My ACA health insurance nightmare

[Danny Bateman]

Yeah, I feel like Red Five's solution of drumming up support through media might be a great idea. I'm sure they wouldn't appreciate negative pub, so you may be able to force their hand.

 

I guess this whole thing is a lesson that unfortunately concepts like loyalty and customer compassion have gone by the wayside in our current society. These big insurance providers and CC companies won't hesitate to screw someone over because frankly, we're just a number to them a lot of the time. It's not like them dicking people over is anything new. They'll do that when you're WITH them!

You raise a good point that sending an activated CC, even with a chip, is idiotic. If that fell into the wrong hands, it's an invitation for big-time fraud. That seems backwards to me.

 

KP should absolutely have to provide proof to you that they sent notification on a deal like this. Don't back down on that. If they can't provide actual documentation that they sent you a letter, how are you liable here? Frankly, I agree they should have done more than one form of notification. A phone call would've been great. I'm of the mind it is partially their fault for doing such a sh**ty job keeping you up to date.

 

Lastly, I don't know what the hospital you go to is like, but the one that I work at is pretty good about working with people that are having payment issues. Especially if they're in a situation like yours. I'd continue to try to reach out to them to see what they can do to ease your burden, at least in the short term.

[84HuskerLaw]

You are unfortunately right in your description of the problems you face. Legally, it is going to be an uphill battle vs. both the credit card company and KP as both are very likely following their rules and regulations and the law pretty carefully. I don't believe many credit card issuers send out cards that are in fact 'pre-activated' but as it is a replacement card situation, there could possibly have been a transition date set whereby the old card 'expires' and the new card automatically replaces it. Not the best practice as of course it could be lost or misdelivered.

 

Getting a card company to admit they made an error in a case such as this one will be very difficult as their admission would tend to make them not only responsible for the correction of the premium payment amount but theoretically the card issuer may then be responsible for the medical bills not covered in the future as a result of their negigent actions. Therefore, the card issuer will certainly deny, delay and defend (the 3 Ds of the insurance world) with full vigor and their deep pockets and law firms((with 50 or more partners and names you have trouble repeating).

 

Now the hospital certainly has some responsibility in this as well as they are, I believe, supposed to VERIFY insurance coverage before they administer care so they should, I believe, have called KP to confirm the procedure was covered and would be paid for, per terms and deductibles, etc. Therefore, perhaps the policy was in fact STILL in effect at the time of the procedure? Not sure but I would not be surprised if you can get the hospital to 'settle' for about 65% of the billing amount. Of course, that is still a big chunk of cash or debt you would have to somehow come up with (2nd mortgage, IRA cashing, or something?).

 

Obamacare IS A DISASTER IN PROCESS! The biggest problem with Obamacare as you mentioned is the absolute absence of any serious effort to control medical care costs and therefore the premiums to cover the same. The very existence of 'health insurance' as such has an undeniable economic impact on the price of healthcare in the marketplace. Increase the supply of money available for purchasing of something and you get rising prices and usually greater supply of the product (although health care services is very restricted and government constrains suppies in many ways). The only cost containment mechanisms of Obamacare are the HUGE deductibles and co-pays and premium increases it requires as it attempts to give little or no charge 'coverage' to those who profess the inability to pay and to obtain funds for the same raises premiums charged to those insureds with apparent greater ability to pay. In your case, apparently, you are one of the 'lucky' ones who the ACA (government) says are well to do and wealthy enough to not only be able to afford "Affordable Care Act" coverage and the requisite deductibles and co-pays, etc, but additional premiums to help defray the costs of thos with less wealth than you.

 

I am rather surprised you feel that paying $1450 a month for health insurance premiums that will have thousands of dollars in additonal out of pocket costs in addition for you and your family is "reasonable". Without knowing, I would just take a guess that your annual deductibles and co-pays would likely be around $7,000 per year, meaning for your health care, your household will be shelling out over $2,000 per month. Most families I know simply cannot hope to be able to afford this amount for basic health care costs. This is the root evil of Obamacare. It was 'sold' as Affordable but it is so far from it that even Obama himself refuses to implement and enforce the law on most people, after 7 years. Playing political games with the law until after he leaves office, when the proverbial "sheet" will hit the fan. Small businesses won't be able to afford to insure their workers when the law eventually is actually implemented.

 

The intention is to help people get basic healthcare but it really is just a gigantic 'money tap or spiggot of funds available to health care providers nationwide. A huge government blank check that says 'sell' your services to the people and we (the government) will pay the tab. A disaster without any question or debate. One must make the healthcare market like other free marktes - buyers and sellers negotiate for the price that is acceptable to both for goods and services.

[Lil' Red]

One piece of advice I'd add is to start documenting everything. KP and your CC will probably try and jerk you around as much as possible so it will help your case if you have clear documentation on everything that has transpired. If this ever turns into a legal matter this documentation may be vital to your case.

[JJ Husker]

Once again, thanks to everybody for the advice and suggestions.

I do want to clarify that the new CC WASN'T sent pre-activated. I believe they (Chase bank) told me that they activate automatically after 30 days. I still think that is jacked up because they have no idea if that card is in our possession or not.

84HuskerLaw- I said it was a reasonable plan only in that it is a lower premium and better coverage than my prior non ACA plan. I agree that the premium is high and that my cost shares are still too high but that is not necessarily a result of Obamacare. It is because of the main problem in our healthcare system; rapidly escalating and ridiculous care costs and runaway premiums. Yes, the ACA did not address the most critical problem but it also is not a direct fault of the ACA. My deductible is $1000 or $1500 per person, max about $3000 per family. That is reasonable. I'm not sure what our co-insurance is, I think it is probably 20% until we reach our max out of pocket around 20k. Based on plans I have seen, those are also reasonable limits considering the current CF that is our healthcare system.

[knapplc]

Personal opinion, the ACA's top priority should have been to rein in out-of-control healthcare costs.

[knapplc]

I do want to clarify that the new CC WASN'T sent pre-activated. I believe they (Chase bank) told me that they activate automatically after 30 days. I still think that is jacked up because they have no idea if that card is in our possession or not.

 

 

 

That's an incredibly poor business practice. As several people have pointed out, how do they know that card is in your possession?

[JJ Husker]

Personal opinion, the ACA's top priority should have been to rein in out-of-control healthcare costs.

Uh, that is not an opinion. That is a fact.

 

Some of the drugs I've recently been prescribed are out of this world ridiculous.

 

I started with Lialda/Mesalamine. I was on a generic only plan at the time and it is not available in the US as a generic. My cost with BCBS insurance was $770 for a 30 day supply. Anthem BCBS wouldn't pay a dime of it. I never did pay that for it however. I got free samples from my doctors and ended up ordering it out of a Canadian pharmacy when I did need to purchase it. The generic from Canad was about $200 for a 90 day supply. Weird but true- it shipped out of India though Singapore and then directly to me. Canada never saw it. When I got on the KP plan it was covered and only cost me $30 for a 30 day supply. Of course only 2 months of that and then my doctor put me on something else.

 

Humira- You've all seen it advertised on TV It worked relatively well for me but would not get me to where I needed to be with my condition. When I would pick up my prescription, my share was $5 for the month. Great, right? Well the receipt stated that my insurance had saved me $4,800.....for a 1 month supply, 2 or 4 self injectable pens. I'm sure KP had some lower negotiated rate and they paid it down I'm guessing to about $200-$300. The manufacture offered a cost support program and they would pay it down the rest of the way to where my cost was only the $5. Great deal for me and anybody with health insurance. But they do not offer that cost support program to anyone without health insurance or who was on Medicare, Medicaid, or any state run government program.

 

Entyvio- Sort of the same thing as Humira but requires IV infusion and is a biological more directly targeted to my condition. I am also supposed to be in a manufacturers cost support program for it. I think my cost is supposed to be capped at $50 or $200 per infusion. I haven't determined yet if they ran it through that coverage and the additional charges are for the infusion center charges or what. But $25,000 for one bag of fluid that takes about 1 hour to drain into me......I don't care how you spread that out, it's ridiculous. I needed to stop that one anyway. It hasn't appeared to work any better than the Humira and probably wasn't working as well.

 

If I lose my coverage, I will have to go back to the Mesalamine from Canada and hope my condition does not worsen in the next 8 months. The cure is surgery but it is also a last resort type of thing.

 

I have been relatively lucky in that everything I am on severely suppresses my immune system. Unbelievabley I have not been sick once since starting these drugs. *knocks on wood

[C N Red]

Ah, how I long for the good ole days of being able to get or change insurance at anytime of the year. I guess that was too easy.

[JJ Husker]

 

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.

 

I somewhat agree with this but I just don't see what the CC provider can or would do to really fix this for me. They can't get my insurance reinstated. They can't get me into a new plan for the rest of the year. They could pay my medical bills but I'm sure they won't. If I lawyer up, they will really become hard to deal with, and they have much deeper pockets than I do. I just don't see what the CC company can do, or would be willing to do, at this point in time. Same goes for KP except that they could and hopefully might still agree to reinstate my insurance. Problem is that is obviously a money losing proposition for them. Hopefully they do the right thing or somebody forces them to do the right thing.

[JJ Husker]

Got a little bit of good news to share. I discovered tonight that what my wife told me was a bill from the hospital was actually a details of benefits from KP. The total was almost $25,000 for the one infusion but KP's plan discount was about $11,000 off of that. Then they pay their share and bill me the rest. So, I am more hopeful now that should I get stuck with that the cost of that infusion, with no insurance, maybe the hospital will at least offer me the same discount. So hoping worst case just went from $25k to $14k. Maybe I'm dreaming but seems somewhat logical to me or am I just grasping at straws?

 

Also, this makes me a little more hopeful that KP may do the right thing. They wouldn't be on the hook for as much $$ as I previously thought so that might help allow them to step up and make it right.

[knapplc]

What did the State Attorney General's office say? If you haven't contacted them yet, be sure to do so. They could be your best resource in this situation.

[JJ Husker]

What did the State Attorney General's office say? If you haven't contacted them yet, be sure to do so. They could be your best resource in this situation.

I will be contacting the Division of Insurance first today and I am supposed be hearing from KP....their final determination from my complaint. If that isn't satisfactory, I will contact the AG. Thanks for that advice.

[JJ Husker]

Update; Kaiser Permanente is a bunch of weasel c#ksuckers. That is all.

[Danny Bateman]

Give em hell, JJ. I feel like you got hosed here and you've got to fight it.

[JJ Husker]

Give em hell, JJ. I feel like you got hosed here and you've got to fight it.

I am and I did. Don't think I'll be talking to KP anymore. This morning was the 2nd time I lost it on one of their phone personnel. Guessing she'd never heard some of the words I used before. Heck I'm not sure I've ever used some of them before. I was making them up like I was speaking in tongues I was so hot. That's what she gets for having an attitude. I kind of snapped....