So, yesterday I went to the pharmacy to get some medicine. Will you be paying out of pocket? Um... no, I have insurance. (Thats weird, why would they even ask that?) Well, our system is saying you dont, and that this first antibiotic is $384. After a bit of investigation, I found out this morning that in July, I was sent a letter (which I never saw) that told me my healthcare plan would not be renewed because it is not ACA compliant (which is strange, because Ive had it for 3 years, and it was compliant last year.) When on the phone with CareFirst, they told me it was sent in July, and in searching my email, I found an email that I DID read, but which only stated, We are writing to let you know that a new document (ACA Exit Reminder Letter) is available for you online. To view/print your document or download it as a PDF, log on to CareFirst My Account. At the time, this did not register as anything important (I dont even remember it). After all, what is an ACA Exit Reminder? Its not like it says ACA Plan Cancellation. And anyway, there are always documents for me to look over, but Im not really the type to pour over my Explanation of Benefits. So, for the future, I would recommended BCBS have a more appropriate opening line, like YOU WILL LOSE YOUR HEALTHCARE ON OCTOBER 31. GET ONLINE NOW, SON!!! This would have been especially appropriate due to the slew of medical conditions that I have (cystic fibrosis, type 1 diabetes, flat feet, good looks, and bad eyesight), for which I have put serious effort in my lifetime to avoid lapses in coverage. Lately, I didnt really pay much attention to my coverage, since I had automatic payments online, and I was enrolled in a bronze-rated ACA plan with an HMO in DC, one of the places with a website that actually worked last year. So that was all taken care of, right? Also: A phone call would have been nice, in that 3 month window would have been nice, too. So, I unexpectedly lost my health insurance on 10/31. I now have a lapse in coverage after unknowingly going to the doctors office for a specialist appointment (~$1000) who prescribed two antibiotics (~$600) due to me being sick. When I called CareFirst, they couldnt renew me, as my plan was canceled. I would have to go online to shop for insurance. [cue scary music] I went to Healthcare.gov. It told me to enter my zip code. I entered my zip code, it told me that DC was my state exchange. It provided me a link. The link was broken. I googled DC healthcare, I found the DC site. I try to enroll, but that the enrollment part of the DChealthlink (no joke) is offline for maintenance. (But lets be honest, was this really a surprise?) But the site also said, In the meantime, if you need immediate assistance, please call us at (855) 532-5465 from 8am - 8pm Monday to Saturday. So I did. After getting through the menu, a helper named Tanisha asked me for my information. And what follows is not at all an exaggeration of my phone call after that. I try to quote directly as much as my 7 minute memory will allow me to.) I told her I needed to enroll with a new healthcare plan because my old one wasnt ACA compliant. She told me that they are open tomorrow, and started giving me me their hours before I cut her off. Wait, are you open today? Yes, were open today. Then why would I call tomorrow? I just called you today. Well, we cant enroll you. What? The website is down. Yes, I know. Thats exactly why I called. It told me to call you. Yes, but I cant enroll you today. Oh wait, so youre basically working off the same website as me, which is down for maintenance, so nobody can enroll now? Yes. [hopeless chuckle] Well, maybe you can answer some questions I have in the meantime. I then proceeded to explain how I unexpectedly lost my coverage, and am now on the hook for at least $1500, and I asked whether there would be any chance for me to get that covered. Well, yes, youre eligible for Special Enrollment, and youll continue to be eligible for 60 days after your life changing event. Whats special enrollment? Its for life changing events, like unexpectedly losing your coverage, having a baby, getting seriously sick, or moving to DC (an odd one to put on that list, I thought, but hey, whatever) and if you meet the requirements, and you do, you can get covered through Special Enrollment and have coverage effective December 1st instead of Open enrollment which has effective coverage of January 1st. Wait. . . but its November. I need coverage yesterday, not December 1st. Well, yes, but you have at least another month. Yes, I know. But am I on the hook for $1,500 that I got in November? The carrier can decide if they will backdate coverage. So the carrier will decide if they will pay $1,500? No, the carrier will decide if they will backdate coverage. I dont think you understand: backdating coverage is the same thing as paying me $1,500. [awkward silence.] Well, the carrier can decide to backdate coverage. Does the ACA tell them to do so because Im in Special Coverage? Well, the carrier will decide, and I cant guarantee, but they sometimes do that for special circumstances. So, let me get this straight. Youre telling me that my carrier unexpectedly dropped my coverage, but that if I sign up for Special Enrollment, I can get coverage effective December 1st, and if the carrier, out of the goodness of their heart, because they certainly dont have to, decides to pay me $1500, they will? [long awkward silence] Well, sir you have another month to enroll for Special enrollment. Is there anything else I can help you with. Apparently not. And now I guess Ill call back tomorrow. #thanksobama Mike Allen Steve Hayes Heritage Action for America
Posted on: Fri, 21 Nov 2014 16:46:08 +0000
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