My ACA health insurance nightmare

[Danny Bateman]

 

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....

 

 

If they're not smart enough to realize to not be a jerk when they're talking to someone who's clearly been screwed over, they deserve what they get. That's one career I'd never want.

[AR Husker Fan]

JJ, one thing I haven't seen mentioned is the possibility of enlisting the media. Seems every market has some kind of "investigative journalist" that loves to go after businesses and generate outrage when someone is treated as you have been treated. And that kind of negative publicity can go a long way in changing attitudes. Just a thought...

[JJ Husker]

JJ, one thing I haven't seen mentioned is the possibility of enlisting the media. Seems every market has some kind of "investigative journalist" that loves to go after businesses and generate outrage when someone is treated as you have been treated. And that kind of negative publicity can go a long way in changing attitudes. Just a thought...

Yeah, somebody actually mentioned that earlier in the thread. It could very well be effective but it seems sort of like a last resort option to me. I've only got a couple avenues left, CO division of Insurance and the AG. Hoping one of those will force the right thing before I decide to go all scorched earth on 'em. Just don't want anyone feeling like it's out of their control before then. Thanks for the suggestion.

[JJ Husker]

Also, KP told me something today that I was not aware of. People like me who are not receiving a subsidy or assistance with their premium get cancelled/terminated within 30 days of non-payment of premium. However, if you receive a subsidy, they give you a longer time period before cancelling. Not sure if this is KP policy or the law. Of course they made it sound like it was the law.

 

The more I think about all of this stuff the more I realize just how absolutely jacked up and corrupt the whole system is. Why should policy cancellation depend on receiving a subsidy or not? How can a bill for an infusion be $25k but instantly be reduced by $11k as a negotiated insurance company discount? Why is a drug manufacturers cost assistance program not available to those without insurance or those who are on Medicare or Medicaid? How can the people in charge of determining if they'll reinstate your coverage or not also have access to your pending care costs? Does anyone think they will freely choose to have to pay out $12k instead of collecting a $1450 premium? KP had every incentive to want to cancel my policy at this point in time. They had every incentive to make sure I did not receive that notice. Everyone I have talked to, even at KP, started out understanding and saying how I couldn't see this coming. Then they go review it a bit and all of a sudden doors start getting slammed shut and I'm told no way José. The way the whole system operates is criminal IMO.

[Landlord]

Really sorry to hear about all of this JJ

 

 

I'm not in the same boat, but I'm in a similar boat of frustration. I can't afford any kind of health insurance working part-time and doing freelance work, including dental which my terrible, genetically disadvantaged teeth have a beyond desperate and beyond due need for.

[JJ Husker]

Really sorry to hear about all of this JJ

 

 

I'm not in the same boat, but I'm in a similar boat of frustration. I can't afford any kind of health insurance working part-time and doing freelance work, including dental which my terrible, genetically disadvantaged teeth have a beyond desperate and beyond due need for.

I'm not sure there is a good option for dental anywhere. Every plan I've seen, it seems you would be lucky to get back in benefits what you pay in for premiums. If you have a lot of work that needs to be done, you can make the insurance pay off but, it also requires you to spend a lot on your share of costs. Sort of a double edged sword.

 

Have you looked into your options for health insurance on the exchange? I bet there are packages you could afford, especially if your income is lower. Guessing you are near half my age, your plans would be rated much lower to start with, then with the subsidies that are available, I would really think it would be affordable. Problem is, when you are younger and relatively healthy, any cost for health insurance probably seems unaffordable when you feel you can get by without it. I might be wrong about that but it does seem like the part of the ACA that actually does sort of work (maybe the only part) is particularly in the area of helping lower income people afford coverage. I researched individual plans for my son and his would've been around $200-$250 full load, before subsidy. He probably would qualify for virtually free care through medicaid if we actually chose to go that route. But for sure he would qualify for a large subsidy that would make it affordable if he needed to.

[Red Five]

Also, KP told me something today that I was not aware of. People like me who are not receiving a subsidy or assistance with their premium get cancelled/terminated within 30 days of non-payment of premium. However, if you receive a subsidy, they give you a longer time period before cancelling. Not sure if this is KP policy or the law. Of course they made it sound like it was the law.

 

KP is correct. That is the law.

 

The more I think about all of this stuff the more I realize just how absolutely jacked up and corrupt the whole system is. Why should policy cancellation depend on receiving a subsidy or not? How can a bill for an infusion be $25k but instantly be reduced by $11k as a negotiated insurance company discount? Why is a drug manufacturers cost assistance program not available to those without insurance or those who are on Medicare or Medicaid? How can the people in charge of determining if they'll reinstate your coverage or not also have access to your pending care costs? Does anyone think they will freely choose to have to pay out $12k instead of collecting a $1450 premium? KP had every incentive to want to cancel my policy at this point in time. They had every incentive to make sure I did not receive that notice. Everyone I have talked to, even at KP, started out understanding and saying how I couldn't see this coming. Then they go review it a bit and all of a sudden doors start getting slammed shut and I'm told no way José. The way the whole system operates is criminal IMO.

 

There are a lot of things within the healthcare system that could use some tweaking. Negotiated discounts is one. Depending on if you have KP, BCBS, UHC, etc you pay a different rate at the doctor. These are "volume discounts" not unlike you would see at a Sam's or Costco buying in bulk. One big problem with the discounts is that they lead to problems with transparency as a doctor/hospital can't tell you what a service costs since it depends on you insurance company, network within the insurance company, and then actual insurance plan. Also, Medicare/Medicaid rates are artificially low, so doctors/hospitals try to make that up on the commercial/individual population.

 

Also, if you walk in off the street with no insurance to get a service, you can negotiate with the doctor/hospital to get a discounted rate. They would rather get some money than no money at all.

[JJ Husker]

 

Also, KP told me something today that I was not aware of. People like me who are not receiving a subsidy or assistance with their premium get cancelled/terminated within 30 days of non-payment of premium. However, if you receive a subsidy, they give you a longer time period before cancelling. Not sure if this is KP policy or the law. Of course they made it sound like it was the law.

 

KP is correct. That is the law.

 

The more I think about all of this stuff the more I realize just how absolutely jacked up and corrupt the whole system is. Why should policy cancellation depend on receiving a subsidy or not? How can a bill for an infusion be $25k but instantly be reduced by $11k as a negotiated insurance company discount? Why is a drug manufacturers cost assistance program not available to those without insurance or those who are on Medicare or Medicaid? How can the people in charge of determining if they'll reinstate your coverage or not also have access to your pending care costs? Does anyone think they will freely choose to have to pay out $12k instead of collecting a $1450 premium? KP had every incentive to want to cancel my policy at this point in time. They had every incentive to make sure I did not receive that notice. Everyone I have talked to, even at KP, started out understanding and saying how I couldn't see this coming. Then they go review it a bit and all of a sudden doors start getting slammed shut and I'm told no way José. The way the whole system operates is criminal IMO.

 

There are a lot of things within the healthcare system that could use some tweaking. Negotiated discounts is one. Depending on if you have KP, BCBS, UHC, etc you pay a different rate at the doctor. These are "volume discounts" not unlike you would see at a Sam's or Costco buying in bulk. One big problem with the discounts is that they lead to problems with transparency as a doctor/hospital can't tell you what a service costs since it depends on you insurance company, network within the insurance company, and then actual insurance plan. Also, Medicare/Medicaid rates are artificially low, so doctors/hospitals try to make that up on the commercial/individual population.

 

Also, if you walk in off the street with no insurance to get a service, you can negotiate with the doctor/hospital to get a discounted rate. They would rather get some money than no money at all.

Yeah, there is just so much of it that is open for abuse and really what most reasonable people would consider criminal behavior. The lack of transparency is another huge issue. Nobody, and I mean nobody, has a chance in hell of deciphering a bill like we typically get from our hospital. I had a colonoscopy a few months back and the charges for all the line items on the bill from the hospital......f#*k. Literally 1 to 5 word descriptions that we had no idea about. No date of service, no specific information whatsoever. I have no way of knowing if they were legitimate charges or not. A guy hopes that the insurance company is holding their feet to the fire on those types of things but the average person has no chance in hell. It really doesn't have to be that way. I think the providers and insurance companies want to keep the consumer in the dark because then they can do and charge whatever the hell they want to. It just isn't right and I feel that is a huge contributing factor to the real problem with our system; runaway, escalating care costs.

[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 did finally get my complaint filed with the Division of Insurance. I told the guy I spoke to that a few people had recommended that I contact the AG. He said I had in effect done that by contacting the div of Insurance. He said if I had contacted the AG they would immediately kick it back to his office without comment anyway. He further explained, if the investigation and process led there or needed the involvement of the AG, they would take care of that. I was highly impressed with the guy I spoke to at the Div of Ins. He seemed to completely understand my complaint and all of the related issues and laws. He said technically what KP did complied with the law as far as providing notice and terminating but he also said he was somewhat hopeful and optimistic for a good resolution. He said typically Insurance companies, in those situations, will take a very hard line with the consumer but that they are usually much more receptive when the Insurance Commission contacts them. He felt the proof that I had in fact attempted payment and my incentive to obviously want and need coverage were compelling. He also indicated that dates, time frames etc. sort of go out the window at this point. I was concerned about a quick resolution so that coverage could be reinstated and continued before it became impossible due to too much time elapsing. He said there was no magic date where KP would be unable to do that even considering how the ACA law is written. I guess we'll see where it goes.

[JJ Husker]

Interesting tidbit-

As I was perusing the information on the Colorado dora site, they had yearly reports and summaries for all complaints filed in prior years. 2014-2015 saw a 29% increase in complaints on health insurance companies from the prior year. Maybe that is to be somewhat expected with the implementation of the ACA but it was obviously a very large increase when prior years complaints had been showing a pretty flat trend.

 

Can I say it? Well I will anyway ....Thanks Obama.

[knapplc]

What a convoluted nightmare of a process. It really sucks that you have to go through this, JJ. Here's hoping you get a good resolution, sooner rather than later.

[JJ Husker]

Well I think my insurance is being reinstated by Kaiser. Received a premium bill in the mail today for 4 months (April, May, June, & July) *ouch btw*

I have not received any letter or email or anything from KP or the State Insurance Commision explaining that it has in fact been reinstated but I'll take this as a good sign that we likely will have coverage again. Will follow up on it tomorrow. Now I have to see about getting them to kick in for some of the meds I had to buy out of pocket while they were dicking around with my coverage. The best part of this is that $25K infusion I had that was in question should now be covered and I have the option of continuing that treatment. I have been doing very well with my condition for the last 6 weeks or so, so it may actually be doing some good. I'll update again as I find out more.

[zoogs]

Yay!

[Danny Bateman]

Congrats JJ!

Score one for the good guys. Shame you had to fight that hard over something that seemingly simple, but I'm glad that everything worked out for you. I really wish it wasn't this hard for you or anybody else to get something as vital as healthcare ironed out.

[admo]

Good to hear JJ