First , let me start off by saying this is NOT a political statement thread. This is a personal account of what has happened to me in the last 3 months that I felt I wanted to share with people to see if anyone else has experienced this. Ill get right to it.
PART 1:
August 2013 I signed up for a Kaiser Permanente Plan in Georgia called the Classic 1500 plan. This plan had the following benefits:
$1500 Deductible
20% CO-Insurance
$1500 Max out of Pocket Costs
$40 Dr Visit to PCP
$70 Specialist

My Premium was $204/month for a 33 year old male in good health with no prior existing issues/conditions. If you recall around last November when the ACA started to roll out, there were a lot of people who had their plans cancelled. President Obama was famous for the "if you like your plan you can keep it" and because of the backlash over the loss of the plans, he instituted a grandfather clause that would allow you to stay on your current plan/premium for at least another year.

In December, KP sent around letters asking current plan holders to OPT IN to their current plan or face the possibility of it changing to a new ACA Compatible plan later on. After 3 days of trying to get through to their offices, I resorted to mailing/faxing a letter in. I received a fax confirmation back and I dropped the letter in the mail around 1pm EST the day before the deadline.

ALL IS GOOD! or so I thought..........

Flash forward to June 9th 2014 and I am playing a pickup game of basketball at a local LA Fitness. Sparing the gruesome details, I come down funny and my knee is toast. I immediately knew I had torn my ACL. I schedule an appt and go to the doctor the next day, and my PCP tells me that I need to be referred to and Orthopedist. The referral takes 3-4 days to go through, my knee is the size of a watermelon at this point, but, they give me crutches and I wait.

June 15th I get the appt to the Orthopedist. Within minutes she confirms my worst fear, I suffered a torn ACL in my right knee, but she will need an MRI to confirm.

June 22nd, I get an MRI ($478 out of pocket). June 26th I go back to the Orthopedist to discuss the MRI results and I suffered a Grade 3 tear (complete tear) and surgery is required. From this point on, it was shocking how little information or even correct information I received from both Kaiser Permanente(KP) and Peachtree Orthopedic (PTO).

I leave PTO on June 26th and call KP to see what to do next. They inform me that they will get a diagnosis from PTO and someone will schedule me to do surgery in the next 5-7 business days...........

July 7th, I have heard nothing from anyone. I call KP, they inform me that they have not received any records from PTO and that there is nothing to report. I call PTO, they assure me the records and diagnosis has been sent over. I ask them to send it again, they comply.

July 10th, all silent. I call KP again, they claim they have received "something" but they cant access the system to see what it is. But, I am assured that someone from "Scheduling" will be in contact to discuss my surgery. At this point I ask a question about my Plan and how it works. I specifically ask
"How much will this surgery cost me in regards to my plan"?
KP- "Well, you have spent $478 on an MRI, so that goes toward your deductible, and your max out of pocket cost."
"So, $1500-$478 , whatever that balance is"
KP- "Yes that is correct"
"When does my plan renew or reset? I know I joined in August 2013, do my benefits reset then?"
KP- "No Sir, your benefits are paid on a Calendar year from January 1- Dec 31"
So, I move forward. I go on vacation, I return July 23rd, and still have heard NOTHING. I call KP again, this time Im much more aggressive. I get to a division that assures me that they will have my PCP call me back that day. Wonder of wonders, that call never comes. July 24th, I call again, and they schedule a call back from my Doctor at 1215PM. 315Pm my doctor calls me, and tells me that KP is wrong, that there is no "authorization" needed and there is no "scheduling" , PTO will handle everything. I am flabbergasted because for basically 4 weeks, I was waiting for something that was never going to happen. My PCP also tells me the only thing she needs to do is the PRE-OP exam to make sure Im ready for surgery. I tell her thank you and proceed.

I call PTO and schedule surgery for August 13th. The scheduler informs me that there is no need for KP to do the PRE-OP EXAM because Im in great health and young enough that they can do it. I agree and set PRE-OP for AUG 11th.

August 1st I get a letter in the mail from KP that has a new Medical ID card in it. I figured, ehh, old ones must have expired. The letter simply states "HERE IS YOUR NEW ID CARD". Thats it. I think NOTHING of it and put the ID card in my wallet and go about my weekend.

August 4th, I , being the proactive person that I am, call KP to make sure all my ducks are in a row, and I ask if they have some type of estimate on the surgery cost to make sure Im prepared. On the phone the lady tells me "you can go to our online site and there is a surgery estimate calculator you can use. Hmm..... I see your plan just changed though. Thats odd........" I ask her "maybe the name did or something but, well, I did get new ID cards recently... wait, did my deductible change"

She says "yes it did, but, your old benefits will carry over, they are paid out on a calendar year so youre fine."

I hang up, open my wallet, and sure enough, my new ID card says:
$2500 Deductible
$6350 Max Out of Pocket Cost
30% CO-Insurance

YIKES!!!!!! Thats a $5000 increase in my max out of pocket cost. Now Im starting to panic.

To Be continued