The Ongoing Saga for Healthcare Coverage

I have been trying to compose a blog post on this topic since November 19. This is currently my 5th draft. I’m hoping to write a composed entry, rather than an unbiased ranting of a raving lunatic, because really, I’m so frustrated I just want to throw things.

I have epilepsy, which left me no choice for insurance but the Federal PCIP program when my COBRA ran out. When I had to wait 6 months without insurance to apply for PCIP, we felt that financial pain on our budget just on my meds alone, which cost an average of $1000/month. I have not calculated or included the cost of my husband’s medications at this point.

Now, we’re facing the same situation again. PCIP is going away at the end of the year. If I’m unable to find affordable coverage by December 15, I will not have insurance at all on January 1, 2014, and I’ll get to pay a penalty for that privilege.

I have tried to do what is right and required of my family and me by law. When the Healthcare Marketplace opened up on October 1, I knew the first week would be hectic and the website would be swarmed with traffic. I decided to wait until the second week to open my account.

The following is a copy of the documented record I’ve kept of all of the issues I’ve encountered trying to obtain coverage. BTW, my family still does not have coverage.

I know I’ll probably get this question; or, at least, some of you may ask it as you read the post, so I’ll add this paragraph in my 5th draft. There are some who may ask, “Why didn’t you just call in and start a new application?” I didn’t because I already had an application in process. With two applications going, I did not want to confuse things further. This happened at one time when my son was on CHIP and it only slowed things down further when trying to obtain healthcare coverage for him. I did not want to go through that experience again for my entire family.

Ladies and Gentlemen, I give you

The Saga…

October 18, 2013

After multiple attempts October 7-11, 2013, I successfully created an account on healthcare.gov on October 18. I had to wake up at 5:15am in order to do so. The process still took me two hours, and at the end of those two hours, when I hit “Submit”, I waited and the screen flickered, then I was left on the same page as though nothing happened. I was never taken to a page confirming the process was complete.

I tried about 6 or 7 times. I even tried logging out and logging back in. Finally, I tried their chat support. They have this handy link at the lower right corner of the page that says, “Live Chat”. I figured their phone lines would be swamped, so I went that route. There was no disclaimer on what their chat did or did not support. Usually, when there is a chat link on such a page, it is level one support and they can help you with at least part of your problem. They can, at least, access your account.

I was mistaken.

The agent informed me they could not access any account information or help with the application process on chat support. Although I just needed to know if my application completed, the agent could not even answer that question. I had to call phone support.

The agent on phone support informed was friendly enough and asked me if I had an account number. I said, “No. I have an application number. I’m in the very last phase of the application process and that’s where things timed out. I clicked submit but I’m not sure if it worked. I just need to know.” I was told that without an account number she could not pull up my in-process application. She could not pull it up with the application number I had, nor could she pull it up with any of my personal information. My only option was to go through the application all over again on the phone (the same application I just spent two-hours completing and had no desire to go through again). If she took me through it by phone it would take 2-6 weeks for a confirmation; whereas, if I completed it online I got an immediate response.

Why the difference? Why couldn’t she get the same immediate confirmation?

I didn’t want to dig up all the information again, so I logged out and logged in again so I could read through the in-process application and give her the responses she needed. To my surprise, I received a new message. I had some file I had to download, indicating I’d been approved! (It should be noted, there was nothing in this message about income levels, or financial assistance – my family of 3 should qualify for subsidies). I read the message to her and she confirmed this meant I’d receive an email shortly with my coverage options.

I never received it.

October 22, 2013

I tried logging back in this morning. My username and password did not work. I thought, “Perhaps I forgot one or the other.” So I clicked on the link that said “Forgot Username”. I populated my name and my email address associated with my account. I did not receive an email. I checked my spam folder to be sure.

I contacted their chat support again. Surely, they can at least assist in resetting usernames and passwords.

I was again, mistaken.

I actually made a post about this experience here.

Subsequent Attempts until November 11

I have tried logging in and calling support about my account since October 22. Unfortunately, I have not recorded subsequent dates between October 22 and November 11, 2013 when I attempted to login and get information on what subsidies or financial assistance my family qualifies for, so we can choose a healthcare plan. My experiences on these attempts were various problems – timeouts, slow behavior, etc… I found them frustrating and the call center equally unhelpful; I admit I did not make many attempts due to my frustration. However, I was also running on the knowledge that I had an in-process application at the final stage, and my last conversation with someone did confirm I was “approved”. I just wasn’t sure what I was approved for, really…

Last week, November 11-15, when I attempted to get this information, I had an entirely new experience with the website.

The week of November 11, 2013

Between November 11 and 15, 2013, when I accessed my account, I could see my in-process application. When I selected it, I had to answer questions regarding whether or not family members smoked or ever smoked tobacco products. I then received a message stating my application is missing information and I was prompted to click on a hyperlink to complete the application before I could proceed further. When clicking on the link, I was not taken to a page showing what was missing. Instead, I was taken to the page showing a link to my in-process application. When I clicked on that, I was taken to a page that said my application had missing information, and to please click on the link below to complete the application… a vicious and frustrating circle. This was not a one-day “glitch”.

Oh, and BTW, you will hear the word “glitch” used in every apology and excuse given when you call in to the support line. I am so tired of the word “glitch”.

November 19, 2013

Today, I logged in to the website in order to get my application ID and call in to support in order to resolve this issue. I was unable to login. I received the following error message:

 healthcare marketplace system is down

I called support anyway. The system may have been down but she was able to access my account. She was able to find my application. Unfortunately, I’m the only person who can see if I qualify for financial assistance. I started venting my frustration at that point. She promised to escalate my issue for a callback. I mentioned how I was promised a callback before and it never happened. She assured me someone would call me back within 1-2 business days. We scheduled it between 10am and 2pm. I should hear from someone by November 21. (This is noted, soon…)

November 20, 2013

I logged in successfully! After much searching, despite the links that showed my application was incomplete, I was able to find the determination letter sent to me on October 18. This letter showed my family was approved for coverage through the Marketplace; however, we were not approved for tax credits or any available options to lower our monthly premium costs. Medicare or Medicaid was not listed as an available option. My 15 year old son did not have CHIP listed as an option (of course, this may be due to his age).

The agent confirmed my only option was via the appeals process. She did not know how long the appeals process would take. She only had a phone number to give me to start this process. She gave me a phone number to call to start the appeals process: 877-541-7905. When I called it, I found it went to 211 Texas. No options in their IVR mentioned anything about the ACA, Healthcare Marketplace, or appealing any decisions regarding these types of matters. (It should also be noted that although I chose to participate in the survey at the end of this call, I never got the survey. I never heard the agent disconnect the call. She feigned ignorance of the survey process. I think she just “dodged” the survey.)

I looked up the appeals process on healthcare.gov and it said to call 800-318-2596. This is the customer support line for the Healthcare Marketplace (the number I called when given the number routing me to Texas 211). It also has a form one can fill out and mail in.

I called back. After a short wait I had hold music then dead silence. Rolled call? Possibly.

Third time is the charm. I called again. Spoke with David Noble. It took breaking down in tears on my part instead of going on a rant. It took explaining I have epilepsy and if I don’t have some kind of coverage by December 15 I won’t have any coverage on January 1 and I won’t be able to control my seizures. It took playing on guilt and emotions rather than expressing my true anger and frustration. Suddenly I found someone who was very helpful.

David never was able to get a time for me on the appeals process. The person who could answer that question wasn’t available for 10 more minutes. Meanwhile, he did show me where the form was that I needed to fill out. He also said if I need an attorney to help expedite matters I can get one, but I said I can’t afford one. That’s when he suggested trying to get in touch with a healthcare navigator for assistance.

Navigators can help you on the appeals process. He offered to help me find one and took my zip code. He said the City of Houston Dept of HHS has them, but I can also find them at:

Change Happens
713-374-1200
3353 Elgin St, 77004
8am-6pm

At 8:26am I called Change Happens. I was transferred to Stacey Thompson to help with the appeal. She offered to get me the paperwork but I already have it. I asked how long it takes. She did not know how long the appeals process took but got the Healthcare Marketplace call center online to find out. (Didn’t I just ask them that? I was just on the phone with the same people.)

They told Stacey they have up to 60 days to complete the appeal. There is no way to expedite the appeal once they receive it. But I need to fill this out and send it in today. Stacey Thompson said if I have problems filling out the paperwork to call her back and she can answer any questions. I can ask for her direct.

Later that morning, after filling out the paperwork and mailing it off, I did find in the appeals information on the website that they actually have up to 90 days to process the appeal and return their decision. So I am still not sure if the appeal will take 60 or 90 days. Regardless, I only have about 3 weeks (21 days) to find healthcare coverage before experiencing a lapse on January 1.

11/21/2013

November 19, I was told I would receive a call within 1-2 business days, between 10am and 2pm. I should have received a call yesterday or today within that window of time. I did not receive a call.

I would like to say “Thus ends the saga”, but I can’t. The appeal is in process; who knows what they’ll say because the letter was dated October 18 and I didn’t receive it until November 20. Have you ever tried to appeal a decision a month after it was made?

I’ve never been one to vote for one party or another based on one specific issue. I certainly do not agree with the Republican Party on many issues (for that matter, I don’t agree with either party anymore). However, after this experience, I’m angry and frustrated enough to see Red. I’m what they consider a “swing vote”. I may just go have a cup of Tea after this experience. I haven’t tried it but I hear anarchy tastes delicious with biscotti.

Anarchy In A Cup

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~ by Duch on November 22, 2013.

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