Client Problems.......look in the File!!

[AllenChicago]

Found out today that HC.gov did/does not share the actual application with insurers if a subsidy was involved. Even if the applicant completed the application at the insurer's own website after qualifying for a subsidy.

HC.gov mistakingly stripped Pediatric Dental from hundreds of family plans in Illinois. Govt won't add the dental unless they research and find that it was one of the applications where it was erroneously omitted...which takes time.

Meanwhile my client's child is having emergency toothwork done today which may not be covered. Only hope is that the fall down the stairs makes the dental work a Medical claim.
ac

 

[Norwayguy]

Found out today that HC.gov did/does not share the actual application with insurers if a subsidy was involved. Even if the applicant completed the application at the insurer's own website after qualifying for a subsidy.

HC.gov mistakingly stripped Pediatric Dental from hundreds of family plans in Illinois. Govt won't add the dental unless they research and find that it was one of the applications where it was erroneously omitted...which takes time.

Meanwhile my client's child is having emergency toothwork done today which may not be covered. Only hope is that the fall down the stairs makes the dental work a Medical claim.
ac

Are you saying if someone completed an app say on a blue cross website and it had a subsidy the carrier does not get the app just a file from the feds?

Anyone else feel uncomfortable about that.

 

[somarco]

To be perfectly honest, I never expected this thing to go smoothly anyway. That being said, the complete incompetence did surprise me.

Uncomfortable is one word you can use.

Another is yougottobefreakingkiddingme.

 

[AllenChicago]

Are you saying if someone completed an app say on a blue cross website and it had a subsidy the carrier does not get the app just a file from the feds?

Anyone else feel uncomfortable about that.

That's exactly right Norwayguy. BCBS-IL told me today that they could not pull up subsidy-eligible applications completed/submitted at BCBS-IL because the application was somehow not actually on their servers. All they receive is a form from HC.gov with all the applicant's information. (Now I understand why I could never view/print a subsidized app at BCBS's website. The usual view/print link was there after submission, but clicking on it rendered a "Database 500 Error". That's because the app was not on their server.

If something is wrong or missing (as in the Pediatric dental), BCBS has no way of verifying, and can't make any corrections, when the client calls in to say that they learned from the doctor that a requested benefit isn't part of the approved policy.

BCBS agent services pretty much confirmed what we've discussed in this forum several times. If it's a subsidized health plan, that policy is pretty much owned and controlled by the government. Any and every request for policy changes has be done by calling the Marketplace. The insurer merely takes the order and recalculates the premium, if applicable.

 

[kgmom219]

To be perfectly honest, I never expected this thing to go smoothly anyway. That being said, the complete incompetence did surprise me.

Uncomfortable is one word you can use.

Another is yougottobefreakingkiddingme.

The word I would use is TEQUILA....

And then I try to figure out why I am surprised

 

[Norwayguy]

That's exactly right Norwayguy. BCBS-IL told me today that they could not pull up subsidy-eligible applications completed/submitted at BCBS-IL because the application was somehow not actually on their servers. All they receive is a form from HC.gov with all the applicant's information. (Now I understand why I could never view/print a subsidized app at BCBS's website. The usual view/print link was there after submission, but clicking on it rendered a "Database 500 Error". That's because the app was not on their server.

If something is wrong or missing (as in the Pediatric dental), BCBS has no way of verifying, and can't make any corrections, when the client calls in to say that they learned from the doctor that a requested benefit isn't part of the approved policy.

BCBS agent services pretty much confirmed what we've discussed in this forum several times. If it's a subsidized health plan, that policy is pretty much owned and controlled by the government. Any and every request for policy changes has be done by calling the Marketplace. The insurer merely takes the order and recalculates the premium, if applicable.

And you read the stories of the subcontractors paying employees not to enter apps and you get this really bad feeling in the pit of your stomach, like bad Mexican food feeling.

And I cringe at this as a consumer and agent that does not sell health insurance.