Rant about being an LPR and healthcare pass-the-buck-itis

[VeeNDee 44]

So, long story short we discovered my health insurance was terminated earlier when I tried to fill a prescription. After a long series of phone calls with the insurance company and the Washington state health plan people as well as the pharmacy, they told me my lawful presence wasn't verified. This was bogus since we have sent in my greencard multiple times in the past as proof of my residence. We got ticket numbers for resolution, and then a few days later were phoned and told I was now fully covered again.

That was, until we got a letter in the mail saying my coverage would now be terminated on January 31 instead due to lack of proof of lawful residence.

Full disclosure: I am currently pregnant and have some health issues, and I need health insurance!

We emailed the appeals department and customer support - And the customer support email bounced back and said their inbox was FULL. What, really?!?

We just heard back from the appeals department today and I am going to cut/paste what they said (and edit out identifying details). Anyone else dealing with this?? I could use some tips and maybe just some support because I am incredibly frustrated right now!

Mr. [Last Name],

Thank you for your email regarding your frustration with Healthplanfinder and the Washington Health Benefit Exchange. We are sorry you’ve had problems.

Ms. [Last Name]’s information was previously verified and sufficiently confirms that she is lawfully present. However, in researching this issue it is apparent that the system is not recognizing the information that we have manually verified for her. This is an error and we have submitted a ticket to fix this system error under ticket #[#####]. This system error may take 6-8 weeks to resolve, which means that healthplanfinder may not reflect her having active coverage during that time. In the meantime, you can follow the progress of ticket #[#####] by contacting Customer Support at 1-855-923-4633. Once this ticket is resolved, you may also ask Customer Support to retroactively cover Ms. [Last Name] for the period of time in which coverage was erroneously terminated.

Unfortunately, the Presiding Officers do not have authority to rule on your matter. However, you may request a hearing by filling out the attached form. Please be aware, that we will likely ask the Presiding Officer to dismiss the case on the grounds that they have no authority in the federal regulations to hear your appeal. In other words, we believe that the resolution to the issue you’ve described does not lie in the Appeals Program.

However, there are other options to resolve the issue you’ve described.

If you’d like to file a complaint you can do that by any one of these options:

1) Write a letter mailed to: WAHBE, PO Box 657, Olympia, WA 98507-0657

2) Use the online complaint form: www.complaints.wahbexchange.org

Thank you,

Appeals Program

So, basically if we appeal it will be denied, and if we file a complaint (again) it will take 6-8 weeks to process and in the meantime I don't have health insurance. I don't know if I even believe the retroactive coverage - I know the pharmacy wouldn't give me my medication last week when this all started unless I paid for the full cost and I have trouble believing the government would just give me a check to cover that.

ARRGHHHHHHHHH!! I can't be the only one can I?!?

I'M HERE LEGALLYYYYYYYYYYYYYYYYYYYYYYYY!!!!!!!!!!!!!

[Udella&Wiz 325]

Brutal red tape - anyway to find out the highest person's email you can find and document your case?

[novedsac 355]

I'm not sure what you would be appealing.

The second paragraph seems to admit their fault (ie, coverage was erroneously terminated), they have already submitted a ticket to fix the internal problem and that after the issue is resolved (ie, the ticket is closed out) then you can apply for reimbursement of expenses which were denied in the interim.

I think 6-8 weeks is excessive; I would expect someone to manually fix the issue within 48hrs, but at least they've admitted the issue and its on its way to getting fixed. The other options are for making a complaint about this insurance vendor ... which i would recommend, but only after your situation is resolved.

Yes, I would expect that you would need to file a claim for those expenses you incur now and that they would reimburse you for the amount the insurance would have covered had the claim been processed the way it should have been. Again, considering this is an error on their end that should not have been made, I would make the case for the claims and the payment to be expedited.

I'm not really sure about the 'legal presence' thing ... must be new ... my exwife had no legal presence for ten years and had no issues with the health care insurance whatsoever - three births, a few hospitalizations and two years of mental health - and despite a thick accent, the topic of her immigration status never came up once.

[Flames9_RN 358]

Contact ur congress person!! Never know they may be able to help

[VeeNDee 44]

Brutal red tape - anyway to find out the highest person's email you can find and document your case?

I'm not sure - I keep calling asking to speak to different people but it's a bureaucratic maze.

I'm not sure what you would be appealing.

The second paragraph seems to admit their fault (ie, coverage was erroneously terminated), they have already submitted a ticket to fix the internal problem and that after the issue is resolved (ie, the ticket is closed out) then you can apply for reimbursement of expenses which were denied in the interim.

I think 6-8 weeks is excessive; I would expect someone to manually fix the issue within 48hrs, but at least they've admitted the issue and its on its way to getting fixed. The other options are for making a complaint about this insurance vendor ... which i would recommend, but only after your situation is resolved.

Yes, I would expect that you would need to file a claim for those expenses you incur now and that they would reimburse you for the amount the insurance would have covered had the claim been processed the way it should have been. Again, considering this is an error on their end that should not have been made, I would make the case for the claims and the payment to be expedited.

I'm not really sure about the 'legal presence' thing ... must be new ... my exwife had no legal presence for ten years and had no issues with the health care insurance whatsoever - three births, a few hospitalizations and two years of mental health - and despite a thick accent, the topic of her immigration status never came up once.

Yeah you think 6-8 weeks is excessive for one little error too huh? Yup, ridiculous! Come on now! I am pregnant and need OB coverage, not to mention one of my medications costs $3500 per month out of pocket and I am supposed to just magically pay for that? I have had the ticket expedited by various people as medically urgent due to being pregnant and the cost of the prescription.... but I don't think their definition of 'expedited' is the same as mine.

Contact ur congress person!! Never know they may be able to help

Getting close to that point... my husband keeps mumbling about suing for how badly this is being handled.

[VeeNDee 44]

So an update on how the situation is going - last week I called again (I call every few days) and was told my ticket was RESOLVED and I was good to go! Like a moron I assumed I was now covered by insurance. Nope, they resolved the ticket by making me 'eligible' for coverage and just left it there. So, I still don't have coverage.

We paid for January in December, for February in January, and now for March in February for all 3 of us. The amount of BS I have had to deal with is incredible. They tried to charge us a fee to add me onto the account - UM NO I should already be on there. They told me I had to prepay an extra month for the entire family for March before they could fix February - I don't believe it but we paid it anyway. They told me I should get Apple Health, but then they told me I don't qualify since I haven't been a citizen for 5 years (no duh!). They added us ALL back on our original health plan by re-enrolling all 3 of us, but then apparently they forgot to click a button because when we called back, we weren't on a health plan for next month. Holy cow, how hard is it to put me back on the plan we originally picked?!?

After spending an hour and a half on the phone on Friday and speaking to THREE different people, I managed to make some progress and as of March 1 we are all on the same health plan. Well, that's fine and dandy but it's February and I still don't have health insurance.

I spoke to the 'retroactive department' and they told me if we had ALL been erroneously terminated, one button click would have retroactively dated our coverage but because it was just me (AND THEIR FAULT GRRR), we all had to pick a new plan to go on together (aka the same plan we should have been on all along), and they opened another ticket.

As of right now, I have another ticket open to retroactively date my coverage and they said it could take up to 5 weeks.

Can I go hit my head on my desk now?!??!?

All because of the dumb green card error THEY made Oh to be a citizen and not deal with this mess!