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 17^th.

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 12^th 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.

DAVE

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