Sorry, You’re Screwed

The letter came from The State of Ohio, The Ohio Department of Insurance, and Medical Mutual.  Good news never comes with that many names on the top of the letter.

We are sorry to inform you that your Ohio High Risk Pool coverage will be canceled at the end of the day on November 30, 2012.

The letter was dated November 12, 2012.

Some of the unhealthiest residents of the State of Ohio were being tossed off their insurance policy, the Ohio High Risk Pool.  In less than three weeks they would no longer be insured.  And nobody is standing in line to cover them.  How could this happen?

The Ohio High Risk Pool is part of the Patient Protection and Affordable Care Act (PPACA).  A stop gap measure, the states were charged with the duty of offering coverage for the chronically uninsured suffering from significant preexisting conditions.  The federal government also provided five billion dollars of which Ohio received $152,000,000 for the four year program. 

To qualify for the Ohio High Risk Pool you must prove:

  1. Citizenship
  2. That you have not been credible insurance coverage for at least six months
  3. That you have been declined by two insurers within the last six months
  4. You may skip #3 if your medical records show that you have a major illness that would have gotten you declined 

You can not have had credible insurance coverage in the six months leading up to your application for coverage under the Ohio High Risk Pool.  This is a federal requirement.  Neither the State of Ohio nor Medical Mutual of Ohio, the insurer running our plan, has anything to do with this rule.  Some people who are not easily insured have purchased supplements, a better than nothing option.  If something happened while they were attempting to find real insurance or qualify for an affordable program, these responsible people were trying to do what they could.

My friend Dave is a conscientious insurance agent.  He took a letter from American Medical and Life Insurance Company (AMLI) to the Ohio High Risk Pool.  The letter, dated February 11, 2011 was sent to clients to advise them that their policy was no longer HIPAA credible coverage.  Dave verified that since the AMLI CoreValue policy was no longer credible coverage, his clients, including family members, could retain this minimum semblance of coverage until they had six months of no real insurance and could enter the Ohio High Risk Pool.  NO PROBLEM.

It is those people, those responsible people who attempted to have some coverage, no matter what, who are being kicked to the curb.  The letter from the State specifically notes:

Our records indicate you were enrolled in an AMLI policy in the six months prior to enrolling in the Ohio High Risk Pool Program. Therefore, CMS directed us to cancel your coverage because you are not eligible for this program.

The PPACA is a poorly written law.  We know that.  Worse, the rules and regulations are being written on the fly.  What complies one day is non-compliant the next.  We went through this with the grandfathering rules.  The costs, both human and financial, can’t possibly be calculated.

The Ohioans being kicked out of the High Risk Pool did nothing wrong.  They followed the rules of that moment.  We are talking about individuals who are gravely ill.  What do they do now?

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3 Responses to Sorry, You’re Screwed

  1. Excellant.
    Hope you din’t scare hell out of people that applied after being 6 months naked?
    I received the blog in my in-box
    I received your note generated from the website?
    don’t know what bounced back?

  2. says:

    A follow up comment from Dave Randolph that was published on the original blog site:

    Dave Randolph – December 30, 2012 6:36 PM
    Great news regarding the OHRP clients that were wrongly cancelled on Dec. 1 They were reinstated back to Dec.1.
    These clients were cancelled because it was determined (wrongly determined) by HHS and CMS that the defined benefit plan they puchased to bridge the Gap for 6 months and ease the pain of going without any coverage until they were eligible for the OHRP was changed for Non Credible to Credible coverage after they were accepted by the OHRP.
    Not only were they cancelled with less than 30 days notice, no one seemed to take responsiblity for canceling them.

    Each client sent appeals to HHS, CMS, ODI and everyone else they though might help them.

    Don’t know what changed their mind, but reinstating these client was the only right thing to do. They followed the rules and and were accepted for coverage by OHRP.
    he fact that a politician (CMS and HHS officials are political appointments)will admit making a mistake is refreshing.

    This is excellent news and restores some of my faith in the system.

    Dave Randolph

  3. says:

    That is terrific news! Your hard work has been rewarded. And yes, it is nice to see our government employees reverse themselves for the good of our citizens.

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