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War is hell. And so is the Massachusetts Health Connector. Still
By adamg on Wed, 08/26/2015 - 12:05am
Daniel Quinn chronicles what is now a 4+ month effort to fix problems with his Health Connector-based health insurance.
August 18. I need some medicine. So far I have not used my insurance for anything, I am just sending the government money, for no reason really when it comes down to it, gambling every month in an absurd game against my destiny. I decide to pick this medicine up at the local CVS, and learn that my insurance has been rendered “inactive.” I am refused the medicine unless I pay full-price ($400 for something that costs $25 with insurance). I feel like the hobbits returning to the Shire after it has been taken over by the dark wizard Saruman. That same day, I receive another fascinating bill that declares I owe (negative?!) -$300.41 for my dental plan (a plan that costs $34 a month, mind you), and $1005.15 for my health–an account for which I was overcharged nearly $700 but a month before.
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Comments
The old saying...
We are from the government and we're here to help comes to mind.
Thanks for helping.
I had health connector insurance
and then got a promotion at work that made me eligible for my benefits through my employer.
I called the health connector to cancel my insurance. They told me I had to give 60 days notice in order to cancel the plan. I pointed out that employers generally don't give 60 days notice as to job start dates, and that I was not going to pay for two health insurance plans (My connector plan was about $320 at the time, and my employer-provided plan was about $200; I was making $15/hour at the time, so it's not like I had tons of money to throw away on bureaucratic whims.)
The clerk then told me that in order to process a cancellation, I had to give 60 days notice in writing to cancel the plan, but if I stopped paying for the plan starting with the month I'd be on employer insurance, it would terminate after two months retroactive to that month provided I did not use the benefit.
So I could cancel the plan by not paying for it, but if I called the health connector and tried to cancel it in an above-the-board way, I'd have to pay $640 for the privilege of being honest.
I can see that you are a lucky man
Somehow, you never had to deal with the kafkaesque and bizarre behavior of a private insurer who doesn't want to pay for anything, hoping that you die before you can sue them to honor their contracts.
This is one man who has had a serious problem with the system. There are millions of Americans in extreme debt due to problems with the private health care system. You are a very lucky man if this is all you have to say about the subject.
Love my "evil" private insurer
I dropped and broke my vial of insulin one week after I refilled my script. Called them at 10:00a. They voided, or whatever the exact term is, and called me back at 10:30ish to say I can now call in and refill again. Had my new vial by lunch. OTC cost wouldve been $300. As a Type 1 (juvenile) diabetic I've had nothing but great experiences with them for 14 years. $15 and $20 co pays for brand name medicines. $50 ER visits.
I dread the day if and when I have to deal with the government when it comes to my health. I've already have lost two great job opportunities because the government turned me down for a CDL due to diabetes. Even though I am healthier than any person without. My A1c's haven't been above 7% since I was 17. Do not wear glasses. No vision problems. I am 38 now. They were using archaic guidelines from the early 70s when people were still boiling needles. Private insurance is by far the lesser of two evils. And by the way, there's a lot people in this country and others who are suffering under government healthcare. Either with waits and denials of procedures and in the case of this country just trying to sign up.
Waht about the millions of people on Medicare....
.....I can give you dozens of people within my own extended circle that have had incredibly good experiences with it and pay virtually nothing - my mother went through cancer treatment and paid nothing, out of pocket for her treatments, all done at a local hospital with incredible care....
Medicare with no co-pays?
Medicare with no co-pays? Never heard of that before. Did she have another plan in addition to Medicare? Again, I've had dealings with Medicare and never ever heard of something like this.
Most people need additional coverage to go along with their Medicare.
..she has bridge coverage
..she has bridge coverage that has a minimal monthly cost - I believe around $150
And that's evil private
And that's evil private insurance, right?
I thought so. Medicare does
I thought so. Medicare does not cover everything so when it was posted she had surgery plus with no cost, I knew that didn't sound right.
And don't forget, your mother probably did pay for that medicare through payroll deductions many years prior.
I agree. I've been on
I agree. I've been on employer based insurance all my adult life and have never had an issue. Granted, some private insurers only offer the barest of minimums, but we've never had an issue. You get what you pay for. I love that I get reimbursed at the end of the year for all my gym dues, have had day surgeries, er visits, doctor visits, prescriptions, family pediatric care, etc and never had an issue with coverage or reimbursements.
If you listen to those like Swirley, who may have had a bad experience, you'd think all private insurers are that way. I disagree.
Whoah there, Swirl
The fact that private insurance is just as screwed up as MassHealth doesn't excuse MassHealth.
I just recently got off MassHealth, which turned out to be much easier than I anticipated, given previous issues similar to that of the previous poster. I spent 12 hours once getting a 'script refilled. Turns out I hadn't taken all of the steps necessary to cancel the insurance I'd be on before so they simply assumed I had other coverage and cancelled MassHealth without notifying me. I got to deal with MassHealth, private insurance, a third-party benefits administrator and the pharmacy. Of the lot, the private insurance company (which i was no longer a subscriber to, mind you) was the most helpful.
I think we can agree that insurance administration is screwed up across the board. And we shouldn't just blindly accept that.
I have to go with you here.
I have to go with you here. It's one thing to point out that private is pretty much as messed up as MassHealth. It's another to be so indignant about it. MassHealth does give relevance to that quote regardless private insurance is any better.
I said long ago that if we are going to do insurance relying on the government, we going to have to do it right. To the conservative/libertarian ear, that probably mean no involvement at all. I can understand the logic formed from the central axiom. But I recognize capitalism does not incentivize service unlike other areas. And in other countries, we have seen the structure of single payer works. I care for what works regardless where it lies. And currently, this doesn't work.
Also, you can switch private
Also, you can switch private insurers easier than you can switch governments, which is nice.
If you work for a large employer
And you have no "preexisting conditions", which are defined as "you didn't tell us that you had a pap smear six months before you enrolled so we won't cover your appendectomy".
Sorry, but the new system is far better than the old on a population basis. Individual situations may vary, but you lucky people somehow never had to deal with chronic conditions and the whims of insurers before the new law went into effect. I can tell.
Misery loves company?
You are apparently unseemingly gleeful at the problems some of have had with MassHealth, Swirly. Again, why do the sins of pre-ACA private insurance excuse remarkably crappy service on the part of MassHealth?
Exactly.
Apples and oranges. One should not discount the other. And, personally, I have chronic conditions and have had no issues with my private insurance; they have been great! But maybe I am one of the lucky ones.
And there are people in debt due to problems with PPACA
There are a lot of people who are in that gray area between subsidies and MassHealth. They can't afford most of the plans on the Connector so they have super low level plans that have very high deductibles and low coverage.
Those people are hurting because they pay premiums and get almost nothing in return. When they get ill, they're in a lot of trouble.
And many people just starting
And many people just starting out are saying "fine me instead", its cheaper and they use the ER when needed. Unfortunately I know of a couple of early 20 somethings who deal with it this way. I'm also sure they're not alone.
That defeats the whole purpose of ACA.
I don't know what the answer is. VT tried single payer and couldn't afford it and those comparing the USA to Scandanavian countries is like apples and oranges..
I'm also not holding my breath that any of the current crop of Presidential candidates has any promising ideas in this area either.
One does not simply...
I'm just starting my health insurance application process through the connector.
This review is not comforting.
Private Insurance
Is exactly the same hell hole. I went 6 months last year when I pointed out things weren't being counted properly against my deductible my doctor mysteriously became out-of-network. Funny, he was perfectly in-network before they had to cough up any money. The only thing that will improve the crap system is going single-payer, the money saved in man hours by streamlining the billing process and people not having to call 87 times over every little thing will eat a lot of costs.
Single Payer?
Lets give the Government more control of our Health Care because they've done such a superb job so far.
Actually, they have
Massachusetts was screwed up for reasons unique to our state. Look at Kentucky for an example of a state where the rollout worked well and thousands of people are now getting decent medical care. And then there's our existing single-payer system - Medicare - which actually works.
If you think Medicare works
If you think Medicare works you are going to have a lot of fun when you get old.
The VA and TriCare are such charlie foxtrots no one with other options will go near them.
I for one do not want government run healthcare with MBTA levels of efficiency and quality. There's no accountability.
Not to belabor this, but
Not to belabor this, but Medicare does work. My father received terrific treatment from private hospitals/doctors as well as VA facilities when necessary/applicable for over 40 years under the system and my mother - 91 and counting - continues to get the same; in fact went through knee replacement a few months ago, with little or no out of pocket cost.......and great, considerate care, to boot.
And, not to belabor this
And, not to belabor this again, they had additional coverage for if they had just Medicare, they would be paying many out of pocket expenses not covered.
Sounds like your father was covered by the VA....
If we go full on single payer, I will thank the powers that be
that I have enough money to pay for private insurance.
Medical Tourism
Is skyrocketing, with many of its clients coming from countries like the UK, France and now the US who have government mandated heath care.
It's a thought. Like in the
It's a thought. Like in the UK, those that can afford to purchase supplemental plans.
its pretty funny that their
its pretty funny that their website functioned fine back in 2011 but somehow four years and millions of dollars bought us less #massachusetts
Millions?
Try $1 Billion. Deval is a clown for not fighting to keep what was already in place prior to ACA becoming law.
Romneycare became Obamacare
Romneycare became Obamacare
Weird. When I was on
Weird. When I was on insurance purchased/subsidized through the state while temping (because temp agencies can charge your daily employer 30$/hour for your work, give you half of that, and still not provide insurance), I never had any problems. Paid the bills, got the card, used the card, easy. Granted I didn't have any major health issues nor did I need meds at that time, so all I was using was basic access, but it was fine overall. Way easier to work with and soooo much cheaper than the private insurance I eventually did manage to get through that shitty agency.
My issues are more UI stuff with the Web site
I haven't had any real problems with the current Web site, but the UI really sucks. When you click on the page to pay your bills (you have to pay medical and dental separately, which is a bit annoying), you don't get a form, you get details on how to pay online. You have to scroll way down to get to the actual form. Then you fill out part of it, click to go onto the next bit and boom, you're back on the instructions again. Only when you scroll down do you find the next section of the form, under the section you've already filled out. It's annoying.
Medical and dental is
Medical and dental is seperate with employer provided health insurance as well. If your biggest complaint is that and scrolling down on a web page then you might be just a tad too delicate.
Did I say they were major problems?
Could you reread the beginning of my comment? What I have are annoyances - nothing like the guy whose post I linked to. Even under Broken 1.0 of the new system, we never lost coverage (although I suspect it helped we were grandfathered in from the previous, fully functional state-only system).
adam, you are NOT alone
When I went in person to MA Health to get reinstated after losing my coverage (see below), I had a chat with the angelic woman who worked the counter. She said people had whopping confusion when paying online. And when I made a payment on cancelled coverage, the payment went through and I never received a notification that my payment just went towards nothing.
Jesus H
This makes my kafkaesque interactions with Direct Loans look like a straightforward, sensible cakewalk. And at least i could throw myself on the mercy of the DoE ombuds office. Good luck to you, dude.
Insurance hell is a special kind of hell
When I switched jobs recently, my employer-based health insurance was not going to kick in until I had been employed two full calendar months. Granted, I could have said "eh" and not had insurance for two and a half months, as the tax penalty kicks in at three months, but I needed to go to my doctor and I had some prescriptions I preferred to not pay full price for.
I briefly considered the Connector, but since I only needed insurance for a small period, and I needed it ASAP, I ended up calling the insurance company directly and buying directly from them. I tried to pick a plan from the 35 they offered me that balanced cost with benefits, and canceled once my employer picked me up.
I have never been quite so thankful for employer-based insurance.
yup.
I used to work at a private insurance company (technically "non-profit" - isn't that a scream?), and I had all kinds of fun last year with MassHealth (in short, I left one job where I had insurance, started another where I didn't, and had to wait for months for MassHealth even to figure out that I'd applied...at which point they declared that they'd been covering me for the entire calendar year. lol nope). I've seen both sides, and both sides are screwy. Healthcare in the U.S. is a mess, even though there have been some improvements (thanks, Obama, for real).
I want to chime in and say
I want to chime in and say that hospitals also suck. One of my insurance statements had 4 charges for the same damn procedure and insurance paid up. What the hell?
It's called a mistake. Call
It's called a mistake. Call the billing department and all charges will be reversed and the insurance carrier will be reimbursed.
former insider's perspective on "what the hell"
It's possible that it's an error. But it's also possible that, in medical coding, that one procedure had four different medical billing codes associated with different components of it. For example: a surgical procedure might have one code for cutting you open, one code for the anesthesia, one code for fixing whatever the problem was inside, and one code for sewing you back up. Medical coding is a bizarre thing, but it's possible that your one procedure had four different components - each of which your insurance company was able to pay for. Better than the alternative!
Sometimes different people or
Sometimes different people or organizations submit bills for the same procedure. For example, one from the doctor, one from the hospital, one from the lab, one from the radiologist who read the x-ray, ...
If this stuff wasn't so complicated, maybe it would be possible for patients to make informed decisions about their health care, taking into account what something will cost before they decide to do it.
yes.
I used to work in Member Services, and at least half of my calls related to people who were incredibly confused/angry about the dozens of bills they received for one ER visit. They'd get bills from the ambulance company, the anesthesiologist, the hospital itself, the pharmacy, etc., etc. - and while I was able to reassure them, in most cases, that we'd cover everything minus the copay, it was still a harrowing experience for them to look at pages and pages of bills, thinking they were on the hook for $10,000 or so.
(There were times when the caller wasn't covered for their $10,000 worth of medical expenses, and those were some tough conversations.)
Anyway, tl;dr it really is insane how we do healthcare here in the U.S.
Thanks for posting my ordeals
Still ongoing though. Still no coverage! But if you keep sharing this, maybe I'll be able to pick up my prescriptions someday.
After 10 months, three mails,
After 10 months, three mails, three faxes, and four visits downtown to attempt to address it in person... my address is still not "verified" with the MA Health Connector. Despite the fact they've sent me bills every month. And that there was no such issue prior to the ACA integration and it was just Commonwealth Care for the prior 3 years.
Helpful hint on how to deal with the Connector
Call your state rep or the governor. They tend to be pretty good about escalating and expediting cases like yours.
How?
So I've sent emails to two of my state representatives. Everyone says "call your state rep." Where is this magical phone number? Has anyone actually had any success with this or do they just say it like it'll work if we believe it will?
They don't answer emails
Yes it does make a difference but you have to get on the phone and call.
Here's a link to their phone numbers
https://malegislature.gov/People/House
Here's the governor's information:
Boston Office
Massachusetts State House
Office of the Governor
Room 280
Boston, MA 02133
Office Hours:
Monday – Friday
9:00am – 5:00pm
Phone: 617.725.4005
888.870.7770 (in state)
Fax: 617.727.9725
TTY: 617.727.3666
Seconding this
Phone calls are much harder to ignore than emails. Calling is the way to go.
RE: state reps
Thanks guys, I called the Governor's office earlier today and talked to one of their reps. She said she'd get in touch with the Connector.
Hours later, I got referred to the "Member Care Specialist Urgent Services" department within the Connector, which until now wasn't an option anywhere. They called me and said they're "taking over my case." Then when I followed up with the insurer afterwards, they decided to lift the hold while they sort out the billing.
One can only wonder if the two incidents are related.
Had a similar problem this spring. It was my fault.
His account was probably cancelled.
In February, I enrolled in a new plan, made my first payment online with the wrong bank account number (savings, not checking-- and my credit union wouldn't allow ACH from savings). Now, granted, they did email me a "You have paid..." email as soon I did it, which I assumed was a receipt. I didn't read it until too late.
About 2 months later, a prescription refill was turned down. When I got home from CVS, I dug out that email which definitely did not actually say the payment had cleared. I had read it quickly and had assumed it said what most of those things say.
Further digging, and I found the email saying that I needed to resubmit the payment within 60 days of the original or my plan would be cancelled. Because it didn't have "HEY DEADBEAT" in the subject line, I had blown past it. And since my second payment had gone off without a hitch & had disappeared from my account, my radar wasn't on.
I should have picked up on the first payment never being deducted from my account. Life got busy. When I ran down to Friend Street in a panic, they were able to get me re-enrolled and apply the second payment I made to get it going. I did have a delay in the re-start, but they were EXTREMELY helpful as I stood there sputtering.
My guess is this guy has a similar problem. Probably can be resolved if he's willing to sit patiently on the phone or head to North Station.
Actually no, that wasn't my problem
I paid on time and exactly as they wanted me to. It was a methodical series of idiotic mistakes on the part of the Connector that made my account more and more screwed up, which I documented thoroughly in the link this story is about. Only a call to the Governor's office and this publicity made the Connector change its tune, and now my insurance is active again.
However, that this kind of mess is possible is a serious problem, especially for people who don't have the time to fight the Connector like I did for months. I've reported the case to the AG's office and plan to follow up with the Governor's office once they get back to me.
Try moving to Texas
I was on Masshealth when my kids were younger and it was great, as I made more money I got transferred off and was able to buy Commonwealth care for the low price of $89 a month. I just moved to Texas 3 months ago, you want to talk about hell, I'm in it when it comes to health care. There is literally never a time you can get someone on the phone, the cost for the cheapest single person insurance is $420 per month and thats with a $3000 a year deductable with very high co pays. It costs me more for insurance than I truly miss
Mass insurance and the customer service they give.