Health insurance coverage nightmare

[DirtySouth]

This is going to be boring as hell, but I've got to vent somewhere.  It should NOT be this hard to get coverage and I'm so fucking PISSED.  If you read this, thank you for listening to me (and, really, anyone who cares about how our health care system works and people having access to coverage should read this insanity). 

October 2014 - I leave my job that covered my health insurance.  Went onto the Marketplace website, filled everything out, picked a plan through Humana.  At the end it said that I need to contact Humana directly to pay the premium, and that the policy doesn't go into effect until the premium is paid.  I needed coverage effective within 24 hours.  I call Humana, who says it can take a couple of weeks for the info to get to them from the Marketplace, so it was impossible to get immediate coverage.  I never paid for this policy (and, again, the marketplace says the policy doesn't go into effect until paid).

So I contact a broker, who sets me up with a Humana HMO effective the next day.  Awesome.  The broker says that the Marketplace is a mess and only makes sense to use if you qualify for a premium subsidy.  I set up online bill pay to pay for this policy each month.

Humana issues my policy with the wrong PCP on the card.  Also, I'm really unhappy with the HMO limitations on doctors.  So, open enrollment comes up, and I apply through a broker to switch to a Humana POS.  The plan is to go into effect Jan 1.  I get an enrollment letter from Humana confirming this.

I schedule a dermatologist appointment in Jan because I have some funny looking moles (also, pale skin and a history of getting lots of sunburns and being an idiot and going to the tanning bed).

Before my Dr appointment, I am mailed a new insurance card.  For the HMO.  WTF?  With the HMO, the derm isn't in network and I also need a PCP referral for a specialist, so I cancel appointment.  (The POS would have covered my visit).

After many hours on the phone being transferred around to different people at Humana, talking to people at the Marketplace, and a bunch of confused people just scratching their heads, and then getting my broker involved, we find out what happened.  Even though I never paid for the Marketplace policy, which I applied for in October, the Marketplace made an error and sent a notice to Humana to continue coverage of this HMO policy for 2015 (you know, the one that I never had through the marketplace because I never paid).  (which makes no sense).  So my POS was active for one day, Jan 1st, and then cancelled and an HMO issued, but now it's a Marketplace HMO.  Without anyone bothering to check with me first or even notify me.

Humana said the Marketplace had to first cancel their policy and tell Humana, then Humana would reinstate the POS.  People at the Marketplace are all confused and don't even understand the issue.  I finally get a hold of a really nice woman who gets it, and in January she submits the request to cancel the HMO, and tells me the effective date of cancellation will be February 10th.  Sucks, but fine, I'll wait a couple weeks and live with the shitty HMO.  I get an emailed confirmation from Humana that the POS will begin on Feb 11th.  I get a mailed letter dated Feb 11th thanking me for my enrollment and giving me an explanation of benefits packet for my new POS.  Great!

I schedule an appointment with the dermatologist to check out these moles.  The appointment was this morning.  I don't have my new insurance card, but gave them the policy number and letter confirming coverage.  A few minutes later they say that Humana says my policy was cancelled.  I ask them to double check. Nope, no coverage.

I walk out of the doctor's office in tears.  This is the second time I've tried to get these moles checked out and haven't been able to because Humana fucked up.  I'VE BEEN PAYING THE POS PREMIUM THIS ENTIRE TIME!  The March payment was just taken from my account.  I spend all morning on the phone with Humana.  I feel like going postal.  The guy tells me they show the POS in effect for just January 1st, then an HMO effective Jan 2nd through Feb 10th, and that now I have no coverage.  I explain that at that very moment I was holding a 2/11/15 letter from Humana saying I was enrolled in the POS.  And, WTF did I just pay for on March 1st and why did Humana cash my check for the amount for the POS for the full month of February?! Dude pretty much called me a liar and said this coverage never existed.  He's like, I can submit an inquiry that someone should review in a couple of weeks.

Um, NO.  I'm fucking paying for the product.  I have written confirmation that the product was issued.  FIX THIS.  I call the broker, tell her what's up, and say that I'd like to just switch to BCBS.  Even though she says Humana is much better coverage, they are taking my money and giving me no coverage, so anything is better than this.  She says, well, I get what you are saying, but you can't switch because it's no longer open enrollment.  HAHAHAHAHAH WUT?  So I'm stuck with trying to get Humana to extend the coverage I'm paying for or to just give up and be uninsured.  Awesome!

She and I three way called Humana. It's like the Twilight Zone, or Who's on First.  We are stuck in automated loop hell.  Finally we get to someone, who actually believes the broker and doesn't call HER a liar, and does some digging.  She finds something in the file confirming that the POS should be in place and be retroactively stated to Jan 1st.  She says that she spoke with her supervisor, who said to transfer us to an agent, who will retroactively reinstate the policy.  We are transferred.  The agent says, um, no, I am not able to retroactively reinstate a policy.

At this point I have a client waiting to meet, so I have to go.  The broker says she will keep working on it.  I got an update email from her that she reached a person who submitted an inquiry (LMAO) asking that my POS be reinstated, and the broker will follow up on Friday.

THIS IS SOOOO FUCKING WRONG.

In the meantime, I'm worried about these moles, especially after reading ShanBrite's blog.  I was irresponsible with the sun for a good two decades, have an itching spot that is growing, and a weird looking mole, and I need to see a doctor, damn it!

[AJL]

I don't know what to say. *Hugs*

[Bad Dingo]

Reach out to your State Attorney General and State Healthcare Advocate.

[downtoearth]

Ditto Bad Dingo - there are some good resources out there and they need people like you (who have documentation) to help regulate this crap!

I'm so sorry and it shouldn't be this hard for anyone who is PAYING for a product to use it. Health insurance is still broken IMO.

[DirtySouth]

I've started doing some research on this because certainly some laws are being violated, but this is soooo outside my area of expertise. I'm at the point where even if my issue is resolved, I want to do something to shed some light on this problem. Thankfully, I'm healthy (assuming these moles aren't a real issue). Imagine if this happened to someone who needed to receive dialysis, or chemo, etc. It is beyond wrong that this can even happen.

[anonymous]

that is so effed up. I am so sorry. I hope they resolve it ASAP.

[keyslover]

Mar 4, 2015 14:15:31 GMT -5 DirtySouth said:

I've started doing some research on this because certainly some laws are being violated, but this is soooo outside my area of expertise. I'm at the point where even if my issue is resolved, I want to do something to shed some light on this problem. Thankfully, I'm healthy (assuming these moles aren't a real issue). Imagine if this happened to someone who needed to receive dialysis, or chemo, etc. It is beyond wrong that this can even happen.

Contact the AG's office and Dept of Commerce (they regulate health insurance. Good luck with the nightmare.

[DirtySouth]

In the past, my state health insurance commissioner's office has been absolutely no help (I had trouble getting my adopted son coverage prior to finalization because there was a mistake on his birth certificate and we couldn't get him a social security number right away). I was in a panic that I couldn't get coverage for my nweborn, and it felt like no one gave a shit. Finally, an awesome broker did a ton of work and figured out a way to get him covered.

[MrsAxilla]

Man, that really sucks.

[penguingrrl]

That's insane. I'm so sorry. I hope they can resolve this quickly. And yeah, this whole health insurance as private industry thing is an absolute crock of shit.

[btdt]

I'm sorry this is happening to you. IMHO, health insurance companies are evil incarnate. Okay, BCBS is evil incarnate. I despise them with every fiber of my being after the absolute craptastic "service" I've gotten from them this year.

[brewco]

I don't normally post on this board, but saw this post in the new topics. I work in a medical office (skin cancer surgery) and deal with this situation a lot. Would it be worth your peace of mind to pay cash for an office visit to get your moles checked? Let the office know that you're paying cash and they can generally give you a break. I understand it's not ideal while you're paying the premium for health insurance and not getting coverage, but it is an option to look into temporarily. Sorry that you have to deal with all of this, I hope you're able to figure this out and get coverage ASAP.

[craftyone]

I hope you get it figured out soon. I've probably spent 30 hours on the phone with Anthem since January trying to find out information for my sons' coverages and how it needs to be authorized, find ing out why a claim was denied when it shouldn't of been and we just switched from the HMO side to PPO. You would think that they could see that they are in the same company, but my experience they are completely clueless.

[CallingAllAngels]

I'm so sorry. Health insurance is The Worst. It makes me want to scream, throw things and burn shit down. I hope you are able to get a satisfactory resolution soon, and that your moles are okay.

The thing that makes me craziest is that I think about all the people out there that don't have the resources that I do. How many people are insurance companies screwing over with their shenanigans because they count on them being too overwhelmed to fight?

[DirtySouth]

Mar 4, 2015 15:58:11 GMT -5 brewco said:

I don't normally post on this board, but saw this post in the new topics. I work in a medical office (skin cancer surgery) and deal with this situation a lot. Would it be worth your peace of mind to pay cash for an office visit to get your moles checked? Let the office know that you're paying cash and they can generally give you a break. I understand it's not ideal while you're paying the premium for health insurance and not getting coverage, but it is an option to look into temporarily. Sorry that you have to deal with all of this, I hope you're able to figure this out and get coverage ASAP.

This did cross my mind.  My concern is that biopsies and lab work will simply not be something I can afford to pay out of pocket.  I suppose I can call the doctor's office and get price information to find out what kind of expense I'm potentially looking at.

[lg28]

Ugh. Big hugs to you and good luck as you get it all sorted out.

[scout8]

OMG. I would be so livid. So sorry that you are in this mess. I can't believe they are taking your money, but claiming you don't have coverage. That is insane. I hope you get it figured out soon.

[Deleted]

I forget all the details, but something similar happened with my sister and her newborn last year. He was born at the end of January, and they enrolled him in healthcare, and got some temporary cards while everything was being sorted out (since the exchange was super brand new). They brought him to the doctor for his newborn shots and other checkups, multiple times, then finally got the real cards in the mail months later -which showed that they were on a different plan than what they enrolled in, and the doctor they had been going to was out of network, which apparently wasn't covered at all. What? So they had to pay 100% of the first several visits because their insurance company had them on the wrong plan and didn't bother to send them documentation for months.

Of course, they weren't willing to refund the premiums paid during that time, so my sister had to pay 100% for visits AND several hundred dollars a month in premiums. It was total BS.

Thanks for the reminder, though, that I switched my health insurance and it's March 4th and I have yet to get anything in the mail about the coverage that should have started on March 1st. Of course, my bank shows they cashed my check a couple of weeks ago. Hmm. I wonder if I'm actually covered at the moment?

Anyway, good luck getting it straightened out.

[DirtySouth]

This is my rough draft letter to the Insurance Commissioner's office (I contacted a friend at the AG's office, who confirmed I have to go through the insurance commissioner).

To Whom it May Concern:

I am having an urgent issue with individual health coverage. I have timely and consistently paid my health insurance premiums to Humana, who is accepting my money, has issued written statements confirming that a policy is issued, but when I attempt to go to a doctor, Humana then denies that any policy exists. Currently, according to Humana, I am uninsured. I have twice cancelled a very important doctor’s appointment due to Humana’s refusal to honor the policy that they issued and for which I have paid.

On December 2nd, 2014, I applied through insurance broker XXXX for a Humana Gold POS policy. See attached Exhibits “A”, “B” and “C.” Coverage was scheduled to begin on January 1, 2015. Humana confirmed my premium payment for said coverage via email on December 31, 2014. Exhibit “D.”

In January, I received a health insurance card from Humana, but it reflected that my coverage is an HMO policy. I applied for, paid for, and was issued a POS. The coverage through the HMO compared to the POS is very limiting in my access to doctors. I had to cancel an important upcoming specialist’s visit because my chosen specialist is covered under the POS that I paid for, but not under the HMO that Humana issued. I called Humana, and after lengthy conversations found out that Humana issued a POS that was effective only for the day of January 1st, then they cancelled the POS and put an HMO in place. Included on the last two pages of the attachment labeled Exhibit “E” is a January 29, 2015 email from me to my insurance broker, XXXXX, further detailing Humana’s explanation for this cancellation.

The cancellation was done without my authorization or even Humana sending me notification. Additional information regarding the details of this cancellation is included in Exhibit “E”, which should be read from bottom to top. I was informed that the problem was resolved, the HMO that I did not want was scheduled to cancel on February 10, 2015, and the POS that I applied and paid for goes into effect on February 11, 2015.

On February 11, 2015, Humana issued a letter that was sent to me via mail confirming enrollment in a POS policy. Attached as Exhibit “F” is this letter and the attached Summary of Benefits and Coverage for a Humana Gold POS plan. Thankful to finally have the issue resolved, I rescheduled my specialist’s appointment for March 4, 2015.

On March 4, 2015, when I attended my specialist’s appointment, I was informed that the policy information I provided is for a policy that was cancelled on February 10, 2015. I showed the doctor’s office the February 11, 2015 letter with the policy number that shows that coverage was issued and in place. The doctor’s office again called Humana, who stated that no policy is in place. I had even made a premium payment to Humana on February 12, 2015, and Humana deposited this money, sent a confirmation email acknowledging the payment (attached as Exhibit “G”), yet they claim there is no policy that existed on that date.

Once again I had to cancel this important specialist’s appointment due to Humana’s mistake. This is putting my health in jeopardy, and is unacceptable since I have made all of my premium payments. Due to Humana’s incompetence, I am currently without health insurance. I asked my broker if I can get a policy through a different company, but was informed that I cannot since it is no longer open enrollment. I am being forced to remain uninsured.

Please assist me in establishing health insurance. I currently have health needs that are going unaddressed due to no fault of my own, and I have no options since it is not open enrollment.

[lemon360]

Mar 4, 2015 16:31:12 GMT -5 DirtySouth said:

Mar 4, 2015 15:58:11 GMT -5 brewco said:

I don't normally post on this board, but saw this post in the new topics. I work in a medical office (skin cancer surgery) and deal with this situation a lot. Would it be worth your peace of mind to pay cash for an office visit to get your moles checked? Let the office know that you're paying cash and they can generally give you a break. I understand it's not ideal while you're paying the premium for health insurance and not getting coverage, but it is an option to look into temporarily. Sorry that you have to deal with all of this, I hope you're able to figure this out and get coverage ASAP.

This did cross my mind.  My concern is that biopsies and lab work will simply not be something I can afford to pay out of pocket.  I suppose I can call the doctor's office and get price information to find out what kind of expense I'm potentially looking at.

I'd at least pay to go to the doctor to have them look at it and to assess whether you could hold off on a biopsy until the insurance issue is straightened out. They can usually tell by looking at it how serious it is.

[JayhawkGirl]

Your letter is good. Forward a copy to your broker and ask that the broker send in to Humana. Send a copy to Humana also, and hope this gets their attention. What a mess.