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 Carol's Journey

Health Insurance Red Tape Resolved

My journey started first week in January
Current provider was filing bankruptcy
Policy expiration end of month notified
January 5th ultrasound cost just incurred

Contacted Marketplace for my options
Several plans met my budget limitations
But doctors not covered in same network
Two options later given one should work

Still had to verify doctors with network list
Insurance phone number provided for this
Without plan name could not help anyway
Called local broker assisted me right away

Local broker completed application by phone
However he did not tell me plan was an HMO
1996 bad experience for needed sinus surgery
Repeated tests done resulted in referral delay

By Jan. 20th premium invoice for Feb. not received
Called marketplace who said HMO policy enrolled
Shocked I made mistake of going with other option
Cancelled HMO and then submitted new application

Thought I had seen doctors listed on alternate policy
Something told me to recheck website immediately
I had looked up wrong plan name for doctor listing
Called Marketplace same day for policy switching

Due to the change March 1st was new effective date
Next day bill for Feb. premium continued my fate
Invoiced at over $300 with tax credit not applied
Called insurance company my situation explained

Based on new effective date could I forego payment
Then wait next month which they were in agreement
By Feb. 20 new statement had not yet come by mail
Called insurance policy termination had prevailed

Marketplace conference call confirmed March 1st date
Escalation department claim filed to research and reinstate
Notified it could take 72 hours up to 30 days for a decision
Called back 3 days then 10 and it was still under investigation

Scary letter from insurance came weekend before my second call
Stating reinstatement request denied due to no payment overall
Deeply concerned by the news I called a dear friend for prayer
She reassured me God is able to cut through all red tape there

I would phone the Marketplace around noon March 2nd Monday
When the lady said the letter meant nothing I had relief that day
March 12th I called again and found out Feb. 27th was resolution
On March 2nd computer may not have yet updated information

Escalation dept. ruled terminated policy could not be reinstated
Lady said I still had plan with March 1st effective dated as noted
But I needed to promptly contact insurance company for payment
Insurance provider at first stood behind letter against reinstatement

Only allowance would be for new application to be submitted
I asked for conference call with Marketplace which was agreed
Man at Marketplace could not hear me so it was a timely blessing
Everything I said lady from insurance really helpful in repeating

After my situation explained Marketplace agreed to new application
Would open enrollment ending Feb. 15th hinder such authorization
Apparently not since it was an existing case with retroactive history
He started process with insurance lady repeating my answers clearly

He congratulated me for successful application of the HMO policy
I will call insurance company for payment Mar. 20th with certainty
God indeed handled all the red tape to reinstate my health insurance
Overall result could have been far worse in the entire circumstance

Much higher premium to pay had Marketplace coverage been denied
Wrong Feb. invoice amount not been reimbursed till 2015 taxes filed
Had longer health insurance lapse occurred potential penalty to pay
God protected me from all these real scenarios each step of the way

Still waiting for revised tax form for insurance premium verification
Before filing 2014 taxes since government messed up all information
Thousands of people waiting to receive same documentation by mail
April 15th deadline is fast approaching but God’s timing will prevail

There may be challenges I will face under HMO insurance policy
On website one RX says prior authorization and limits on quantity
Also may incur referral delays to see specialist such as my ENT
God will protect me and give my doctor wisdom with all certainty

© Carol S. 3/17/15
 








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