My ACA health insurance nightmare

[JJ Husker]

I am going to share this true story, not really to complain about the ACA but in the hopes that it may prevent even one other person from having anything like this happen to them.

 

Prelude- As some of you are aware, I am not an Obama fan or necessarily a fan of Obamacare, especially the way it was rammed through congress. I also still believe they failed to address the single biggest problem with healthcare; runaway premium and care costs. I have not been proven wrong on that concern yet.

 

I am in Kaiser Permanente Gold plan for myself and my family. The premiums have been relatively reasonable (currently $1450ish per month for myself, wife and 2 kids). The plan coverage also has not been bad. I purchased this plan through the exchange in Colorado. I have been on this plan since January 2015. It has been better than the small group plan I left behind.

 

My Nightmare

On March 31, 2016 I went online to pay my April premium. I charged it to Visa card, as we always do, to get the perks from using the credit card. We keep our credit cards paid off. I got a payment confirmation from KP's online payment system. I assumed the premium had been paid. So, I went back online in early May to pay my May premium. It was a few days late but we'll within the 30 day grace period to pay it. Problem is, I could not pay because the system said my policy had been terminated. So I call KP to see WTH. They inform me that my CC PROVIDER had declined payment of the charges and they said they mailed us a letter informing us of that. Bigger problem- we never received the letter. They terminated our policy and refuse to reinstate it. We cannot get back into any exchange policy until the open enrollment period at the end of the year. So myself and 3 family do not currently have health insurance.

 

I called my Visa provider to see if and why yhey decline ed payment. They informed me that they had recently sent us new chip cards. We knew that but we had not activated them yet. The CC provider took it upon themselves to provide these cards and to activate them with a new expiration date. So they declined payment based on the exporation date not matching (even though I got an online payment confirmation at the time).

 

The Ugly part, I have been receiving some Entyvio infusions at the hospital. I received one in late April, when I thought I had insurance but didn't. The bill arrived from the hospital last Friday..... $25,000 for one infusion.

 

I have little recourse on anyone on this. KP's policy is, if it's not their fault, they will not reinstate. The ACA law is written so that people cannot hop on and off plans and avoid paying premiums. I understand that but it is so black and white that situations like ours don't trigger any common sense loophole. We didn't know our premium had not really been paid and we did not know KP was going to cancel the policy or that they in fact did.

 

Lessons for you

1- Don't assume a payment confirmation means jack sh#t. It doesn't, at least to Kaiser Permanente, even their payment system generated.

2- Don't a assume that anyone will provide you more positive notice than saying they put a letter in the US mail. We all know they have a 100% delivery rate, right?

3- If you get a new credit card you better activate yourself immediately. I always figured the old one was good through the expiration date or until you activated your new card.

4- Everytime you receive healthcare, you may want to double and triple check that your insurance is in force before receiving the care.

 

I'm guessing the hospital is under the delusion that I have some intention of paying that 25k bill. I dont, and won't. I just hope, with my medical condition, that I can make it to the open enrollment period without incurring any more high dollar care bills. Anyway......

[JJ Husker]

Sorry (it was supper time and I was hungry) I've got a couple more lessons to incude.

 

5- If you don't want any surprises on your hospital bills, insist that someone provide you with what your share of the costs may be. I received 2 of these infusions in March and 1 in April. Of course the April one is the seriously ugly one but I did not receive any of the hospital bills until May. My share of the infusions in March, when I had insurance, was about $1500 each. I asked my doctor before, they didn't know. I asked the first 2 times at the hospital, they said they didn't know "wait for us to bill you" Had I known my share was even the paltry (ha) $1500 I would not have consented to this treatment.

 

Summary

I and my family have had continuous healthcare coverage forever. Always. Period. One of the driving forces behind Obamacare ACA was so that everyone would and could get coverage. You doubt the law of unintended consequences? Because of the way they wrote the law, I now for the first time in my life , when I really need it, cannot get healthcare coverage for a period of about 9 months. Thanks Obama. And f#*k you Kaiser Permanente. And f#*k you US Postal service. And a big f#*k you to Chase bank Visa provider.

[JJ Husker]

BTW, if anyone has any suggestone on what I can possibly do, please share. As far as I know, my only recourse at this point is to file a complaint with KP (which likely won't do any good). I'm pretty sure those bastards were looking at my outstanding bill and comparing it to my premium and they decided no frikken way we're going to reinstate. I can and will be filing a complaint with the the state Insurance Commisioner. Probably pissing up a rope. And I will attempt to explain my situation to the hospital, hopefully get my bill reduced and hopefully they are willing to wait a long time for it to get paid off. I'm guessing I will end up engaging the services of a lawyer but I really have no idea what they will be able to do to help other than help me out of even more money.

 

So anyway, any suggestions would be greatly appreciated.

[JJ Husker]

Oh, and to top it off, I will get hit with the penalty on my taxes for not having sufficient coverage for 9 months of the year. And they wonder why we drink.

[BigRedBuster]

There is just so much about this mess that was not thought out well at all.

 

I firmly agree with the idea of trying to provide access to health care to everyone. But, both Democrats and Republicans screwed the pooch on this one.

 

JJ....I haven't worked within the system enough to know what your options are. sorry.

[knapplc]

How is this an ACA problem? This seems like your credit card company screwed up.

[BigRedBuster]

To me, it looks like both.

 

Yes, the CC company screwed up by denying the bill.

 

The ACA is a problem because once that happened, there are no options for him to restart his health care coverage for 9 months. And, during that 9 months that he really wants to have coverage but can't get it, he will then be fined for not having it.

[knapplc]

Even if you've missed open enrollment, or in this situation some bizarre thing cancelled your policy, you have options. They may not be great, but you can at least have something for the next nine months.

 

https://www.healthinsurance.org/obamacare/miss-open-enrollment-youve-got-options/

[Danny Bateman]

Wow, what a jacked up mess.

I agree that it seems like the CC company really screwed you over. I've never had a card that I didn't activate myself. But I typically use my debit card because I don't ever really buy anything too high-dollar. And you always have to activate those when they send them to you. Do they send credit cards to you pre-activated? I can't remember with either of mine.

Either way, it's royally f---ed up coming and going that both A) they sent it activated and failed to tell you that your old card was useless at that point and B) that one declined payment from a snafu this minor is cause for cancellation of your plan on the part of KP. That seems particularly heinous and unjust.

 

I'd say your best resource is to continue to seek action against the situation using consumer protection type of agencies. As you've said, a lawyer may be good-- if you visit the right one-- if for no other reason than to learn more about your options at this point.

 

Personal advice moving forward would be to switch over to paperless notification on as many things as possible so you don't have to worry about losing anything in the mail again. Unless you're really an old-school type of guy. I've just found it's helped me eliminate clutter and keep everything in my inbox.

 

Also to anyone else, I can't overstate the importance of JJ's #5 tip. You have a right to see whatever a hospital is billing you for. Even more, I was listening to a Clark Howard (CNN money guy) podcast not too long ago, and they were talking about how there's even professional bill audit companies that go back and double check everything a hospital bills you for. A lot of the time, due to inefficient billing departments and patient volume, hospitals often don't get your bills right. These companies go back and find the mistakes. Unknowing people often just pay the extra because, well, how would they know? Here's a couple pieces explaining this in further detail.

Long story short: He's right. Check your bills carefully.

Good luck man. Keep us updated on everything.

[knapplc]

JJ, I would also contact the Attorney General's office in your state (CO, right?). They may be able to put pressure on the CC company and KP to try and resolve this. While you still (might) be able to get short-term insurance until the next open enrollment, you should challenge their seemingly arbitrary decision to just axe your coverage over one missed payment.

[Red Five]

First of all this sucks for you.

 

BTW, if anyone has any suggestone on what I can possibly do, please share. As far as I know, my only recourse at this point is to file a complaint with KP (which likely won't do any good). I'm pretty sure those bastards were looking at my outstanding bill and comparing it to my premium and they decided no frikken way we're going to reinstate. I can and will be filing a complaint with the the state Insurance Commisioner. Probably pissing up a rope. And I will attempt to explain my situation to the hospital, hopefully get my bill reduced and hopefully they are willing to wait a long time for it to get paid off. I'm guessing I will end up engaging the services of a lawyer but I really have no idea what they will be able to do to help other than help me out of even more money.

So anyway, any suggestions would be greatly appreciated.

 

Make sure that you do all of this. Also, keep bitching to your CC company about it. Maybe contact your local TV news outlet? They love stories like this.

[Red Five]

How is this an ACA problem? This seems like your credit card company screwed up.

 

This is correct. It is a CC company problem, not an ACA problem. They are the ones that f'd you. Raise holy hell with them about it. Don't take "no" from anyone there. KP is just following their rules, although they should have some appeals process that you can go through.

 

There is a reason that people can't jump on/off health insurance whenever they please. If you allow that, then its not really "insurance". And if people think costs are high now, you don't want to see what would happen if people could come and go as they please.

[JJ Husker]

JJ, I would also contact the Attorney General's office in your state (CO, right?). They may be able to put pressure on the CC company and KP to try and resolve this. While you still (might) be able to get short-term insurance until the next open enrollment, you should challenge their seemingly arbitrary decision to just axe your coverage over one missed payment.

Thanks guys for the suggestions. I am still just getting into this so I'm not sure where it will lead. I can't get over the feeling that somebody along the way will do the right thing but it sure isn't looking like that will happen yet.

 

Knapp- as far as your question "how is this an ACA issue?" KP has repeatedly told me that due to how the ACA law is written, once a policy goes 30 days without being paid, they have to cancel and cannot reinstate, unless it is their fault. All parties can be blamed to some extent IMO. I guess even I have some culpability for not knowing that the online payment confirmation didn't mean squat. Maybe I should have checked a few days later to make sure our balance had been reduced to zero? Logic tells me that shouldn't be required but in a critical situation like this, maybe it would be wise.

 

I blame KP first and foremost for providing a payment confirmation and then reneging on it. I also blame them for cancelling our policy while prior only supposedly providing one mailed notice. Seems like a fairly significant action to take without maybe a call first to the insured and notify them more positively. They cannot provide proof they mailed that notice. They think their word that they mailed it is sufficient proof. Who really knows if they did?

 

And yes, I blame the CC provider. Seems to me they should never automatically activate a new card. What if the reason I hadn't activated was because I didn't receive it or it got stolen or delivered in error? They activated a card that may not have been in my control and they cancelled a card that for all I knew was still good. Yeah, they're to blame also.

 

The problem with insurance outside the ACA is that they can specify waiting periods, exclude certain things, etc. Hell, if they're going to exclude my medical conditions, I may as well save the money and hope something unrelated or serious doesn't occur in the next 8 months. Right now it looks like I'm going to need that premium money to help pay the hospital bill.

[knapplc]

KP has repeatedly told me that due to how the ACA law is written, once a policy goes 30 days without being paid, they have to cancel and cannot reinstate, unless it is their fault.

 

 

I would trust Kaiser Permanente's explanation on that about as far as I could throw a water buffalo. Contact your AG's office and raise hell.

[zoogs]

Hope you get this resolved, JJ. One would hope our laws have become stronger, not weaker, in compelling insurance companies to be fair to people (for example, not allowing them to find some 'pre-existing condition' excuse to simply deny coverage).

 

Like knapp says, what KP is saying smacks of a company ducking under the most convenient excuse they can come up with. I hope there's some recourse here, whether it's from the CC company, AG or whatever everyone else has suggested. KP *wants* you to say "Thanks, Obama - well, you gonna do?" Don't let them.

I can't believe they would provide something called 'payment confirmation' that isn't actually confirmation. Seems like a mistake anyone could have easily made.

 

And really, it seems like the sort of outcome that KP could *easily* reverse -- and it would cost them a lot less than the bad publicity of sticking to it.