Problems with Health Insurance? Under the Affordable Care Act You Will No Longer Be Alone

If you sent in your health insurance payment on time, and paid it the way you always have (as a direct withdrawal from you checking count), but made a mistake when you put the checking account number on your payment,  would you expect that your insurer would drop you?

What if your insurer sent you an email a few days after you sent in your payment saying “Your payment has been received? Wouldn’t you assume that you were still insured?

Mike Holden did. He was wrong.

Yesterday, he sent an email explaining his story.  

 “On March 16, I paid my family’s monthly health insurance bill to United Healthcare (UHC) the same way I have for almost a year now. But I was using a new bank account that we set up after a recent move. Unfortunately, I entered the account number incorrectly. It turns out I left off three digits that are part of the account number but listed separately on the checks.”

Holden had no idea that he had made a mistake. On March 20, he received an email from UHC saying “Your payment has been received.”

Yet in April, when he went online to pay his family’s April bill, he was told his coverage had been terminated. He then talked to a customer service representative at UHC and received a letter explaining that he had until March 31 to correct his mistake.

Unfortunately, the letter, which was postmarked March 27, went to his old address. .

He appealed to UHC, explaining the problem and asking that his insurance be reinstated,

He then received a letter telling him that his appeal had been denied:  “United Healthcare Benefit Services follows the guidelines for payments and grace periods defined by the Department of Labor. Your account has been reviewed and the termination remains, as payment was not received within the guidelines provided.”

                          How the Affordable Care Act Brings Us Together

Beginning in 2014, people like Mike Holden will no longer be alone, trying to stand up to insurance companies. Individuals and families who buy their own insurance will be able to purchase coverage in “Exchanges”—marketplaces where insures will be regulated and individuals and families who purchase their own insurance will become part of a large group. There, they will have far more clout than they do now.

The Affordable Care Act is all about overhauling a fragmented health care system and turning it into a universal system. Pooling their premiums in the Exchanges, patients will be paying for each other, and the Exchanges are designed to protect consumers.
The ACA stipulates that Exchange establish grant programs for outreach to the public for education, enrollment information, to facilitate enrollment and referrals for grievances, complaints or questions. The Exchanges will provide ombudsman to help patients with grievances.
Moreover, if an individual in the Exchange qualifies for a subsidy, the Secretary of Treasury will pay the subsidy directly to the insurance plan. “Individuals who fail to pay their share of the premium will have a three-month grade period before being disenrolled from their health plan.” Three months would have been enough time to sort out Mike Holden’s problem. Finally, under reform, the Individual Exchanges will provide information on reporting of “ consumer grievances, late payment experience, etc., so that consumers can identify plans that have lower costs due to efficient practices versus those that have lower costs due to inferior service, ”  I would say that UHC’s response falls under the heading of “inferior service.”

No wonder some insuers  are trying to undermine the Exchanges.

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