Random Thoughts On Insurance

Since I use this blog for more than quilting stories, I am going to chronicle my health insurance woes both to keep a record and to give fair warning to others. Because of the ACA, my husband's "retirement" was not delayed since we knew that I would be able to purchase insurance despite numerous pre-existing conditions. I had always been insured under his company policies (first warning to women) but now would have my own insurance for the two years until I turned 65. So I went on the healthcare.gov website and signed up with the very same company I had been insured  by for the past decade or more. I had no problem with the government website, picked a silver level policy, and after waiting a week for all of the information to make it into the records, paid my first month's premium on 12/13. I was assured that I would receive my new ID card and user manual within five to seven business days. Well I waited two weeks and then called. The sweet young thing on the other end of the line assured me that she would get it in the mail that day--another five to seven business day promise. After waiting again, I tried contacting the company via computer messaging. Once again I was assured that the card would go out that day--5-7 business day wait. In the meantime I got a letter from the CFO of the company (not addressed to me specifically but to all subscribers) informing me that the company policy had changed. Now if a payment was not received by the due date, the company would cancel the insurance with no possibility of reinstatement.

Given all of the 5-7 business day periods, I had already paid two monthly premium payments, but given how unresponsive the company was actually being, I thought I better take more direct action. Who knows, they might claim I had never paid since I had no ID card. So I wrote a letter to the CFO who to that point was the only person who had given me a full name, title, and address. I explained that I had already been waiting six weeks for my new ID card, it was past 1/1 and I had a dermatologist appointment coming up and wanted my ID. The CFO got this letter, passed it on to a subordinate who assured me that he would personally see to it that I got my card but that once again it would be another 5-7 days since the printer they contracted with was in the midwest. Well I waited but by the time my appointment came, I still had no ID. I contacted the subordinate person again who assured me that my card had been printed but was only going in the mail that day. He said that my subscriber number would be honored by the doctor and not to worry.  It turned out that wasn't true, but since I had been a client for more than a decade the medical receptionist let me see the doctor, assuring me that everything would work out.

I finally got my ID card about a week later (keep in mind that if every time I was promised an ID card I got one in response I would have gotten 4 ID cards rather than just the one). Silly me, I thought that meant all my coverage issues were over since by this time I had paid three months worth of premiums. Last Friday I got an "Explanation of Benefits" statement saying my visit to the dermatologist had been denied because of pre-existing conditions. I had paid more than $1300 for insurance so far and they had denied my claim even though I had been a client for more than a decade and had been a patient of the dermatologist nearly that whole time. I called the company right away and asked for an explanation. The sweet young thing said that it hadn't been "denied" but merely delayed, then backtracked and said that it would probably be denied when the process was complete. She asked if I had any questions. I asked her how it was that I had seen this dermatologist twice a year for nearly a decade, each visit had been covered by the company, and suddenly I had a pre-existing condition. "Whoops!" she exclaimed, "Let me talk to my supervisor." After being on hold the length of a symphony (love that  background music), she came back on the line and said that the company had made a mistake and that they were going to pay the bill right away.

We'll see.