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ACA Successfully Enrolled and then denied by Insurer
Old 11-15-2013, 10:34 AM   #1
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ACA Successfully Enrolled and then denied by Insurer

Just wanted to see how many folks are in our boat.

I managed to complete an application on the market place and even successfully got an eligibility confirmation for the subsidy. I was able to select the option to apply the subsidy to our premium and in the detail the deductible and OOP max where correctly adjusted for the cost sharing amounts. This looked really good and I was then able to click Enroll and was sent to BCBS site where it allowed me to enter my credit card info for the first payment. I thought at this point all was done.

Last week I got a letter via snail mail from BCBS saying they denied our application due to a coding error from the market place and that I should call the market place to correct. I am now several additional hours into calls with the market place and have been told that it cannot be fixed now but hopefully at some point the system will allow them to fix it. They promised to call me back when that happens to correct this.

They could not allow me to even start over with a phone application as the system would not accept it as the market place system says I am enrolled in the policy I choose but BCBS has denied it and my credit card has not be charged for my portion of the premium. So at this point their systems are not talking I was told.

My only options are to just buy the policy out right from BCBS and try to get a tax credit at the end of the year for that part but the cost sharing would be lost or to wait and hope they can fix it all before 12-5-13.

This could be such a big improvement in the individual market if it worked. In speaking with BCBS it appears to be a widespread problem for them. If anyone else thinks they are successfully enrolled make sure you have new insurance cards in hand as you may not actually be covered otherwise.
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Old 11-15-2013, 11:10 AM   #2
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Sorry to hear you had that experience but thanks for posting that as a warning to the rest of us.
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Old 11-15-2013, 11:20 AM   #3
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What a nightmare. So sorry you are going through this. Hopefully they will get things straightened out eventually somehow, but gosh. Worrying about insurance is not on anybody's list of "fun things to do in retirement" or "fun things to do while saving for retirement".
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Old 11-15-2013, 11:47 AM   #4
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What a nightmare. So sorry you are going through this. Hopefully they will get things straightened out eventually somehow, but gosh. Worrying about insurance is not on anybody's list of "fun things to do in retirement" or "fun things to do while saving for retirement".
Amen.

I have my own tale of woe but so does just about everyone trying to use the exchange web site.
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Old 11-15-2013, 02:22 PM   #5
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When did you start you application that had issues?

Thanks,

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Old 11-15-2013, 02:35 PM   #6
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What a nightmare. So sorry you are going through this. Hopefully they will get things straightened out eventually somehow, but gosh. Worrying about insurance is not on anybody's list of "fun things to do in retirement" or "fun things to do while saving for retirement".
It looks like I'm a couple of clicks away from being enrolled, but if the problems that have made me not yet enroll aren't fixed in a few days, I'll probably just enroll and fight the battles after being enrolled. Even though I shouldn't have the $6,000 deductible per the specifics of the law, eating that for a little more than $110 a month ion subsidized premium still isn't a bad deal.
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Old 11-15-2013, 02:36 PM   #7
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They could not allow me to even start over with a phone application as the system would not accept it as the market place system says I am enrolled in the policy I choose but BCBS has denied it and my credit card has not be charged for my portion of the premium. So at this point their systems are not talking I was told.
I think Kafka has returned from the dead and is dreaming up scenarios for the ACA. Sorry to hear of your problems.


I have been very frustrated with buying HI this year. But after reading the other horror stories, I am feeling very fortunate. So if it is any consolation you'd cheered me up .
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Old 11-15-2013, 02:52 PM   #8
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It's just getting silly, the amount of functionality that is missing. Any process dealing with data has to include a 'the data are invalid scenario'. That's real busines/programming 101.

Imagine if this were say a retail online business, and they couldn't take your order due to data issues. How long would that company get business?

I can relate to the frustration.

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Old 11-15-2013, 03:11 PM   #9
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I got my call back from the Marketplace this afternoon.

We too were able to complete an application. We qualified for a subsidy as well,
and I printed up the letter for safekeeping. I was unable to purchase insurance,
however, due to a problem with our application, according to the website. For some
odd reason, I was asked to provide proof of income, even though I listed my
application as homemaker.

Anyway, since October 29, I've been answering every phone call, everyday, hoping
to be able to speak to someone who can amend our application.

The marketplace gal was very nice, but was only performing triage services: she
told me that they are unable to access applications at this time, and doesn't know when
they will be able to, though she said we would get a call back. Gosh, it's worse than I
thought.

We don't need insurance until February, so I am not too worried, and, worse case, we have
a Cobra option, though insurance for our family under Cobra would cost $1700/month, and
as far as I can determine, a Marketplace Bronze plan in our area would come in at around $600/month.
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Old 11-15-2013, 03:18 PM   #10
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The marketplace gal was very nice, but was only performing triage services: she
told me that they are unable to access applications at this time, and doesn't know when
they will be able to, though she said we would get a call back. Gosh, it's worse than I
thought.
Yep, when I've called, "try again later" was pretty much always the "resolution".
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Old 11-15-2013, 03:28 PM   #11
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Last week I got a letter via snail mail from BCBS saying they denied our application due to a coding error from the market place and that I should call the market place to correct. I am now several additional hours into calls with the market place and have been told that it cannot be fixed now but hopefully at some point the system will allow them to fix it. They promised to call me back when that happens to correct this.
"To Err is Human, to FUBAR Takes a Computer" - Anon.

Nowadays, the computers run our life. Once something is entered wrongly into the database, God helps us! You would think someone could override the system, but nooo.

Makes me shudder to think that so much of what we own, or proof of it, is just records inside computers. Stock ownerships, bank accounts, or perhaps even real estate records are stored as bits and bytes. You would hope that they keep backup copies very securely.
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Old 11-15-2013, 08:17 PM   #12
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"To Err is Human, to FUBAR Takes a Computer" - Anon.

Nowadays, the computers run our life. Once something is entered wrongly into the database, God helps us! You would think someone could override the system, but nooo.

Makes me shudder to think that so much of what we own, or proof of it, is just records inside computers. Stock ownerships, bank accounts, or perhaps even real estate records are stored as bits and bytes. You would hope that they keep backup copies very securely.
Don't worry most of these industries , and other similiar, are regulated. The regulators set compliance criteria. Corporate compliance offices are responsible. Consultants are engaged, auditors descend and eat the unaware.

Seriously there are standards and public companies spend lots to prove compliance. The audits can include all kinds of areas but some focus on backup, high availability, and disaster recovery plans. You are expected to demonstrate proof that you've executed these plans.

Vendors are also happy to engage their consulting areas to assist in best practices. Google tier 4 data center to get ideas on how data, applications can be protected. Having the knowledge of how HA is supposed to work makes working with some applications frustrating.

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Old 11-16-2013, 08:29 AM   #13
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Fisherman

I am not sure I understand the "coding problem," but if your insurance company
listed your policy on the ACA website and you were allowed to enroll and now the insurance company is trying to get out of furnishing you a policy this is most likely illegal under your state law. i would file a formal complaint with your state insurance department immediately.

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Old 11-16-2013, 11:13 AM   #14
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Fisherman

I am not sure I understand the "coding problem," but if your insurance company
listed your policy on the ACA website and you were allowed to enroll and now the insurance company is trying to get out of furnishing you a policy this is most likely illegal under your state law. i would file a formal complaint with your state insurance department immediately.
Doesn't sound like an illegality or outright denial by BCBS, but lack of proper interface between Marketplace & BCBS. HI company cannot issue a subsidy-eligible HI policy without Marketplace approval documentation, which is not same circumstance as refusing to issue a privately purchased policy.
FWIW- Problems in Marketplace-HI carrier interaction were predicted by Jon Kingsdale- former Exec Dir of MA Connector (MA HI website) during start-up of 'Romneycare' in that state. Kingsdale has been a long-time advocate of Obamacare, and his present firm provides technical assistance to gov't in support of ACA.

Challenges For The New Health Insurance Exchanges | The Diane Rehm Show from WAMU and NPR

Beyond HealthCare.gov, Obamacare’s other challenges - The Washington Post
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Old 11-16-2013, 01:03 PM   #15
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But he was allowed to apply for Blue Cross and enter his credit card. So sounds like the system connected him to Blue Cross and then later they denied his application. i would still file a Dept of Insurance complaint. I bet if he did his application would suddenly be approved. I have filed complaints against insurance companies with my state Insurance Dept in the past and like magic the problem gets resolved.
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Old 11-16-2013, 01:40 PM   #16
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But he was allowed to apply for Blue Cross and enter his credit card. So sounds like the system connected him to Blue Cross and then later they denied his application. i would still file a Dept of Insurance complaint. I bet if he did his application would suddenly be approved. I have filed complaints against insurance companies with my state Insurance Dept in the past and like magic the problem gets resolved.

My interpretation was the BCBS would like to sell him a policy, but the information from the exchange was inaccurate/incomplete or in the wrong format. So BCBS can't issue/complete a policy until the marketplace provides them the correct info.


He can't get a subsidy unless he buys from the marketplace. Which probably means that BCBS can't just ask for the correct information over the phone.

What Hoosier said
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Old 11-16-2013, 04:23 PM   #17
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My interpretation was the BCBS would like to sell him a policy, but the information from the exchange was inaccurate/incomplete or in the wrong format. So BCBS can't issue/complete a policy until the marketplace provides them the correct info.


He can't get a subsidy unless he buys from the marketplace. Which probably means that BCBS can't just ask for the correct information over the phone.

What Hoosier said

You are correct. That is how it was explained to me. My family and I are in between two systems that are not talking with no method to correct the data.
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Old 11-16-2013, 08:46 PM   #18
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So Fisherman, because the 2 systems are not talking you will lose a years subsidy (in my case around $10,000). How do you know whose fault it is? Maybe Blue Cross's system is the one that messed up. After all you got the subsidy and when you got to the Blue Cross website you were rejected. Maybe Blue Cross will be receiving your subsidy and never give you the credit for it. Who knows?

I still say file a complaint with your state Department of Insurance. Go to their website and there should be a procedure spelled out. If you do that you will probably get your subsidy eventually. You don't need a lawyer and all it will cost you is a stamp and some time. Send the Insurance Dept. copies of everything you have.

While I agree that the Federal Health Care Exchange has major problems, part of the problem is that the insurance companies are not ready either. I have been told that some insurance companies kept thinking the ACA would be repealed and so they did not prepare.

i personally am tired of health insurance companies taking unfair advantage of the consumer. Fisherman, it appears you did everything you were suppose to. I say go after your subsidy.

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Old 11-16-2013, 10:22 PM   #19
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I supposed it couldn't hurt although my experience with both State insurance commission, and the Attorney's General consumer protection division was it was a waste of time to file a complaint about a company.

I can say that odds of it being a failure of the insurance company are really slim After all insurance companies have accepting insurance applications and dealing with those with errors in them for decades. The new kid in block in the system is the new marketplace website. It is the marketplace responsibility to collect and verify the relevant data from the consumer and then pass that info to the insurance companies.
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Old 11-17-2013, 06:35 AM   #20
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I think I'm in now. I'm still fighting the Indian status problem and can't perform a "life change" despite the blurb that says "come back after 11/15/2013", but I enrolled last night and I got an e-mail summary of benefits from BCBS TX this morning which matches the plan I signed up for. I'm assuming that means my enrollment was accepted, but I probably need to follow up to confirm. The cost of the plan (Bronze PPO, $6K deductible which I should be able to eliminate when Indian status is confirmed) is $112 per month based on estimated 2014 income.

That said, I have a twinge of doubt as to whether I'm really "not eligible for insurance under a spousal insurance" plan with respect to the tax credits. I don't think I am eligible for her insurance plan per the specifics of the plan documents, though. The church plan only provides for the ability to purchase spousal coverage with employer-paid dollars, and our council explicitly only approved coverage and budgeting for the employee (meaning there's no way I could add myself paying with my own money, so if they won't pay for it, I can't sign up for it). This decision was put in writing in the minutes of last month's council meeting. It would make an interesting appeal case, but I hope it doesn't go there.

Ours is such a screwed up and complicated situation. We are a one-household "test case" for this system. They should have hired us for their testing!
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