Wednesday, April 30, 2014

Climb Into The Ring


Bloody. Broken. I was flat on the mat. I had thought that I could go the distance. But now? Now I wasn’t so sure. I pulled myself up and tried to clear my head. The referee administered a standing 8 count. And I knew, I knew, that if I was to see this fight to the end, if I was to have a chance of pulling off victory by decision, I needed to appeal to a Higher Power. I looked up and called upon the only One who could help me.

I contacted Senator Sherrod Brown.

J. Bradley Deane is a Staff Assistant working in Senator Brown’s Cleveland office. Two minutes into our conversation I was sure that I was dealing with a problem solver. No excuses. No sales pitch. He quickly grasped the problem and offered to help. He let me know that some problems were solved within a few working days and that some weren’t, but that he would stay involved. And I believed him. I received the required release form moments after our call ended. I turned the paperwork around quickly and he had what he needed by the end of the day, Thursday the 17th.

The insurance company was contacted by the government by the following Tuesday. And I can report to you that R.S. and his son are now properly insured with a policy that is correctly dated April 1, 2014. The client no longer needs to worry that his policy is going to lapse due to this glitch. Neither R.S. nor the US taxpayers were forced to waste thousands of dollars for nothing.

Unanimous Decision – Cunix in 10 rounds!

Could I win two battles in one day? I had my doubts. In last week’s post I detailed the difficulty of adding a newborn to an existing exchange policy. Difficulty may be an understatement. I had more hours and more frustration attached to this (previously) simple service issue than I had invested with R.S. and his son. No one could say with any degree of certainty who was insured. The insurer had part of the family. The mother supposedly had a one-way ticket to Medicaid. And I was afraid that the whole family might find itself uninsured, collateral damage of The Patient Protection and Affordable Care Act (PPACA).

Looking for an entirely different path, I contacted Sam Fiorentino, Past President of our local Health Underwriters chapter. Sam suggested a miracle worker in the Chicago Centers for Medicare and Medicaid Services office (CMS), Ms. Monaghan.

Is Ms. Monaghan a miracle worker? I don’t know. I can tell you that she returns phone calls, works crazy hours, and is doing the best she can within a badly designed system. I can’t say whether her efforts directly or indirectly led to a solution. But at 5:09 PM today, according to the national call center’s records, my client, his wife, and all of his children are on the same policy. A request has been filed to have a caseworker follow up with the insurer to make sure that there is no lapse in coverage.

TKO – Cunix in the 12th round!

So what did we learn from all of this? The first and most important thing is that ALL PROBLEMS can be solved. All you need is the tenacity to follow through and at least one person on the other side willing to do what is right.

We learned that CMS knows that there are glitches and flaws in their program. Specialists and troubleshooters have been assigned to find solutions on a case by case basis. It also appears that an effort is underway to eliminate the root causes. My clients weren’t the only people who experienced these service debacles. Admitting that is a first step to earning our confidence.

We learned that it might not take an act of Congress to get something done, but it never hurts to get a member of Congress to help you.

And, we are again reminded that we have to be willing to fight, to invest the time and effort, to get what we know is ours. Sitting back, whining, and waiting for the world to give us what we think we deserve will never get us a victory.

If you think that you are right. If you think that you aren’t getting what you deserve. Put on those gloves and climb into the ring.



Thursday, April 24, 2014

The Worst Thing You Can Do



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We interrupt the ongoing saga of R.S., the client who magically received the retroactive insurance policy, to bring you an important warning. It appears that I have found the one thing you can do as a consumer that will absolutely tilt the out-of-balance pinball machine that is

Do Not Have A Baby

One of the hallmarks of the Patient Protection and Affordable Care Act (PPACA) is that maternity coverage is built into all of the policies. We now cover maternity the same as any other illness. The deep thinkers in Washington inserted coverage for contraceptives and for pregnancy. They just are totally unprepared for the results of a successful pregnancy. The perfect Obamacare pregnancy lasts 78 trimesters!

I have had two clients attempt to add newborns to the government’s exchange. Remember, the policies purchased through the exchange are just like policies purchased directly from the insurance companies. By taking you through the exchange I may be able to get you a subsidy. The trade-off was that you gave the government a lot of personal information and the government helped pay for your insurance premium and possibly even some of your deductible. Since it is pretty clear that the government already has access to all of this information, why not take the money?

What we didn’t know was that we were also adding the government’s inept bureaucracy into every little transaction.

Adding a newborn to his/her parent’s policy was one of the easiest and most positive tasks I had as an insurance agent in the old days (prior to January 1, 2014). The process was nothing more than a quick signature on the form that showed the child’s name and date of birth. Couldn’t have been easier. But any change, ANY CHANGE, on the exchange requires a whole new application. You may remember that ridiculous series of questions about whether or not you were a US citizen and what ethnic heritage you chose to acknowledge. And of course you also had the opportunity to verify that each of your children were not only your children but the actual brothers and/or sisters of your other children. This mind numbing experience is also a mine field. Every single entry is the portal to another site crash. On a perfect day, with a tiny family, this may take only an hour.

But not every family is tiny. And there are no perfect days with

The client and I thought that this was going to be a simple process. After all, the exchange had plenty of time to prepare for the Special Enrollment Period that began in earnest when the Open Enrollment Period ended. He thought that it would take 10 minutes. I guessed an hour. After an hour and a half, I had not only failed to add the baby to the policy, I had also lost the subsidy for the mother. Yes, the exchange had sent another woman to Medicaid even though her income was nowhere near the required amount.

Both the client and I had had enough for one day. We got back together at his office this morning. We began the process at 11 AM. Two representatives, two specialists, and three documented system failures later, we were told that there was nothing else we could do today. It was exactly 2:30 PM. I had been chained to the phone and computer in his office for three and a half hours. The client’s wife is no longer being shipped out to Medicaid. Our problem, the government’s inability to simply add a newborn, has now been “escalated” (official term!). The client has been promised a call in 3 – 5 business days from a different office.

The baby is still not covered.

What once took moments may now require an act of Congress.


Tuesday, April 8, 2014

Stuck In The Middle With Dave

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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,, 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.

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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

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February 27th. The client and I, after several failed attempts, finally got all of the way through 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.