Tuesday, April 8, 2014

Stuck In The Middle With Dave

Mayfield Heights-20140408-00304

Insurance company greed on one side – government indifference and incompetence on the other. My client? He’s stuck in the middle with me.

You were introduced to R.S. in last week’s post. Quick summary – R.S. purchased a health insurance policy for himself and his son on the exchange. The date was February 27th. He was sitting in my office. The coverage would, by law, begin on April 1, 2014. Weeks later he discovered that the insurer, one of the big ones, issued the policy with a January 1st effective date. Getting three months premium for nothing, the insurer told the client and I that this was our problem not theirs.

Would the government jump at the opportunity to save over a thousand dollars?

April 2, 2014 – My first stop was, of course, healthcare.gov, a website that wasn’t designed to create unsolvable problems, it just does that naturally. Once I had verified that this situation could not be addressed on the site, I reluctantly called the national frustration number, 1.800.318.2596.

I was talking with an exchange representative in just a little over fifteen minutes. It took another ten minutes, but I succeeded in getting her to admit that yes, R.S. did complete an application on February 27th. And yes, his policy was somehow pre-dated to January 1st. BUT, she couldn’t talk to me since this had all happened more than 14 days ago and I was no longer authorized to help my client. Since he wasn’t sitting next to me, she couldn’t (wouldn’t) do anything about the screw up.

“You don’t need an authorization to do the right thing,” I said to the woman invading my profession. This thought, this idea that we are here to solve problems, was totally foreign to her. Dead end.

April 7, 2014 – 10:30 AM with R.S. in my office

Spoiler Alert – If you want a Happy Ending you’ll need to visit a different blog.

This started out promising. My phone timer showed that we were talking to a helpful rep in only sixteen minutes. He took our info, added me into the system for the next fourteen days, and acknowledged our issue. He then explained that he would need to transfer us to a specialist. Not a problem. We looked at the timer. 27 minutes. Then we heard the dial tone!

Round Two – Our second foray wasn’t nearly as fruitful. It again took over fifteen minutes to get through the system to reach a live person. Unfortunately, the woman we reached resented our intrusion into her naptime. She decided to punish us by asking a long series of irrelevant questions. Disappointed that we hadn’t hung up, she finally asked why we had called. We told her and she agreed to transfer us to a specialist.

Hold music! We have achieved hold music.

And we waited.

R.S. had only allocated an hour for this little task. He stayed till noon, 30 minutes extra. I’m still on hold.

We all have certain challenges. Much of the Patient Protection and Affordable Care Act (PPACA) has seemed like nothing more than an endurance test. And when you are on hold for over an hour, chained to your desk, unable to leave, unable to use your phone, this devolves to nothing more than a test of wills.

Mayfield Heights-20140408-00307

Hour and a half on hold – still here.

Two hours – still here.

I was about to give up. I really had other stuff to do. It had been three hours since we had made the first call. Five more minutes. I had decided to give that damn hold music just five more minutes when the music stopped and a recorded voice came on the line.

“Your call can not be completed at this time. Please call back later.” CLICK!

Now what? Do any of us really believe that R.S. is the only victim of this particular glitch? How many months’ of unearned premiums are the insurers collecting? How many thousands’ of dollars are we, the taxpayers paying for nothing? And how many Americans will lose their coverage when the insurer terminates these policies because the people can’t pay these unnecessary charges? But you can’t answer those questions, you can’t even acknowledge that there are even problems, unless you actually care. AND THEY DON’T. Not the insurers. Not the people locked in some cubicle farm near Washington, D.C. And least of all, not the politicians of either party who are equally responsible for the mess we now have.

And the client? He’s stuck in the middle with me.


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Tuesday, April 1, 2014

Money For Nothing

Mayfield Heights-20140401-00295

February 27th. The client and I, after several failed attempts, finally got all of the way through healthcare.gov on February 27th. We chose a policy for him and his son and hit the final button. The Congratulations screen was anticlimactic. We were both so relieved that this was over that we just sat there in my office staring at the monitor. He was IN! His new policy would begin April 1, 2014.

The client, R.S., and I did have some questions about the policy. Information was provided on a “need to know” basis and the insurer (who will remain nameless for obvious reasons) decided that my client didn’t need to know anything until he sent in his first premium. R.S. sent in his check and his card arrived a week or so later.

R.S. may not be an insurance expert, but even he knew that he had a problem the moment he saw his insurance card. The card said that his coverage had improbably begun on January 1st! Worse, a bill for February, March and April quickly followed. R.S. was being charged for three months of coverage that he had not had. He had been insured by a different company all the way through the month of March. Worst of all, the federal government, YOU and I, were being charged for these three months as well.

Billing issues are not insurmountable. In fact, these are some of the easiest messes to resolve. Well, usually. I sent a copy of the erroneous bill and the February 27th award letter from the exchange to the Agent Services desk at the insurance company. I acknowledged that this could possibly be a government error or an internal mistake and asked that this be corrected.

I received the following response a little over five hours later:

The member will need to contact the exchange to initiate the eff date correction.

Translation: We like getting Money for Nothing. We aren’t going to do anything about this. Your client can either pay the extra money or fight the government.

Is this problem unique to R.S.? How has the insurer handled similar situations? SILENCE. I immediately asked the following questions:
  • Does the insurer have access to his application?
  • Does the insurer have access to the date of his application?
  • Will the insurer acknowledge that there is a problem?
  • What is the insurer’s official position on the client’s issue?
That was yesterday. Here is the response I got late this morning:

We do not have access to the on exchange application. The information we received was provided by the exchange. All changes or corrections to an application for an on exchange policy are handled by the Exchange. Thanks,

In the immortal words of Freddie Prinze, “It is not my job, man”.

But you know what my real question is. I want to know what this insurer would have done if the situation were reversed. How would they have pursued this if the client was scoring three free months? I suspect that they would be more engaged.

My biggest problem as an insurance agent isn’t the government’s intrusion into my business. It is our nation’s business schools’ invasion of our industry. Thirty-five years ago the board rooms of the insurance companies were populated by insurance people, men and women committed to the pooling of risks and to solving our clients’ problems. Our people worked daily with the nation’s hospitals which were led by physicians who had not forgotten the importance of patient care. Now the clients are widgets and the patients are units of care.

Widgets are interchangeable. Units stack up nicely. And money stacks up best of all.



Monday, March 17, 2014



I’ve been meaning to get around to it. It was a great article in Time magazine, I learned some interesting facts, and I wanted to express my appreciation. It was an article on Procrastination and it appeared in 1979. And I will get that letter off to them soon. I know I will.

Open Enrollment, your chance to purchase individual health insurance, ends March 31, 2014. That’s it. We have two weeks left, according to the Patient Protection and Affordable Care Act (PPACA or Obamacare) to get a policy. On April 1st the doors are closed and the gates are locked.

The deadline is two weeks away and the procrastinators are about to be closed out. And they aren’t alone. The insurers aren’t advertising. The State of Ohio is uncharacteristically silent. A surprising number of people are still trying to determine whether any of this, this Obamacare, has anything to do with them. Others won’t start looking for insurance until their current policy renews in June or July and their premium goes through the roof. Boy are they going to be surprised.

Since we are no longer asking health questions and since preexisting conditions must be covered, there has to be an open enrollment period each year to purchase coverage. Otherwise, people would wait until after an illness or an injury to apply for insurance. We can’t have ambulance drivers selling insurance on the drive to the hospital.

These are the qualifying events for a Special Enrollment:
  • Loss of Minimum Essential Coverage (Loss of Minimum Essential Coverage does not include termination due to non-payment of premium, including COBRA premium, or in the event of rescission)
  • Becoming a dependent through Birth
  • Becoming a dependent through Adoption or placement for adoption
  • Becoming a dependent through Marriage
  • Error in enrollment
  • The plan or insurer substantially violated a material provision of the contract under which you are enrolled
  • Newly eligible or newly ineligible for advance payments of the premium tax credit or experience a change in eligibility for cost-sharing reductions through the Exchange Marketplace
  • New coverage becoming available as a result of a permanent move
In simple terms, you must have an insurable event, a major change in your life. And if you don’t, you will have to wait till the next open enrollment at the end of 2014 for a January 1, 2015 effective date. Your only other choice will be short term coverage.

I know, I know. You are going to get around to this. No problem. You’ve still got two weeks.



Sunday, March 2, 2014

Month Six

IMG-20140301-00272(The Last Month of Open Enrollment)

The first open enrollment of the Patient Protection and Affordable Care (PPACA or Obamacare) is coming to an end. Six months. Much anticipated. Terribly disappointing. We began in October with a system of crashing computer sites and missing forms. We end way too close to where we began.

Even with all of the television, newspaper, and magazine stories, an incredible number of people are still surprised when I tell them that there are no longer any health questions on the application. So, let’s do a quick reminder:

Date of Birth?

Where Do You Live?

Do You Smoke?

Those are the questions, the only questions, used to determine the price of health insurance under the PPACA. It doesn’t matter whether you purchase a policy through the government website or through an agent, the rules are the same. Preexisting conditions are covered. Maternity is covered. And if your income is low enough and you would like some help in paying the premium, we’ve got that covered, too.

Healthcare.gov is still a mess. There are days where it works well. There are days when it doesn’t work at all. What many of us have discovered is that success on Healthcare.gov is purely random. No luck at 10 AM and Jackpot two hours later. We still have clients misdirected to Ohio Medicaid. We can still spend an hour and a half, get to the last screen, and watch it crash. But two weeks ago I zipped through an entire application, start to finish, in less than an hour with a single woman who has had the same job for years.

Avoid Healthcare.gov unless you are getting a subsidy. You don’t need the extra steps. You don’t need the aggravation.

These posts have detailed the successes and failures of both the government and the insurance companies as we attempt to process the changes our new system has wrought. And there have been successes, huge victories for the previously difficult to insure. And there have been moments of terrible frustration, anger, and tears.

New stuff since the last update:

Billing – It appears that the insurance companies have forgotten how to generate timely paper bills. I have clients still looking for their January statements. Electronic Transfers from checking accounts seem to favor the insurer. Cancel a policy with certain insurers and the next payment may still disappear from your account. My suggestion? If given the option, choose automatic payment from a credit card. It is much easier to reverse an erroneous charge. No bounced check charges. Less hassle.

Individual Mandate – The House Republicans are set to vote on their 50th attempt to dismember the PPACA. Oddly enough, if they had packaged this request, the postponement of the requirement to purchase coverage till next year, with less vitriol, I suspect that it would pass easily. Too many Americans have given up on Healthcare.gov or have simply chosen to sit out this year for the government to enforce this part of the law. Postponing the Individual Mandate till 2015 would actually help the Democrats much the same way as skipping the Employer Mandate made the fall of 2013 more pleasant.

Kicking ‘em When They’re Down – An insurer, who will remain nameless, is still digging out from a problem created by a President who was only trying to help. Call it the law of unintended consequences. On November 22, 2013, the administration changed the deadline for January 1, 2014 coverage from December 15th to the 23rd. This caused any number of problems for the insurers. At least one major insurer failed to change the computer programs. The applications received after the 15th were coded with a February effective date. Those people were not in the insurer’s system for January. No coverage (technically, no coverage without a fight), no billing, no insurance cards. Worse, when the insurers backed them out of their systems, the new applications were not necessarily reentered in a timely fashion. Again, this blog will not gloat over this system failure. I have talked to the employees of at least one of the affected companies. They are aggravated and embarrassed.

New taxes – insurers must now collect the following Federally Mandated Fees (Taxes) each month:

PCORI - $0.18

Reinsurance - $5.32

Market Share – 2.4% of the total premium

This money goes directly to the government and the fees are subject to change (UP).

Short Term Policies – UnitedHealth One is having a banner year in Ohio. They aren’t on the Exchange and their individual policies aren’t competitive in our area. Their Short Term Major Medical Policies, plans perfect for those people who choose to sit out 2014 and avoid the PPACA, are very popular. Cheap and easy wins out again.

Kicking ‘em When They’re Down II – A woman (not a client) felt compelled to share with me the problems she is having with her current insurer. The insurer has a well-known name, but does not have much of a market share in Greater Cleveland. Their reputation was that they were paperwork challenged. This insurer also undercharged on certain conditions which, of course, was reflected in their over-all rates. Anyway, she took the time to detail improper charges, months without coverage, and excessive withdrawals from her checking account. I offered a simple solution, change insurers. We still have two weeks to get her covered for April 1st. She declined. After all, her current policy is less! I quoted David Ackles. “They suffer least who suffer what they choose.”

Anthem Blue Cross – The senior division, the area that sells Medicare Supplements, Medicare Advantage, and Medicare Part D, has been providing great service to my clients and me. Of course, the PPACA hardly touched this division. We are holding out hope that the rest of the company regains solid footing.

Medical Mutual of Ohio – Sure there have been challenges, but I must report that the last six months have given me a greater appreciation of the employees on East 9th Street and out in the Strongsville outpost. Maybe it is the local aspect. Maybe it is the corporate culture. Regardless, nobody returns phone calls faster or trying harder to get through this changeover. G-d knows we’ve given them the opportunity to shine.

The open enrollment ends in 30 days. Are you where you want to be?

Six months and we are still in this together.



Monday, February 24, 2014

The Patient Laughed

It was a scene that is played out daily in Greater Cleveland. The participants may change, but the message is always the same – The Rules Apply to Everyone But ME.

A physician, we’ll call her Dr. Peg, was discharging a patient from one of our local hospitals (Don’t ask me which one). The subject of insurance came up. The patient laughed and said that he had none. Dr. Peg suggested Healthcare.gov since the patient could now purchase coverage even with his preexisting conditions. He saw no reason to buy insurance. And if there is a penalty, he’ll just pay it.

Not only would the patient not waste any money on insurance, he also knew how much medication he could demand on his way out the door. Dr. Peg looked down in disgust at his paperwork. “Dave”, she later told me, “This guy lives in a nicer neighborhood than me!”

Did the sharpy get his discharge prescriptions? Absolutely. The hospital knew that the medications were cheaper than the malpractice suit.

One of the elements of the Patient Protection and Affordable Care Act (PPACA or Obamacare) is the Individual Mandate, the rule that everyone needs to have insurance. As anyone who has ever been hit by an uninsured motorist can attest, no law and no penalty, no matter how severe, will ever force everyone to be responsible. But that doesn’t mean that we shouldn’t try.

The Individual Mandate was a significant part of the Republican Party’s response to Hilary Clinton’s healthcare plan in the early 1990’s. The Individual Mandate reappeared in 2003 when the Republicans created Medicare Part D (Rx). Failing to enroll in Medicare Part D when first eligible may result in a lifetime penalty.

How much does the penalty (tax) have to be to force someone to be personally responsible? It may be a Risk / Reward issue. The upside of the PPACA has, for me, been the opportunity to easily insure the previously challenged. Sick? Injured? Doesn’t matter. One of my biggest frustrations has been my encounters with people who believe that insurance is for suckers. They think that it is our job, yours and mine, to cover their healthcare costs so that they can spend their money on fun stuff.

It is not our job.

Dr. Peg was really angry. “Obamacare was supposed to cure this”, she told me. And it might. But remember, every time you see a politician, TV ad, or internet spot discouraging young, healthy Americans from acquiring health insurance, we are institutionalizing this ME First / ME Always attitude. We need everyone in the system. And we need them now, before they meet Dr. Peg.



Thursday, February 13, 2014

I Fought The Law And The Law Won


I apologize for the wait Sir. Unfortunately, you are not going to like my answer.

That was, of course, an understatement. After three separate attempts to insure a young family through Healthcare.gov, after today’s efforts which had already wasted an hour and a half, after killing another twenty plus minutes on the phone with the national help(less) center – we were told that they I could see that we had not made any mistakes, but that the federal exchange had decided, for no apparent reason, to send the wife to Ohio Medicaid.

We can write subsidized coverage for the twenty-four year old husband and his infant son. But we cannot write a subsidized health insurance policy for his twenty-two year old wife.

The feds have submitted the young woman to the State of Ohio for Medicaid coverage. She will not qualify. We will eventually receive a letter from the State which will allow us to reapply with the feds. When the federal exchange turns her down, again, we will then be allowed to file an appeal. And since the feds have yet to address the appeals’ process, we are doomed to failure.

The good news, and yes, there is good news, is that the family currently has self-paid individual coverage. They will be paying hundreds of dollars per month more than they should, but they will be covered.

I’m really sorry Sir. Do you want to speak to a supervisor?

“No”, I told her. “I have no reason to doubt you. You have laid out our options. Spending more time to hear the same thing is counter-productive. Bouncing up to the supervisor for the purpose of yelling at someone for this mess is really counter-productive. I’m just really disappointed. We expected better than this”.

And that is the truth. We, the American people, deserve better. An experienced agent, I was able to cut through the crap and get to the root of the problem. My clients told me that they would have still been stuck in the application loop. And my clients, unlike many others in their circumstances, would still be uninsured and unprotected.

In a couple of hours on Tuesday, February 11, 2014, I fought the law and the law won.


Update – I took a single woman who has worked at the same job for years through Healthcare.gov today. 50 minutes from start to finish. Proof that it can be done. Further reason that we should expect this or better every time we try.

Tuesday, February 4, 2014

So, How Are We Doing? (The Update Post)


Pat Carr, the CEO of UnitedHealthOne, the individual health insurance division of UnitedHealthCare, had a goal. On Tuesday, January 21st, Mr. Carr sent an email to insurance agents in which he shared the news that his company had had a record-breaking December. His goal? He pledged that his company would try to have 90% of those applications through underwriting by February 1st. 90%!

UnitedHealthOne isn’t buried under an avalanche of applicants taking advantage of The Patient Protection and Affordable Care Act (PPACA or Obamacare). No, this deluge of new clients comes from individuals and families attempting to avoid the PPACA for at least another year.

Welcome to the PPACA, where much of what you’ve been told on TV is not quite true.

There were seven editions of Health Insurance Issues With Dave posted in the last quarter of 2013. At the same time I sent an additional seven separate PPACA updates to my clients. These updates have been more insurer specific and action oriented. Today’s post will merge these two communications, at least for this week.
  • UnitedHealthOne – Mr. Carr’s email is an indication of a new attitude of transparency. His company does not have an exchange policy in Ohio. Their emphasis is on Short Term Policies (more of that later) and off-exchange contracts.
  • Medical Mutual of Ohio recently sent an apology to its agents. The Cleveland-based insurer admitted that it has had significant service issues through the conversion and that it hopes to be back to normal soon. Based on today’s experiences, soon can’t come soon enough.
  • Anthem Blue Cross is overwhelmed. The clients and I have been underwhelmed.
  • The insurers and their websites were as unprepared for October 1st and the PPACA roll-out as the federal government. The timing, a national insurance revolution in the middle of the annual Medicare Open Enrollment and the time of the year that American businesses reevaluate their group health policies, over-taxed our system. This could not have been worse.
  • As reported in the Washington Post, over 20,000 Americans have filed appeals with the government over mistakes made by Healthcare.gov. Overcharges, denial of benefits, and being sent to the wrong policies are just some of the problems cited. But the biggest problem is that the federal government has no way to correct the problems.
  • The upheaval we are witnessing overshadows the Medicare Part D (Rx) rollout of eight years ago. This mess is closer to the disaster of Y2K. And like Y2K, we will get through this, too.
  • There is no reason to go to Healthcare.gov unless you will qualify for a subsidy.
  • For those who will qualify for a subsidy, Healthcare.gov is working better. I say that even though I spent close to three hours on the site yesterday attempting to help two clients. We were not successful, and will be trying again later this week.
  • Applying for a subsidized policy through the insurers’ websites may still prove to be the easiest path.
  • The Medicaid Expansion will help millions of Americans access affordable care.
  • Will there be a tax / penalty for not purchasing a PPACA qualified policy in 2014? A lot of people are guessing, NO. Short Term Policies, once thought to be the victims of the new health care law, are having a revival. These are G-d forbid policies. They only cover accidents and illnesses that are new, big, and different. And, they are very cheap.
  • Many healthy Ohioans, even ones who may qualify for a subsidy, are finding that their old policies are cheaper. If you don’t need maternity, why would you change?
  • Unhealthy individuals and small employers who have been charged extra because of unhealthy employees are buying the new policies and saving a bundle. For now. $700 per month. $900 per month. $1,100 per month. It is incredible. Of course, if the only people rushing to purchase insurance are the people most likely to use it, the system will crash. Politicians may shade the truth, but numbers don’t lie.
The government is still making up the rules and regulations on the fly. The insurers are playing catch up. And the consumers, you and I, are trying to keep the whole thing straight. Almost 20% of our economy is devoted to our health care. This will get fixed.

We are all in this together.