I suppose this is a sort of guest post. The following is the experience that a friend of mine had in wake of the “Affordable Care Act” implementation. He posted this to his FB and asked to share. Disclosure: My friend is more a classic liberal with a streak of libertarian in him. He’s a believer in liberty and the free market; but is far from being a social and foreign policy conservative. He’s also an agnostic atheist.
*UPDATED 2/23/16* PLEASE READ AND SHARE!!!
“Uncovering Covered California”
A brief recap of my last year and a half of bureaucratic nightmare. It’s a bit long but please read and share to get the word out.
Fall 2013: Skyrocketing insurance premiums in anticipation of the implementation of the Affordable Care Act force me to move from my Kaiser Permanente plan, that I had for about ten years with no problems, to a Covered CA plan with Kaiser which, even with a partial subsidy, is more expensive than my previous plan a year earlier.
August 2014: I receive a notice that Covered CA needed documents to prove my citizenship even though I had already provided them when I signed up 10 months prior. (I was born in California) I provide them with those documents.
September 2014: Covered CA sends me a letter saying they received the documents and that I did not need to worry further about the matter.
October 2014: Covered CA sends me a letter saying that our policy will be terminated on October 31st due to lack of documents proving my citizenship. This is very concerning as my wife is pregnant. I call them to provide them with the documents for the third time. They are unable to accept my documents in spite of my protests because they are in a “closed period” where they can’t make adjustments to files. I am told that they can’t make changes to my files until November 2nd.
November 2014: I call on November 2nd and am told they now can not make changes until November 11th. I call on November 11th and after 3 hours on the phone they were able to locate my documents. I was told that the changes would take “a month or two” to process.
December 2014: I receive notification that my policy has been terminated. I was not allowed to pay any premium payments. I start receiving bills for medical services rendered in November and December. I pay those out of pocket. I call to find out what is going on and Covered CA tells me that my status is still pending but it will soon be reinstated.
January 2015: I’m reinstated, and pay my premium. I soon find out that they accidentally put me into a deductible plan instead of the HMO plan I’m paying for. I get more bills for services rendered. I spend around 20 hours getting that straightened out but after a week or two I’m back on the HMO plan.
March 2015: I receive a premium bill that is more than three times the cost of my usual premium bills. I call, I spend about 30 hours on the phone between Covered CA and Kaiser and no one knows what’s going on. I pay my normal premium amount in the meantime.
April 2015: I’m told the reason the premium is so high is because my payments made from January thru April had all been pushed backwards two months to cover November and December of 2014 even though I had no coverage during that time. I inform them that they need to apply the payments correctly to the months I actually had coverage. I’m told that this problem will be fixed and that I need to continue making my normal premium payments in the meantime.
May 2015: I add my newborn son to my policy in a process that took several hours and involved me answering questions several times regarding his employment and marital status. He was nine days old.
May-October 2015: I repeatedly call to find out the status of my premiums spending over 100 hours on the phone being bounced around. I am repeatedly told that everything looks correct in their system and that the next bill should reflect that. It doesn’t. I keep making the monthly premium payment to make sure I’m doing everything correctly on my end.
October 2015: I’m unable to make my premium payment for November online. I call and am told that my policy has been terminated again because my payments were still being pushed back to the two months in the previous year when we were not covered. This left our most recent premiums as “unpaid” and caused them to terminate the policy. Even though I paid through the end of October, I had been terminated in August without being notified. It’s a good thing we had no medical emergencies during that time. I spend another 30-50 hours trying to get the reinstatement process initiated again.
December 2015: I’m told that I will be reinstated on January 1st of 2016. I make the premium payment (which now even with the subsidy is double the cost of our policy before being pushed to Covered CA). I make a payment on December 15th to cover the month of January. I am told that once I’m reinstated that I will need to pay for November and December of 2015 because we used the “believe me” policy to receive temporary coverage during that time.
January 2016: I receive a letter from Covered CA saying that my son will no longer be covered on Covered CA because he qualifies for Medi-Cal which is “free”. I do not receive any refund for the amount of his Covered CA coverage. I also haven’t received any confirmation on whether he’s actually covered or not. His employment and marital status has still not changed.
Early February 2016: I receive my premium bill which is now seven times higher than my monthly premium instead of the three times it should be (to cover November ’15, December ’15, and February ’16). I call to find out what’s going on. I’m told they accidentally generated two accounts for my policy and applied the ’16 payments to the wrong account. My payment made on December 15th is returned to me on January 31st. I now owe for four months of coverage. I am unable to pay online or via telephone because their computer system was tied to the wrong account. I’m told I will have to pay for four months via cash or check in order to maintain my good standing. I do not have this amount of money on hand in cash as the previous payment was returned to the credit card.
Mid February: They supposedly fix the problem with two accounts allowing us to make the back payments for November and December of 2015 as well as January and February of 2016. The premiums that I am paying include coverage for my son on Covered CA even though he is now supposedly on Medi-Cal. I have not received any refund for the difference nor does anyone at Covered CA seem to know how to initiate that on their end. We update my income on the Covered CA website as my hours were cut at work. The next week we receive a bill again for seven times the normal premium. We are told that it was a mistake and will be fixed “eventually”. We speak to Medi-Cal and are told that my son is activated in their system but they’re waiting for his account to be linked to the state. We are told there will be no interruption in coverage.
Late February: We take my son in for his 9 month checkup and are told he is not covered by Covered CA (which I paid for) or Medi-Cal. I call Medi-Cal and they tell us that because we changed the income on Covered CA, he has to be re-approved for coverage with Medi-Cal. I’m told I need to upload my new reduced pay stub to Covered CA to restart the approval process for Covered CA. I won’t receive my first reduced pay stub for another nine days so I can’t even begin the process of reinstating his coverage until then. He is currently not covered on either Covered CA or Medi-Cal in spite of the fact that I paid for his coverage in full with Covered CA.
As of today, February 23rd, my son has no health insurance even though his coverage is paid for. I do not know if I am covered or if my wife is covered. It depends on which department you speak to. I do not know how much I will end up owing and how much longer it will take before this is sorted out. I’m hoping that my son does not get sick or hurt while the bureaucracy tries to figure out if they allow us to receive what we paid for. I just hope it gets fixed before my son’s employment and marital status changes.
PLEASE SHARE SO WE CAN DO SOMETHING ABOUT THIS SYSTEM!!!
A former fetus, the “wordsmith from nantucket” was born in Phoenix, Arizona in 1968. Adopted at birth, wordsmith grew up a military brat. He achieved his B.A. in English from the University of California, Los Angeles (graduating in the top 97% of his class), where he also competed rings for the UCLA mens gymnastics team. The events of 9/11 woke him from his political slumber and malaise. Currently a personal trainer and gymnastics coach.
The wordsmith has never been to Nantucket.