I apologize in advance for a long winded post completely devoid of attempt at humor or eloquent turn of phrase I love so much. I feel compelled to complain about a serious American problem. If you are an American with a health care problem. Please read and join me by posting your story. At the very least, it will be cathartic. At best, someone will listen.
In November I reviewed my insurance options under the Affordable Care Act, Covered California for me, and found all of my doctors and hospitals accepted the Blue Shield Platinum PPO. So I signed up for it and paid my fee. My very expensive Anthem Blue Cross policy expired on December 31, and my Blue Shield policy . . . did not start. I was able to see on line that my policy was set to commence on February 1. I wrote to Blue Shield, no response. I tried to call and gave up after being on hold for more than 2 hours and decided to just put my family on lock down until the policy went into effect. Frankly, with my son being more of a coder than athlete, I didn't have to worry about him.
When my wife went to the doctor about a month after the policy went into effect, we found out the doctor did not accept the insurance. The Blue Shield web site listed them, the doctor's website said they accepted Blue Shield, but the doctor made it very clear that they did not accept Covered California Blue Shield policies. They also informed me that UCLA, Cedars Sinai and just about every other nearby hospital would not accept Covered California policies. My spanking new $1200 a month policy is pretty much worthless. I called to find out how to change and found that under the Affordable Care Act I cannot purchase a different policy until open enrollment in November to go into effect in January. Fortunately or unfortunately, I did not have to worry about terminating my policy because they did it for me.
Since commencement of the policy I dutifully made payments monthly and received confirmation of payment. However, today I received a letter dated over one week ago, telling me my policy was terminated as of May 30 for non payment. Of course this was disturbing, but it also struck me as odd since I had this email evidencing the last payment:
I thought I would be able to call, give the confirmation number and clear things up. Very quickly I learned this was not the case. My call was received by the call center in India. The gentlemen on the phone told me my policy was terminated and there was nothing he could do. It was up to Covered California. I gave him the payment confirmation and he said they had no record of it. I asked for a supervisor and he would not connect me. I asked to ignore the prior payment and let me pay now, and he told me it was not possible as it was up to Covered California. He made a call to Covered California while I waited and told me he could reinstate the policy as of August 1, leaving me uncovered for 6 weeks. I told him this was not acceptable and he conferenced Covered California into the call. When I asked to reinstate he told me again, it was up to Covered California. The Covered California agent said it was up to Blue Shield and asked to talk with a supervisor. We got one. She got on the phone and said the decision to reinstate was up to Covered California. Once again he told her it was up to Blue Shield. She told me should could not reinstate because "there are rules." I asked what the rules are, and she said she could not tell me. They could not accept a new payment to reinstate, they needed a proof of payment. I told her I had an email from them and she said I had to send it to billing by fax or posted mail and I would receive a response within a few days or weeks.
I am not making a political statement and despite the doctor and insurance company's favorite excuse, this not "because of Obamacare." The actions of the doctors and the actions of the insurance companies are their own. Blue Shield misrepresented the insurance policy they sold to me. The company induced me to commit to the policy by listing doctors and hospitals who were not under contract. The doctors will not accept the policy because they are not getting paid enough money for their services. This is a fine reason to leave, but tell me you are under compensated, don't blame it on Obamacare. Finally, after giving me confirmation of receipt of payment, the insurance company terminated my policy for non payment and is now questioning whether it will reinstate.
I cannot be the only one in this situation, and those of us who are, cannot accept this treatment. The larger our numbers, the more powerful we become.
One of the marks of a truly vigorous society is the ability to dispense with passion as a midwife of action—the ability to pass directly from thought to action. Eric HofferYour ability to read this shows we have a communication platform more powerful than ever before. Please make a comment, add your story and let's get someone to listen.