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From what I understand, this gentleman had a heart attack on Dec. 31, the day before his coverage was to go into effect. He had cardiac surgery in January. It is not known whether or not he had any insurance coverage prior to Jan 1. Wouldn't surprise me in the least if his carrier tried to deny payment based on the initial event occurring prior to his effective date.
The larger issue seems to be not with the insurance per se but with the company (Xerox) that was contracted to collect his payments and forward those payments on to his insurance carrier. They apparently neglected to do so.
There have been lots of issues with Xerox and their systems. Anyone living in a state where they have been contracted to provide service would probably do well to send their payments directly to their carrier.
I saw the same thing. If he was admitted on Dec 31st, that is the day of incident. He also has standing for care after the 1st since he paid his premium in good faith--especially since it was withdrawn automatically from his account. Also, did he get insurance cards in the mail--doesn't sound like it. The issue lies with UHC-not "Obamacare". Their system isn't linking up with the exchange---and he was using a broker on top of that---there should be documentation that he did indeed enroll---did he or the broker print the confirmation page.
His triple bypass should have been covered as it happened in January and he should have been covered in January. Xerox, is the company that appears to be at fault in all of this.
I don't have time to read a 65 page pdf file. Care to give us the few instances where a subsidy can be gotten from a non marketplace plan? The rule had always been subsidies only from markeplace plans, then they allowed some people in states with poor marketplsce websites to buy direct from the insurance companies.
I don't have time to read a 65 page pdf file. Care to give us the few instances where a subsidy can be gotten from a non marketplace plan? The rule had always been subsidies only from markeplace plans, then they allowed some people in states with poor marketplsce websites to buy direct from the insurance companies.
You can get marketplace plans through the insurance company directly--this has been discussed before...or through a broker--you don't have to buy ON the exchange site---or you can call and sign up....
You can get marketplace plans through the insurance company directly--this has been discussed before...or through a broker--you don't have to buy ON the exchange site---or you can call and sign up....
We are interested in a source for that info and weeding through 65 pages of a fine print pdf isn't going to happen. Does anyone have a source for this because I've seen so much contradicting info regarding this point and I don't know which is true.
We are interested in a source for that info and weeding through 65 pages of a fine print pdf isn't going to happen. Does anyone have a source for this because I've seen so much contradicting info regarding this point and I don't know which is true.
I posted 2 sources and this has been discussed and sourced on several other threads....
I posted 2 sources and this has been discussed and sourced on several other threads....
One source states it but backs it up with a link to the 65 page fine print pdf. It has been discussed here but I have never seen it resolved nor I have seen proof that this is true. When trying to find info about it I stumble upon much more pointing to the need to purchase directly from the exchange in order to receive subsidies. If anyone has a link to proof (or even a page number for the PDF for anyone that has read it in full) that would be great. Thanks.
Try this--go to a local insurance company website, try pricing out plans for non-marketplace and marketplace plans and see for yourself how it works--or call a broker in your area, ask for assistance in this matter and see what they have to say...or call the 800 for your local exchange and ask them if you can sign up over the phone....
I just went directly to the Kaiser website because that was the main plan that popped up for us when I looked on the exchange the first few times.
This is the message I got:
Quote:
See how much you could lower your monthly premium. For more details, please check with the Marketplace for your state or call 1-800-488-3590. You can also contact your agent or broker.
For questions, please call us.
1-800-488-3590 Federal financial assistance will not apply for plans purchased directly through Kaiser Permanente.
I checked ehealth prior to that and got the same message stating that I needed to apply through the exchange if I wanted to get a subsidy.
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