update on health insurance issues

vlagrl29 · November 2015

I was working on getting everything gathered to send to our senator so his case worker could help me contact the ACA appeals dept and get this over with. The drop in coverage happened May 1 and I sent the appeals stuff at the end of June. I didn't even find out our insurance was dropped until June 4th. I called the appeals dept today to see if I could get them to send me some of the documents I originally sent them so I had them for the case worker. Guess what as of November 10th they decided to rule in our favor - holy hell I can't believe it. The rest of this process may take a couple months because the appeal dept needs to send documentation to Coventry and then Coventry will have to reopen the policy for 1 month - that's when we had about 2k in doc bills. We have since been on a new coventry policy since July but there was that small lapse that needs to be figured out. Now I can call our docs and update them so they won't send us to collections. What a relief!

hoffse · November 2015

Great news! Congrats on getting that headache worked out!

formerlyGDaisy09 · November 2015

So happy for you!

jessica490 · November 2015

Yay!

PurpleBookmark · November 2015

Awesome news!!

CuriousKiddosMama · November 2015

That is awesome news!

smerka · November 2015

Nice!

blondie42107 · November 2015

Wonderful news!!

brij2006 · November 2015

What a huge relief!

Yet another reason why this "new, awesome, amazing" healthcare system is so messed up. This isn't the first case I've heard of like this, and they don't have the staffing to handle these cases or the workload from offering the exchange.

short+sassy · November 2015

brij2006 said:

What a huge relief!

Yet another reason why this "new, awesome, amazing" healthcare system is so messed up. This isn't the first case I've heard of like this, and they don't have the staffing to handle these cases or the workload from offering the exchange.

To be fair, insurance was a huge mess before ACA. And this kind of stuff happened all the time. One of my coworkers keeps complaining about our insurance rates going up and blames ACA. I'm not sure how he doesn't remember insurance rates always going up for less and less coverage...long before ACA...because I sure do.

Anyway, not trying to get into a political discussion, ACA is sure not perfect. Just saying insurance sucked pretty hard in largely the same ways before ACA also.

I remember my mom getting a new medical bill for me for a minor surgery I had...FOUR years after the surgery. That was 20 years ago.

And then HR for a new job I started screwed up my enrollment and neglected to add me to the med. insurance. That was 15 years ago. Insurance refused to pay it a $200 dr.'s bill even after it got sorted out. I could have endlessly fought it and probably would have eventually won, but it just wasn't worth it to me.

vlagrl29 · November 2015

Thanks everyone! It is a huge relief that I don't have to go thru the senator process. Its just too bad it took me threatening an attorney and senator to get any action. I've changed how I pay the premiums due to this experience. We did have it auto debited from DH's business account which I don't have access too so I personally call in the payment every month to coventry.

I have to say even with this mess I still think the ACA was a step in the right direction. No more pre existing condition excuses and honestly its the best policy we have ever had. I'm going to be signing up for 2016 coverage next week. I already updated our application thru the govt website. Looks ilke our premium will be only $10 more and our deductibles are a tad lower than this year. Baby #2 will be much more affordable for us medical bill wise.

als1982 · November 2015

brij2006 said:
What a huge relief!

Yet another reason why this "new, awesome, amazing" healthcare system is so messed up. This isn't the first case I've heard of like this, and they don't have the staffing to handle these cases or the workload from offering the exchange.

The ACA isn't a "health care system" but a mandate to help make private insurance affordable and accessible. If you want to point fingers, point them at the insurance companies making these kinds of mistakes. Companies where profits are more important than people.

brij2006 · November 2015

Oh not saying ACA is a horrible product. The health insurance industry had become a monopoly and needed to get smacked a little. But the marketplace and people working for ACA just aren't enough, so there are more situations happening like this than we can ever think of.

I currently have 20 clients through the marketplace who have had this same exact issue and they're still fighting it. Yet us insurance agents are allowed to help at all. So the client sits and waits for months and months while the hospital is threatening to send them to collections for an unpaid bill.

vlagrl29 · November 2015

brij2006 said:

Oh not saying ACA is a horrible product. The health insurance industry had become a monopoly and needed to get smacked a little. But the marketplace and people working for ACA just aren't enough, so there are more situations happening like this than we can ever think of.

I currently have 20 clients through the marketplace who have had this same exact issue and they're still fighting it. Yet us insurance agents are allowed to help at all. So the client sits and waits for months and months while the hospital is threatening to send them to collections for an unpaid bill.

Its very unfortunate and I know we aren't the only people this has happened to. Personally I believe the govt should be kept out of the health insurance. yes while insurance is a PITA at least those that know how to work best with it can get it done for you WAY faster than the govt employees. More than half of them don't give a crap about your situation and aren't really competent people. Its like dealing with 2 jerks instead of 1. I was also not shocked with the senators office told me there is a dedicated person - the case worker that deals with their issues. That told me that there are lots out there like me needing answers and not getting them because of either laziness or incompetence. Moving forward I believe personally calling in our payment every month will definitely cover our asses more. Believe me if I had been pregnant when this happened I would have hired an attorney to do all this work for me. Luckily we had only 2k of medical bills - could have been way worse.

short+sassy · November 2015

Out of curiousity, I checked out the health exchange for 2016 in my state. So much I don't understand!

There were very few questions and I chose the "right" one for income ($12K-$46K) to see what the government subsidy might be. The next page I am told I don't qualify for a government subsidy, but here are your plan choices. Ummm...okay. And why is that? I mean, it doesn't matter personally, I'm not actually shopping, but still.

The other thing I don't understand is at my employer...on a group plan...they pay something like $1200/month for a single employee's traditional plan and the employee contribution is something like $325. Yet, off the exchange, I could have purchased an even better plan than theirs for a total cost of only $303/month. Why would a rando individual's plan off the exchange be SO much less than under a group plan?

I don't necessarily expect anyone else would know either, but I feel like I'm missing something, lol.

vlagrl29 · November 2015

short+sassy said:

Out of curiousity, I checked out the health exchange for 2016 in my state. So much I don't understand!
There were very few questions and I chose the "right" one for income ($12K-$46K) to see what the government subsidy might be. The next page I am told I don't qualify for a government subsidy, but here are your plan choices. Ummm...okay. And why is that? I mean, it doesn't matter personally, I'm not actually shopping, but still.
The other thing I don't understand is at my employer...on a group plan...they pay something like $1200/month for a single employee's traditional plan and the employee contribution is something like $325. Yet, off the exchange, I could have purchased an even better plan than theirs for a total cost of only $303/month. Why would a rando individual's plan off the exchange be SO much less than under a group plan?
I don't necessarily expect anyone else would know either, but I feel like I'm missing something, lol.

regarding your income - you should have a subsidy. Anyone that makes $60k or less will get a subsidy of some sort - this is Gross income if you are corporate or Adjusted Gross Income if you are self employed. Believe me the govt website use to be confusing to me too, but after this mess I've learned a lot about it. Personally it's best to either call the marketplace or an insurance agent in the company of the provider you want to fill out an application. Right now If I log into my account I can see all the plans that are available to us, what our subsidy is, all the details of benefits of each plan and even can check to see which doctors are on each plan.

This last weekend we actually went into the blue cross office in our area and had an agent there explain all the benefits of the plans we were considering from their company. We ended up choosing a plan that is currently better than what we are on. Max OOP for individual is $500 - Max OOP for family is $1,000. Our premium with subsidy is only $90 per month.

Regarding corporate insurance plans - I think they are so much higher because they are spreading the cost around x-amount of employees. Before the ACA if you worked corporate maternity was included and you really didn't have to worry much about pre existing conditions. On the other hand if you bought your own insurance plan privately, maternity was NOT covered and stupid things such as a sinus infection or a hernia could be considered pre existing. In actuality no one can afford COBRA - its crazy high that only your employer can pay for it.

Needless to say I wasn't expecting much from the ACA as far as helping our family afford a better plan but it really has been great for us - low premiums, low max OOP, no worry about having to foot 100% of maternity bills for #2 next year.

short+sassy · November 2015

@vlagrl29, thanks for commenting. That's quite the 180 from how it used to be as far as buying a policy on one's own vs. a group plan. It used to be, plan vs. plan regardless of who was paying, group plans were substantially cheaper because company's are buying in bulk. So they got catered to vs. an individual.

I was primarily looking:

1) If there is a plan worth buying that would save me at least as much if not more on my monthly scripts. A long shot, but wanted to check it out.

2) If I lose my job, what would my options be.

I think it would be easier to just talk to an agent. Plus there were so many options with most of them being high deductible plans, which is what I already have at work so not what I am looking for.

I don't think I'd qualify for a subsidy now, but I should if I lost my job. Hence why I chose the option I did in the hopes I could see what that situation would look like. Only to get the weird message that I don't qualify.

Xstatic3333 · November 2015

short+sassy said:

@vlagrl29, thanks for commenting. That's quite the 180 from how it used to be as far as buying a policy on one's own vs. a group plan. It used to be, plan vs. plan regardless of who was paying, group plans were substantially cheaper because company's are buying in bulk. So they got catered to vs. an individual.
I was primarily looking:
1) If there is a plan worth buying that would save me at least as much if not more on my monthly scripts. A long shot, but wanted to check it out.
2) If I lose my job, what would my options be.

I think it would be easier to just talk to an agent. Plus there were so many options with most of them being high deductible plans, which is what I already have at work so not what I am looking for.
I don't think I'd qualify for a subsidy now, but I should if I lost my job. Hence why I chose the option I did in the hopes I could see what that situation would look like. Only to get the weird message that I don't qualify.

I think I may know why you didn't qualify with a hypothetical "unemployment" income. This will be a very nutshell version; I'm sure one of the insurance or health industry ladies could give you a more detailed one. As part of the ACA, there was supposed to be a federally funded expansion of Medicaid so that it would cover people in higher income levels to bridge the gap between the truly poor (already receiving Medicaid) and the middle class (who would be able to purchase healthcare on the exchanges). In a number of states, particularly those with state governments and/or governors very opposed to the ACA, this federal money to expand Medicare was declined. This left an "in between" group of low earning but mostly employed people who neither qualify for subsidies or have access to Medicaid. Perhaps the income you entered put you into that category. My inlaws are in this category in Florida. They can't afford insurance without subsidies but make too little to qualify into the subsidy system and too much for Medicaid, if that makes sense.

If you watch the debates at all, this was the move the Kasich had to spend some time defending himself against in the first Republican debate. He accepted the Medicare expansion for Ohio, while most other GOP candidates declined it.

vlagrl29 · November 2015

The company I use to work for back in 2007 provided us insurance for no additional cost out of our paychecks - that plan when I was laid off was $425 - for an individual. No way could I afford that when I could buy a short term plan or even a better individual plan off the private insurance. For my parents that plan that my dad had on them was $1k - in my experience corporate plans have always been way much more money than if you buy individually thru that insurance company.

short+sassy · November 2015

Xstatic3333 said:

short+sassy said:

@vlagrl29, thanks for commenting. That's quite the 180 from how it used to be as far as buying a policy on one's own vs. a group plan. It used to be, plan vs. plan regardless of who was paying, group plans were substantially cheaper because company's are buying in bulk. So they got catered to vs. an individual.
I was primarily looking:
1) If there is a plan worth buying that would save me at least as much if not more on my monthly scripts. A long shot, but wanted to check it out.
2) If I lose my job, what would my options be.

I think it would be easier to just talk to an agent. Plus there were so many options with most of them being high deductible plans, which is what I already have at work so not what I am looking for.
I don't think I'd qualify for a subsidy now, but I should if I lost my job. Hence why I chose the option I did in the hopes I could see what that situation would look like. Only to get the weird message that I don't qualify.

I think I may know why you didn't qualify with a hypothetical "unemployment" income. This will be a very nutshell version; I'm sure one of the insurance or health industry ladies could give you a more detailed one. As part of the ACA, there was supposed to be a federally funded expansion of Medicaid so that it would cover people in higher income levels to bridge the gap between the truly poor (already receiving Medicaid) and the middle class (who would be able to purchase healthcare on the exchanges). In a number of states, particularly those with state governments and/or governors very opposed to the ACA, this federal money to expand Medicare was declined. This left an "in between" group of low earning but mostly employed people who neither qualify for subsidies or have access to Medicaid. Perhaps the income you entered put you into that category. My inlaws are in this category in Florida. They can't afford insurance without subsidies but make too little to qualify into the subsidy system and too much for Medicaid, if that makes sense.

If you watch the debates at all, this was the move the Kasich had to spend some time defending himself against in the first Republican debate. He accepted the Medicare expansion for Ohio, while most other GOP candidates declined it.

I know exactly what you are talking about. It's such an unbelievable atrocity. Like, "Thanks for being the working poor, but you're too poor to get a subsidy. Better cut down on the little income you have so you qualify for Medicaid."

Louisiana was one of the few states who also turned down the Medicaid expansion, which put 1/4 million people in that "in-between" category. But the very short form I filled out was weird. There were only three income choices...."below $12K", "between $12K-$46K", and "above $46K". I picked the middle one so that I hypothetically fell into the correct category.

And just to tie-in with current events, the LA governor who turned down that expansion is the former GOP candidate Gov. Bobby Jindal. Who just resigned from the Presidential race today.

Yep. Pretty tough to get the Republican nomination when the approval rating from your constituents is a dismal 20%. No one who lives here understands what fantasy land he was living in.

Xstatic3333 · November 2015

Agreed @short+sassy, it is atrocious, especially since it was just done to prove a point. I almost made a Bobby Jindal joke in my first post but didn't want to offend in case you were somehow in the 20%

short+sassy · November 2015

Xstatic3333 said:

Agreed @short+sassy, it is atrocious, especially since it was just done to prove a point. I almost made a Bobby Jindal joke in my first post but didn't want to offend in case you were somehow in the 20%

Haha, appreciated. I am definitely NOT in that 20%. He's considered by many, myself included, to be one of the worst governors in our history. And that's saying something...even former gov. Edwin Edwards who spent 8 years in fed. prison on racketeering charges is better liked and more respected, lol.

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