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Wow. I think I have a happy update. Emblem had until tomorrow to respond to our appeal but this afternoon the phone started ringing off the hook. I was in the basement so didn't hear it initially but caller ID showed several calls from emblem (bear in mind over the month of begging them to fix this, they never once got back to us when they said they would). As I was scrolling through caller ID another call came in from the Dept of Finance. I'd filed a complaint with them last thursday but never heard anything back. A very pleasant woman from the agency told me she'd read my complaint and personally spoken to her contact at emblem and the matter was now resolved and coverage reset to the appropriate date.
I asked her repeatedly if this meant I currently had coverage and she said yes. As soon as I hung up with her emblem called and a very sheepish sounding woman explained the same thing to me and walked me through all the details. Apparently they issued a refund of premiums last week (which we had specifically told them NOT to do) but they would now need that money back plus may's premium. I kept asking her too if this meant I was covered right now and she said yes, as long as we make that payment by next tues. She called several more times this afternoon with more details.
But, we have nothing in writing (they said they'd send a letter next week) and I have yet to actually receive any medical coverage through this plan. I'm getting bloodwork tomorrow that I should have had three weeks ago and will try to have a sono on friday. There is a bunch of other stuff I need done.
All I can say is if a simple billing error is this complex to resolve there is a HUGE PROBLEM with the architecture of the system. I really hope what happened to us was just a fluke and isn't happening to other people.
Thank you so much for your advice. It was a poster in this thread who urged me to contact the insurance commissioner . Go city data!!!
All I can say is if a simple billing error is this complex to resolve there is a HUGE PROBLEM with the architecture of the system. I really hope what happened to us was just a fluke and isn't happening to other people.
The sad fact is it is going to happen to many more people, and it’s happening to people as we write. The pattern of events as you outlined them isn’t something new. Insurance companies have been pulling these stunts way before the ACA came into being.
Unfortunately, with the ACA and exchanges, they just point their finger at the exchange (even though everything they said and done clearly point to an internal company problem) and people will jump to blame the exchange without ever considering the real culprit. Since the regulations require the exchange to have messed up in order for the exchange assist you, they are using a delaying tactic as you chase phantom problems with the exchange.
In your case, the exchange clearly wasn’t the problem based solely on what and how the insurance company was responding to you, yet the insurance company knew that that just the mention of a problem with the exchange would focus your attention off of them. They were hoping that the frustration with not getting the exchange to solve the problem (because it was never theirs to solve) would get you so frustrated that ultimately you may just go some other route and leave them alone.
It’s sad that the exchange has become so hated by some that just the mention of some problem and they focus their attention on the area because they want the exchange to be the problem.
Unfortunately, there will be lots of horror stories yet to be published in the months and yeasr to come - all away up to the election. As Rabrrita said, insurance companies will continue to behave like insurance companies and deny coverage at every opportunity, and now they have the perfect scape goat to blame it on. They will blame it on the "exchange", and customers will then assume it must be "Obamacare's" fault. The right wing media are hungry for these stories to sell their subscriptions and further the GOP agenda, so they will publish these "horror" stories stating the failure of Obamacare.
I don't like to whip a dead horse, but I'm afraid until you get the for profit insurance companies out of the mix, we will never be free of insurance company abuse. You don't see these shenanigans played out by Medicare. If they make a mistake, they make every effort to correct it immediately.
You have seen first hand that it took a third party with some clout to step in and make them do the right thing. If you hadn't gotten someone to intervene, I'm afraid you would not have had the same outcome.
It was a ridiculous case, that should have never escalated to the level it did.
People continue to refer to "Obamacare" as insurance and as hopefully most know, there is no such thing as Obamacare insurance. It is only legislation stating what insurance companies must offer at minimum in their policies for coverage. The exchange is only a vehicle for selecting an insurance policy provided by private insurance companies and the exchange's only purpose is to display these policies (submitted by private insurance companies) on line, and deal with qualifying eligible individuals or families for subsidies. Other than that, it is the insurance companies that call all the shots. The exchange has no power to make the insurance company do the right thing if the insurance company refuses to comply.
But very glad you listened, and got someone else involved. Hope your pregnancy goes well, and you have a beautiful healthy baby.
Last edited by modhatter; 05-15-2014 at 09:43 AM..
Wow. I think I have a happy update. Emblem had until tomorrow to respond to our appeal but this afternoon the phone started ringing off the hook. I was in the basement so didn't hear it initially but caller ID showed several calls from emblem (bear in mind over the month of begging them to fix this, they never once got back to us when they said they would). As I was scrolling through caller ID another call came in from the Dept of Finance. I'd filed a complaint with them last thursday but never heard anything back. A very pleasant woman from the agency told me she'd read my complaint and personally spoken to her contact at emblem and the matter was now resolved and coverage reset to the appropriate date.
I asked her repeatedly if this meant I currently had coverage and she said yes. As soon as I hung up with her emblem called and a very sheepish sounding woman explained the same thing to me and walked me through all the details. Apparently they issued a refund of premiums last week (which we had specifically told them NOT to do) but they would now need that money back plus may's premium. I kept asking her too if this meant I was covered right now and she said yes, as long as we make that payment by next tues. She called several more times this afternoon with more details.
But, we have nothing in writing (they said they'd send a letter next week) and I have yet to actually receive any medical coverage through this plan. I'm getting bloodwork tomorrow that I should have had three weeks ago and will try to have a sono on friday. There is a bunch of other stuff I need done.
All I can say is if a simple billing error is this complex to resolve there is a HUGE PROBLEM with the architecture of the system. I really hope what happened to us was just a fluke and isn't happening to other people.
Thank you so much for your advice. It was a poster in this thread who urged me to contact the insurance commissioner . Go city data!!!
I have been thinking about your post above. (see underlined bold type) Right now, they have no money from you if they sent you a refund, and furthermore they placed conditions on your coverage stating that they must receive May payment by Tues. That spells trouble to me (no matter how much she reassured you) and if you go ahead with your blood work tomorrow and sono on Friday, I can easily see them saying they needed payment including May prior to your being reinstated. I can't help feel you would be better off changing your appointments to end of next week if you can. Remember, you are only going on what she stated to you on the phone. I'm afraid, that will not hold any water in a time of dispute. What you had in your favor before, was something in writing. I know it's terrible not being able to trust people with what they tell you on the phone, but it is unfortunately a reality today. (especially with insurance companies) Can't you make a credit card payment online (where you get a receipt) NOW?
I have been thinking about your post above. (see underlined bold type) Right now, they have no money from you if they sent you a refund, and furthermore they placed conditions on your coverage stating that they must receive May payment by Tues. That spells trouble to me (no matter how much she reassured you) and if you go ahead with your blood work tomorrow and sono on Friday, I can easily see them saying they needed payment including May prior to your being reinstated. I can't help feel you would be better off changing your appointments to end of next week if you can. Remember, you are only going on what she stated to you on the phone. I'm afraid, that will not hold any water in a time of dispute. What you had in your favor before, was something in writing. I know it's terrible not being able to trust people with what they tell you on the phone, but it is unfortunately a reality today. (especially with insurance companies) Can't you make a credit card payment online (where you get a receipt) NOW?
I believe under NYS regulations, if the insurance company dropped the ball, the consumer's policy will be reinstated backdated to the original start date. They are also required to make the consumer whole for all past services that were denied due to the screw up.
I agree it may be a safe bet to postpone care until you have have everythiung settled. The State will force the insurance company to comply and pay retro for all services that should have been covered, but that still puts the consumer between the rock and 20 ton pile of cow poop. I think they have been through enough and may want to just make their life easier by following your advice.
I kept asking her too if this meant I was covered right now and she said yes, as long as we make that payment by next tues.
I, too, was troubled by this.
And am hoping that this:
Quote:
She called several more times this afternoon with more details.
gave specifics on how to avoid the next Tuesday Catch22.
Assume you have names and direct contact info for the Dept. of Finance people in the event there are still issues.
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