Tag: Afforability

Messing Up Your Insurance Paperwork – Hazards of

It Shouldn’t Be This Easy to Lose Your Health Insurance
By Danielle Ofri
Dr. Ofri is a primary care doctor in New York City.

“I’m sorry, Dr. Ofri,” the representative said, rechecking her records, “but you didn’t enroll this year.”

Could that be? Could I have somehow forgotten? Or missed the notification? “But don’t worry,” she said. “We’ve put you on the basic plan.”

“OK,” I said, starting to relax and thinking out loud. “I guess my kids will get to meet some new doctors.”

But the representative did not match my tone. “I’m sorry, but the basic plan is just for the employee,” she said, “not your family.”

That’s when a coil of disbelief clamped my heart to a standstill. My spouse and children would be left without health insurance? The panicked questions quickly percolated: What about their ongoing medical treatments? What about their medications? What if someone got hit by a car, or got cancer? There’s hardly a more devastating feeling for a parent than to realize that you haven’t adequately provided for your family.

from the comments:

In 2015, I was sued for the first time in my life–for failing to pay for routine blood tests. I was sued for $600, then assigned $300 in court fees. I called the insurance company: aren’t these test covered by my very high (yet these days “normal”) monthly premium ? Yes, but I had failed to tell them my new group number, assigned by them. I was bemused. If you assigned it, don’t you have it? Yes, they said, but you had to confirm it. I spent hours on the phone to get someone with authority to reverse the $600 charges. They did, only after I explained I would sit on the phone (I was hung up on multiple times) until I cost them more than $600. I was given a “confirmation” code. It was a lie–the person who gave it was not “authorized” to cancel my charges. I got a lawyer–he said pay, for the law is on their side, and it is only $600. I did, but was deeply horrified to be in a system that is rigged to allow legal robbery for obscenely flimsy reasons. All said, this doctor is not alone, and all of this must stop. We must have sane, not-for-profit medicine. I am aware too this happens to the poor all the time. No wonder the inchoate rage.

As a psychologist I can attest to this phenomenon from the other side. I’ve had patient’s claims rejected for the flimsiest reasons. Each time, I was told that they acknowledged their mistake and would happily resubmit the claim, only to have it rejected for the next flimsy reason: diagnosis code 300.4 vs 300.40, no license number on the invoice (right there in the letterhead), no NPI number (not required), etc. I’ve spent hours on the phone advocating for my patients to get reimbursed, usually to no avail. And each time, the insurance corporation gets to hang onto the patient’s money a little longer and earn interest for another month.

I’m a physician too.
I lost my health insurance when I was 36 weeks pregnant over 36 cents.
At the time, I was working as a contractor. I foolishly bought my insurance through the ACA exchange to support it as a new government program. $3,500 deductible had been met. One day, I went online to pay my premium and my account was gone.
When I called, they said my payment from the previous month was short 36 cents (I switched the cents on the check.)
“If you had bought your insurance directly through the insurance company, we would have just let you pay the 36 cents and re-instated your policy.”
“But because you used the ACA, it only gives 30 days for payment, and if you don’t pay within the 30 days, the policy is terminated.”
No amount of begging, crying or calling changed this situation.

See also:
Fighting the Insurance Company – Example of