Stuck In The Middle With Dave

Mayfield Heights-20140408-00304

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.

 Mayfield Heights-20140408-00307

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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7 Responses to Stuck In The Middle With Dave

  1. And The Beat Goes On…………..and On ………and On.
    It is no use saying, ‘We are doing our best. We have got to succeed in doing what is necessary and doing what is necessary is above these idiot’s pay grade.
    When we take our next REQUIRED Fraud Waste and Abuse required class, Remember this
    The best way to maximize corruption in health care is to turn it over to the government.

    Dave R.

  2. Dave Petno says:

    The real nut of the issue is that the ACA sets up a system where Insurance Companies are unable to directly solve normal problems of their clients. This should have taken one phone call from the client or the agent to the insurance company, and the charges reversed. That is how it worked before Obamacare.
    I recently wrote about a similar experience where I sough to cancel a policy that I enrolled in via I was told by the insurance company that they could not cancel me, and that I had to go back to the web site. I have actual audio of my call with the web site where I tried to cancel.

  3. Christy says:

    I have a similar problem with two different clients. One that needs a DOB corrected, and the other that has a change of address. Forget the “report a life change” area on the website…that doesn’t work for squat. I have wasted 3 DAYS trying to help both of these clients achieve what should ordinarily be a SIMPLE fix. I was told today that the authorization one client gave to me yesterday was only good for 24 hours because I am an agent (you get 2 weeks if your anything but an agent, broker, or navigator). Even with calling in that 24 hour window, they still didn’t have my info on file. I’ve been sitting here now for an hour and a half waiting to get to the dept that handles changes, and hope that MAYBE I can help at least one of these clients today.

    Our jobs are about to become the biggest pain in the butt because we cannot do anything to help our clients without jumping through all kinds of hoops.

  4. says:

    From the original BlogSpot site:
    Terrence Ross
    April 11, 2014 at 10:16 AM

    Hi Dave, Terry Ross here, from the Lake Erie Moose Society. I am having a problem similar to the one you’re describing in your post. I’m trying get a “retro termination” of a Kaiser/HealthSpan health care policy that we bought through the exchange, and started on March 1st. Just days after that, my wife, who had been unemployed for two months, learned that she would be hired back with full health care benefits. She started work again on March 19th, and we tried to cancel the Kaiser plan through, but the site wouldn’t let us select Mach 31st as an end date, only April 30th. We started calling the 800 number to get help, and we spent 10 hours on hold over four days and never got to speak to anyone that could help. (Someone would answer, put us on hold, and three hours later we would give up and go to bed.) We decided to wait till after the enrollment deadline rush and try again in April. I finally got through to someone at the exchange yesterday who told me that my coverage was canceled as of April 30th, and I would need to talk to Kaiser to have that retroactive to April 1st. He gave me the number of someone at Kaiser who said “no problem”, and put me through to someone else at Kaiser who could take care of it.

    That next person said that, actually, they couldn’t do anything–I needed to talk to HealthSpan in Ohio. The person at HealthSpan didn’t know how to help, and eventually put me through to someone called a “connector” (a third party who interfaces between the provider and the exchange). The connector, who was actually with Kaiser, said she couldn’t possibly do anything, only someone from the exchange can make ANY changes. She gave me a number to call — 800.318.2596 🙁 and told me to have a nice day.

  5. says:

    I do, but it is a little late to implement it so I hope it will at least help others who see this. On March 19th you should have cancelled the EFT at your bank. Then, when HealthSpan (former Kaiser) contacted you, you could tell them how you tried to terminate the policy the right way. They could either help you or let it lapse. In your situation, it didn’t matter. Now, you are trying to get HealthSpan to return unearned premium. As per the last two posts, GOOD LUCK. You were provided the National Frustration Number – 1.800.318.2596. This is just a call center with limited capability. This is who I have been calling. I think that you should try this number, but only after you have cancelled the authorization to withdraw money from your account. Just because you have been told that the policy has been cancelled doesn’t mean that money might not “accidentally” come out of your account for May.

    I wish that there was a clear cut path to simple service issues, but the law eliminated the entire process for exchange issued contracts.

  6. […] government’s website, the national frustration number, and letters like this prove again that the people in charge really didn’t know what they were […]

  7. […] government’s website, the national frustration number, and letters like this prove again that the people in charge really didn’t know what they were […]

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