PM   Subscribe

My girlfriend (domestic partner, not registered) has had a ton of trouble navigating the new health insurance landscape. The application process this year was confusing as hell. Today we tried to take her in to see her regular doctor of many years, only to be turned away because now that she's on state insurance, her doc can't see her even if we want to pay out of pocket. This is turning traumatic. We need to find someone or someplace to help us sort this out. Help?

Special snowflake details: GF is currently unemployed and suffers from severe chronic depression. Her (wonderful) psych/mental health nurse practitioner can still see her if we pay out of pocket, but anything else is just a confusing mess. The state website shunted her onto Apple Health (Medicaid) and assigned her to a specific doctor without giving her any choice in the matter--who isn't even a primary care doc (the guy works only at an elderly care residence!).

I pay for my own insurance (self-employed writer) and I make enough that I could certainly cover hers if it came out to the same ballpark, but even that was apparently impossible to sort through when she was trying to sign up. Even when she tried to get on a plan that she/we would pay for without state subsidies, the state site still put her on Apple Health as soon as she truthfully reported her income. Things got to the point that the state health website people gave her an extension on the sign-up period...and then stuck her right back on Apple Health, which was what she was trying to avoid.

It's also almost impossible to find an available doctor on her current Apple insurance regardless, but that's another story.

Are there outside resources for navigating this mess? Does anyone know what to do about this?
posted by scaryblackdeath to Health & Fitness (5 answers total) 1 user marked this as a favorite
I don't know if this helps you, but in WA insurance companies can and do sell individual insurance outside of the exchange. The exchange is sort of setup to match people with the most subsidized policy they qualify for. Have you tried calling your insurer and asking them what it would cost to get her on a similar plan to yours and if the coverage would meet her needs?
posted by stowaway at 1:29 PM on May 13, 2015

I am a nurse case manager, but not your nurse case manager. I work in NC and have some experience with NC Medicaid, but zero with Washington Medicaid/Apple Health. However, after looking at the website for Apple Health, I've learned that your girlfriend should receive a blue "Services Card" from Washington Apple Health, and then (about one month after she enrolled) a second card from the actual insurance plan who will be managing her benefits. She should also receive a benefits booklet with the second card. If the "First-Timer's Guide to Washington Apple Health" can be believed, the benefits booklet contains information about how to switch health plans as well as how to find providers who are taking the plan. Has she received any of this stuff in the mail yet? It looks like some of the answers to your questions can be found here .

It's not uncommon for health plans to require recipients to choose a primary care provider, but your girlfriend should be able to choose who that is.
posted by little mouth at 1:30 PM on May 13, 2015

We had a relative stay with us for the last five months, who was unemployed and transitioning from male to female gender. We live in King County and she signed up for Community Health Plan of Washington. I'm not sure if being transgendered qualified her for subsidized services unavailable to the regular public, but she was able to make appointments with general practitioner and specialist doctors with no real difficulties using that plan. The plan itself cost nothing, and co-pays for visits cost nothing, although we had to buy her prescription medicines.

I'm not sure what led to your GF being shunted to one specific plan, but I would take another look at the list of counties on the Washington State insurance site, and perhaps see what other plans are available. You could also contact the exchange help desk to work out why options are limited, and see what can be done to remove those limits.
posted by a lungful of dragon at 3:02 PM on May 13, 2015

Washington has several health plans from different HMO providers that you can select from for Apple Health Medicaid. Go to the Washington health plan finder and look up your preferred doctors to see which plans they accept. Then call the doctor and see if they are still accepting new patients. You can change to any of the six Apple Health Medicaid plans at any time (effective at end of month), although not all six plans are available in all parts of the state. You will probably find that Community Health Plan has the widest network of doctors.

You are also a permitted to select any doctor in the plan network as your primary physician. You don't have to accept the one they assigned you by default.
posted by JackFlash at 12:32 AM on May 14, 2015

Also, if you don't want a Medicaid plan and want to pay full freight for a regular insurance plan, then you can buy any of the plans on the Washington Health Plan Finder directly from the plan provider by going directly to the insurance company's web site or phoning them. You can use the Washington site to shop for plans but you don't have to enroll through that site. You can shop without logging in and then specifying a large income like $100,000. This will present you with all the possible non-Medicaid plans. Compare and find the one you want then go to that insurance company to buy directly. If you do this, make sure you cancel your Medicaid plan.

One further possibility. You may be able to declare your domestic partner as a tax dependent and put her on your own health insurance plan. There are several rules but basically, if you provide more than half of her financial support for the year and her own income from all sources is less than $3950, then she can be claimed as a dependent on your tax return even if you are not legally married. This in turn makes her eligible for your ACA insurance plan as a household member. Further, since your household now includes two members, you might find that you are eligible for a subsidy, depending on your total household income.
posted by JackFlash at 1:19 AM on May 14, 2015

« Older The State of Condos in Seattle   |   Help me find an mp3 of a song? Newer »
This thread is closed to new comments.