‘Lots of kinks to work out’ understated: One reporter’s Obamacare experience

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(Photo courtesy Pixabay)

There Obamacare goes again.

You may recall that I now have written twice about Obamacare blunders that I have experienced during the past couple of years – pretty significant ones, in fact.

Well, I’m sad to report, that despite repeated assurances (and even a personal phone call from one of the top brass from Blue Cross Blue Shield when this happened last year), that Blue Cross Blue Shield of Illinois appears to be up to their same old tricks.

Not only that, but the exchange itself also is providing misleading, inaccurate information to callers. In fact, I think the bigger issue with the problems I’ve had have been the exchange (probably with the administration of it in the broke state of Illinois, specifically) than with the insurance companies themselves.

Let me explain.

Yesterday (on Thanksgiving Day, when the Blue Cross Blue Shield of Illinois call center was closed) I received an email that read, “Your Blue Cross Blue Shield of Illinois application has been received.” The email even assigned me an application number (for 2017).

Funny thing is, I have not even signed on to the exchange to even begin looking for a policy for 2017. My current insurer is United Health Care (I did have the coveted Silver Compass policy until recently…more on that in a minute).

Last year, Blue Cross Blue Shield did this EXACT same thing – told me I had applied for 2016 (and in 2015 I did have Blue Cross Blue Shield, so such an error back then at least made at least a modicum of sense – I was already in their system). You can read my column last year about Blue Cross Blue Shield by clicking here. They even told me I had been approved in an email that arrived shortly thereafter. In fact, they sent both emails twice.

This morning, I spoke to an extremely courteous Blue Cross Blue Shield representative who assured me this is all going to get work, and he acknowledged my frustration, especially since this has happened twice. He could not have been more professional.

I’ll update this blog when and if I get an explanation.

Last year, someone at the exchange in the D.C. office explained to me that some insurers are attempting unscrupulous marketing tactics, and that maybe that was what was going on.

But they ain’t saints at the exchange either, let me tell ya!

A couple of months back, I got an email from the exchange (Healthcare.gov) saying, “Are you still on track to make $XX,XXX this year? If not, please call (such and such number) to avoid paying extra at the end of the year due to a higher than expected income.”

Well, I have been blessed with lots of good-paying work this year, and yes, I am on track to exceed the amount I listed when I signed up for insurance this time last year. So, I was honest about that, called Healthcare.gov, and the rep ASSURED ME, SEVERAL TIMES that nothing would change with the United Health Care Silver Compass policy that I already had except that my premium was going to nearly double (I pay just over $300 per month for my insurance, which I suppose is in line with people working jobs similar to mine in corporate America, so I don’t really have any complaints about that).

Well, the rep lied. Or had bad information, perhaps. Because I do NOT have the same Silver Compass policy that I had before.

I first found this out when I went to get a prescription filled. My co-pay used to be $5; now it’s $10. Then, when I went to the psychologist, I learned my co-pay had gone from $10 to $30. I see my psychologist (not to be confused with a psychiatrist, which prescribes medications) weekly due to my chronic PTSD diagnosis. I’m very grateful to UHC, actually managed by UBH, United Behavioral Health, for paying for weekly sessions. Of course, the magnitude of what I’ve been through and what led to the diagnosis is pretty heinous and unusual, to say the least.

Then there’s the time that instead of being charged my $5 co-pay, earlier this year during a trip to Walgreen’s (when I still had Silver Compass), I was charged $56 for a medication. I wrote about that several months back too. You can read that column by clicking here.

Be careful out there, folks, if you’re buying insurance off the exchange. It’s still a hot mess. No matter what, in all matters health care in the U.S., you MUST be your own advocate. Never settle when something doesn’t smell right. Ever.

 

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I’m enrolled for 2016? Really? Except open enrollment does not being until Nov. 1

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This piece originally was written on Oct. 27, 2015, for Healthline Contributors. That site is going dark on Dec. 6, so it is reprinted here with permission.

UPDATED 11:42 a.m. 10/27/15

I want to preface this column by saying I am extremely grateful for the affordable health insurance coverage I obtained for 2015 under the Affordable Care Act. Without the subsidy, as a self-employed person it would be extremely difficult for me to remain insured and be able to eat at the same time.

That said, there is a reason why health care in America is the butt of so many jokes. And as a health reporter, it’s my duty to share with you my own bad experience with the health care system this week.

The night before last, I received two sets of emails, two hours apart, from my current health insurer. Suffice it to say that I am insured by one of the giants.

The emails let me know me that, one, my application for health insurance had been received. And about 20 minutes later, I received emails telling me my application had been approved.

Here’s the rub: I didn’t apply for health insurance for 2016 with this provider. In fact, I have had an ongoing email and telephone dispute with them over some unpaid claims and I have made it very clear I won’t be signing up with them again in 2016.

Regardless of whether they had every right to deny my claims based on fine print I can’t find (and don’t understand), their customer service throughout the entire ordeal has been deplorable. And that’s putting it nicely. Every time I would call I would get a different answer. A time or two, frustrated reps flat-out admitted: “Now wait a second. I’m really confused.” And the phone tree and the transfers? It’s the stuff hilarious commercials about poor customer service are made of.

So when I saw these emails confirming my applications for health coverage for 2016 that I never made, followed by emails telling me my applications had been approved (even assigning me a card number and an explanation of how to pay my first premium), my blood pressure shot through the roof.

When I reached a customer service representative at said gigantic health insurer, she very matter-of-factly, confidently and insistently told me: “You were signed up through the marketplace. The marketplace signed you up.”

I said, “Oh really?”

She then proceeded to give me the 800 number for the marketplace, aka Healthcare.gov.

When I spoke with the agent at Healthcare.gov, she confirmed what I already knew: No application for health coverage for 2016 had been made through the marketplace (let alone two…obviously some sort of computer glitch). But it gets better:

Open enrollment does not even begin until Nov. 1.

She said that perhaps I was confused, that maybe the insurer just had used some misleading marketing practices and that I had received an advertisement. As you can see from the photo with the story, that’s not the case. In fact, they told me twice that I was signed up, and they even assigned a card number and let me know how to pay my premium.

But it gets even better. They signed me up for the same plan I had for 2015 – one they repeatedly had told me has been discontinued for 2016, and have alerted me several times that I would need to choose a different plan for 2016.

I reached out this morning to both representatives listed under “Media Center” for said gigantic insurer, but so far have heard nothing. I’ll give you an update and will be happy to share their explanation if I hear back.

In the end, I’m just going to ignore their emails, I’m not going to send them a dime (I’m already paid up through 2015), and I’ll choose a different provider off of Healthcare.gov when open enrollment begins Nov. 1.

Meanwhile, be careful out there. There obviously are pitfalls in the American health care system. Giant ones.

UPDATE: The senior director of media relations for the company has offered a very sincere apology at 11:36 a.m.: “We screwed up taking care of you, plain and simple. Sorry.”

He even shared with me the explanation he was given (see below). Honesty and transparency go a heck of a long way with me, so I may in fact consider re-enrolling with them come Nov. 1. I’ll keep you posted.

Background
An issue was identified in the App Tracker for renewal transactions for the state of IL. The issue caused welcome emails to be sent in error.

Action

When members call, apologize to the member for any inconvenience that this system error caused. Tell the member that they will receive a communication within the next few days that will give additional information on their 2016 plan and rate.

Resolution

The issue has been identified and a fix is being implemented shortly.