ACA Successfully Enrolled and then denied by Insurer

[fisherman]

Thought I would post an update on my ongoing attempt to purchase health insurance through the exchange. I am now another twenty plus hours into my attempt to enroll and at least 10 more calls to the gov and BCBS with no success. I was told as of 12-1-13 they would have tools to correct apps but now that say they do not know when they will have that ability. I still do not know if my app has an error or there was an error in sending it since it cannot be resent.

To try and work around all this I started a new app on 11-30-13 which took three different email address before I could get an account created. I can enter all the personal info and income info but then get a message that the verification system is down and should be fixed within 24hrs. Its been longer than that already!

On my last call to the gov I was told to wait till Jan or later as the system should work well by then. My problem is not as bad as those with cancelled policies but in our case with the rate increase for December and having to keep our old insurance it will cost us over $200 per month if we do not use any medical care at all. I explained that to the call center person and asked if I could just apply for the credit on my taxes and was told no since I must have a policy purchased through the exchange to get the subsidy. They really really could have done a much better job of designing this!

It appears from googling the verification error message that this is a common problem now. At this rate they will not have to worry about the cost of the subsidy's since so few people can get through the process.

Stay tuned as I am sure to have another hard to believe chapter in this saga next week.

 

[pb4uski]

I foresee an increased demand for health care caused by stress related illnesses of people trying to sign up for health insurance.

 

[oldtrig]

I foresee an increased demand for health care caused by stress related illnesses of people trying to sign up for health insurance.

Exactly what has happened at our house. My wife just give up and decided she will go without insurance until she turns 65 in May. When we got off the phone after trying so many times and so many days of to get insurance I took my blood pressure. Yep, way way high (180/110 ) and I am on meds. This type thing I just do not need at this stage of my life. I tried at least but now we have just give up. No more calling for us. I wish everyone well if this works for you but it has been a disaster for us. Since we have give up on signing up my blood pressure is back to normal (110/70)oldtrig

 

[samclem]

Stay tuned as I am sure to have another hard to believe chapter in this saga next week.

Good luck, fisherman. You are not alone. Here's a partial transcript from the chat session a user had with the ACA helpers (source: WSJ Best of the Web):

[2:21:20 pm]: Alan​

Since Sunday, I have been unable to logon. I am certain that I am using the correct Username and Password. I have cleared the browsing history and cookies. I have rebooted. I have tried using three different computers and five different browsers with three different operating systems. Each time I select Log In, I am sent right back to the Log In page.​

[2:22:37 pm]: Dipika​

I apologize for the inconvenience.​

[2:23:20 pm]: Alan​

Thank you. How may I log into my account?​

[2:25:15 pm]: Dipika​

Our website was under maintenance. So may be that was the reason you were not able to log in. It is working fine right now but I am not sure why its not letting you log in if you have used every troubleshooting measures.​

[2:26:11 pm]: Alan​

Is it under maintenance now? I have been trying to log in for the last hour. I keep getting returned to the log in page.​

[2:27:13 pm]: Alan​

Yesterday, I read in the newspapers that the problems with the site were fixed so I have been trying to access my account. I have failed many, many times.​

[2:28:58 pm]: Dipika​

Yes the site is functioning well now but I apologize that its still giving you glitches. If you like, we can help you complete a Marketplace application right now over the phone. And you can try getting back to your account sometime later today.​

[2:30:50 pm]: Alan​

I have done that twice (plus the account I created online) and been promised letters and/or calls within two days or two weeks. In seven weeks, I have received neither. Doing that again seems a waste of time. Better if I could access my account. Can you help with that?​

[2:31:19 pm]: Alan​

Time is running out for me.​

[2:31:56 pm]: Dipika​

I completely understand your frustration.​

[2:32:31 pm]: Alan​

I am not frustrated. I am simply trying to move forward. All I want to know now is whether you can help with that.​

[2:33:31 pm]: Alan​

Can you answer either yes or no so that I can do other things?​

[2:33:41 pm]: Dipika​

If you have already tried clearing browser history and cookies and also used different browsers, there is nothing I could do to help you at this moment.​

[2:34:03 pm]: Alan​

OK. Thank you. Goodbye.​

[2:34:26 pm]: Dipika​

But we are available to help you 24 hours a day, 7 days a week. You can reach us toll free at 1-800-318-2596 and we can't continue with your application.​

 

[NW-Bound]

... I explained that to the call center person and asked if I could just apply for the credit on my taxes and was told no since I must have a policy purchased through the exchange to get the subsidy. They really really could have done a much better job of designing this!

I understand the idea of an exchange is that all available plans are visible in one spot to allow buyers to shop for what is best for them. But once a buyer has found what he wants, what's wrong with letting him work directly with the insurer, then settle the subsidy with the IRS later with the insurer also in the loop?

The above has been how tax credits or deductions work with mortgages, college tuitions, IRA, HSA, and health insurance too, etc... Why the difference now with ACA health insurance?

PS. I still have not tried to get an account. I am grateful that my pre-ACA plan is still available. And I do not want my BP to go up.

 

[Tandemlovers]

I understand the idea of an exchange is that all available plans are visible in one spot to allow buyers to shop for what is best for them. But once a buyer has found what he wants, what's wrong with letting him work directly with the insurer, then settle the subsidy with the IRS later with the insurer also in the loop? The above has been how tax credits or deductions work with mortgages, college tuitions, IRA, HSA, and health insurance too, etc... Why the difference now with ACA health insurance? PS. I still have not tried to get an account. I am grateful that my pre-ACA plan is still available. And I do not want my BP to go up.

Wisconsin is hoping to join a pilot program that would enable consumers who are eligible for subsidies to purchase insurance
outside of the exchange and apply the subsidies to their premiums.
From my local paper:

Walker is also asking the Obama administration to allow Wisconsin to join Florida, Ohio, and Texas in a pilot program that permits eligible consumers to use federal subsidies to buy health insurance plans not available on the exchange.

Wisconsin Insurance Commissioner Ted Nickel sent a letter Monday to the U.S. Department of Health Services asking to join the program.

- See more at: http://www.gazettextra.com/article/20131204/ARTICLES/131209885#sthash.cPt6ULcY.dpuf

We are waiting to see if such a measure is approved since there is an insurance company operating in our
area that provides better out of network coverage for travelers, but is not participating in the exchange.

 

[fisherman]

Here is another update in our ACA saga.

I con now enter all application info in 15 minutes flat for the four of us. The verification system also now gives results. The bad news the results are not correct. One of our children who is 14 is listed as not eligible for a subsidy though both his mother, my wife, and I are. Our son is also not eligible to purchase insurance on the exchange or eligible for medicaid. It says he can go to free clinics! Our other child who is 7 years old is said to be eligible for medicaid.

According to our states medicaid eligibility we all are not eligible for medicaid. According to the calculators we are eligible for a subsidy.

I have now spent over 50 hours on this attempt and still have now way forward other than to file a paper appeal which says they have up to 90 days to decide.

The call to BCBS and Healthcare.gov today was most interesting. I had both on the line at the same time so we could all talk about it for two hours. The government lady even escalated it to her supervisor who then escalated it to the rapid response group. In the end they were all at a lose of how to fix the problem.

If it was not so important and costing us real money it would be comical.

I am seriously considering contacting one of our congress critters to see if they want to have a go at it.

 

[MRG]

Here is another update in our ACA saga.

...............lots of good stuff removed.............

I am seriously considering contacting one of congress critters to see if they want to have a go at it.

I would strongly agree, I'd personally spread it, as in what can your office do to help, to everyone you can. I would also suggest your State Insurance Commission. It can't hurt, you may find that you can at least move up the 90 day review.
Best wishes,
MRG

 

[fisherman]

Here is the latest and hopefully final update.

After my last update on 12/6 I decided to contact my congressman. All our reps are from the party that opposes the ACA so I was unsure if I would get any help. I did get a prompt call back from a staff person who explained they could not help. I let this drop at that point.

Next I filled out the forms for an appeal for my second app that I did in late November that had the eligibility results wrong. One child was placed on Medicaid and the other was denied the ability to even purchases insurance. We are well above the medicaid level. I got a response back in a little more than a week saying they had reviewed my appeal request but all that was included was the original eligibility letter with the old date. They did not bother to look at it since it was so obviously wrong.

I then decided to dedicate another day to the effort on 12/13, yes Friday the 13th . After ten hours on the phone, more than one call, to healthcare.gov I did finally get a rep that said he could actually delete the coverage the site said we had and BCBS said we did not from my first app that had correct eligibility results done in mid October. He did delete it and then reselected the policy we wanted, applied our subsidy, and submitted it. That got me to 65 hours of effort on this. It really took ten hours to get a rep that would/could do this.

Once the application was resubmitted to BCBS I started calling them on Tuesday of this week. Each day I was told it was not yet in their system but check back. As of yesterday I did not accept that answer and asked that they find it and call back that day as it had been long enough. I got a call later that day from BCBS saying I was on a list being worked for just such problems and should have an answer soon. this afternoon I got a call from BCBS saying they had the app and all was keyed in and good. They confirmed the app#, our address, the premium, and the policy selection. The enrollment info is supposedly in the mail!!!!! They said it would have a member number I could use to make the first payment online or by phone and that had to be done by 1-15-2014.

The funniest part of all is after I got off the phone with BCBS I actually got my first call back from healthcare.gov saying they now had the ability to edit my app if I still needed that. The problem was either the app was wrong or they were sending it wrong and I could not tell as no one before could see it so I had requested both options. Since BCBS received my app the second time and it worked it must have been the two systems talking not an error in the app that was the problem apparently.

It looks like this is finally working out. About seventy hours over two months and five days to make it happen but it may be done.

We will save $230 a month on premium and our deductible will go from 10K to 0. Our out of pocket will go from 14K to 2.9K. I also verified all our doctors are in the provider list. Several we could not see before are also on the list so we have more choices and more hospitals are included.

I sure hope everyone else who has had trouble getting signed up gets through also.

 

[audreyh1]

Wow!! What an incredible "journey". I can't imagine your persistence, especially with all the phone waiting I imagine.

And I was just happy that the payment deadline got extended to Jan 10 so that we could see if DH's payment is drafted as we expected on Jan 1, OR the check we mailed on Monday (12/16) gets posted. So far call waits are still running over an hour? So we haven't been willing to wait more than 30 mins on the phone, but we have questions!!!!!

Just found this from BCBSTX for whatever it's worth. I wish we had found that "new Bill Pay Triage Unit" phone number earlier! Blue Cross Blue Shield of Texas - Call Center Seeing High Call Volume Get Help with Common Questions

 

[Live And Learn]

Amazing journey ..... scary, but amazing

 

[fisherman]

I am still in shock that I can finally post this and how close it was. I got the package in the mail from BCBS today. We have our new policy! Premium is paid and cards are in hand. Old insurance is cancelled as of 11:59PM tonight and new starts at 12AM 1-1-14.

It only took 77 hours total to make it happen but it is done as of 4PM local time on 12-31-13. Talk about close.

New premiums are $230 a month less. Deductible is $0 and OOP max is $2900 for the family. Previous deductible and OOP max were $10K. Kids really help on the subsidy calculation.

The amazing part is how much more is covered. Even the kids dental and vision is covered.

I had checked last month when I first selected the policy and all docs, dentists, and close hospitals are in network. We actually have more Dr to choose from than before.

Halleluiah!!!

 

[W2R]

I am still in shock that I can finally post this and how close it was. I got the package in the mail from BCBS today. We have our new policy! Premium is paid and cards are in hand. Old insurance is cancelled as of 11:59PM tonight and new starts at 12AM 1-1-14.

It only took 77 hours total to make it happen but it is done as of 4PM local time on 12-31-13. Talk about close.

New premiums are $230 a month less. Deductible is $0 and OOP max is $2900 for the family. Previous deductible and OOP max were $10K. Kids really help on the subsidy calculation.

The amazing part is how much more is covered. Even the kids dental and vision is covered.

I had checked last month when I first selected the policy and all docs, dentists, and close hospitals are in network. We actually have more Dr to choose from than before.

Halleluiah!!!

Wonderful! Congratulations.