A THCB reader in California writes in…
“As it happens my husband has medical issues so we know to stay on top of our heath care. Our insurance canceled us after years of paying high premiums. We were happy with the coverage and our doctors. We just did not have maternity or pediatric, dental [care].
We are 64-62, children in their 40s. No need there.
They offered us a policy that was $1750 per month with deductibles and out-of-pocket costs no one would ever reach. We went on Covered California to find a policy. We found one with the same company so we thought our doctors and hospital would be in-network, paid the premium Dec 4, and left for Christmas out of state feeling pretty safe.
When we returned we received a letter from Blue Cross stating that they did not receive our payment. And so our metal anguish starts!
I called, was on hold three hours. The system hung up on me [and] called back. Was on hold two hours with Covered CA. When someone came online we spent another hour trying to locate the application. They said that Covered CA had a glitch in the system that was duplicating people. We had three people on our application that was why Blue cross did not take our payment. They said they fixed it took another payment and promised all would be fine.
Went to get my husband’s medication to find out we were not covered. He had to have the meds. Came home and spent eight hours on the phone between Blue Cross and Covered CA trying to fix it. They told me to pay out of pocket for my husband’s medication until they fixed the problem.
I told them that my husband had a doctor’s appointment on Thursday that we could not postpone. It was with his Cardiologist. They had no idea except to pay-out-of-pocket. Went to the appointment, the doctor said he needed an operation NOW.
We told him about the insurance issues and had to postpone the operation until the next Friday hopefully the insurance would be in force by then…”
If you have questions about the Affordable Care Act or your buying insurance on the federal state exchanges, drop us a a note. We’ll publish the good submissions.
Categories: Uncategorized
You can appeal problems with Covered California on their website. It really is a mess. My partner applied for heath care through the CC website in Dec and was promised healthcare by Jan. 1. She was thrown into the MediCal system which is backed up more than 90 days. IN the meantime she was in an accident and has a $55,000 hospital bill. Now, MediCal has finally gotten back to her to tell her she in not covered and she should apply for regular coverage like Blue Cross – which is NOT retroactive. We are appealing and we are going to contact our state senators and perhaps create a Civil Suit.
I am glad Obama pulled off this program but the execution of it is typically a government system mess of slow bureaucracy. NO ONE knows what is going on – Covered California and MediCal tells us a different story every time we call.
This couple needs an ombudsman handling their case, someone in the system or a a resourceful advocate who knows how to navigate the various systems involved. (I don’t know about California, but my guess is that in most cases the official so-called “navigators” are apt to be newly-hired people, recently hired from a swollen population of unemployed or under-employed job seekers, given a flash training course.)
Hopefully this letter to THCB is but one of several. Similar letters and phone calls should be sent to their Congressman, offices of the governor and state insurance commissioner, local media and any other place that might expedite a solution. My experience is that one knowledgeable person — and it might be some low-level functionary taking a personal interest — can cut through lots of red tape.
When my mother had to be placed in a nursing home, it was the concierge of the hospital, not me, who found an open bed at a facility mutually accessible to me and my sister. When she needed Medicaid certification, it was a helpful caseworker in the local Family Services office who did the spade work, someone protected from most of the public by a couple layers of front-line office screens.
I have no idea who might be helpful in this case but a local investigative reporter looking for an assignment might be a good place to start. Records of individual names and copies of all documents are more than helpful. They are totally essential. Good luck. They need it.
Good point Rockville, but retroactive consumer protections aren’t going to aid a person in getting surgery when they need it. Sometimes waiting a few weeks can be very bad or even result in death.
Why didn’t the navigator that assisted with enrollment get this corrected?
Mike, turn this post into a letter to the NC Department of Insurance and include what ever documentation you have.
My past dealings with BCBS of NC were frustrating and fruitless, the DOI at least gives them a heads up they can’t claim to have lost, and they will forward your letter on. Don’t count on the NCDOI to be an advocate though, the fight is mostly yours.
As last resort try WRALs “On Your Side” consumer help.
We are from a suburb of Raleigh, NC and my wife applied on line for the top of the line Obamacare BSBC coverage, paid the first month with a credit card, back in December and has not heard a word from anyone. The charge has not been placed on our credit card but when my wife called she was told that she was covered. We have no BSBC healthcare number or anything that shows she is covered. She needs prescriptions and does not have an insurance number to give to the pharmacy. I would think a month and a half is sufficient time to obtain the verification of insurance coverage but am running out of options on obtaining prescriptions needed. What should we do?
“What do we do?”
After the previous post, “What am I to do?” where we were castigated for not giving the answer, I have to ask – Is this meant to be a rhetorical question or not?
Well, I have to agree that “health insurance” is a misnomer. Only part of it is “insurance” in the actuarial sense. The bulk is byzantine hypercomplex pre-payment.
Yeah, HIPAA was a great job lock “solution.” Not.
Individual policy market medical underwriting was not a crack people fell through, but rather the foundation of risk management and the concept of insurance. Also, please recall the “job lock” problem was cured by HIPAA in 1996. I wonder how many of the ills The Act promised to cure will be marched out as unsolved in a THCB post 17 years from now.
recission. duh.
What a mess. Had we simply lowered Medicare legibility to age 50 — say, as the “public option” (UTIL being highly correlated with age) — and expanded Medicaid to cover the indigent, and outlawed recession, we’d have gone a long way to solving the coverage problem (not there wouldn’t still be outrageous stories regarding people falling through the cracks, i.e., individual policy market medical underwriting, the “job lock” problem, etc).
But, that wouldn’t have comprised the Grand Photo-op Signature Achievement of AHIPcare.gov
There was an article in the New York Times a week or so back about significant administrative glitches at Anthem Blue Cross. A Wellpoint spokesperson said that in one two day period they had one million calls come into their call center which is as many as they normally get in a whole month. It’s a mess in the early going. If it were me, I would try to physically go to one of their offices and offer to pay the premium in person and then get a receipt for it in case the check doesn’t clear my bank on a timely basis.
What kind of consumer protections does the ACA have built in to safeguard against this kind of gray area? does anybody know?