Frustrating Experience with Cancelled Coverage

[redeemed]

I am getting fed up with how insurance companies are handling enrollments under the ACA. Today we had a pretty devastating case that I have no idea how will turn out. I have client who had baby and we placed the newborn on its own policy about a month after birth, the coverage was set up to start at birth.

We followed the case and made sure the policy was issued and the first premium was drafted and notified the client (it was set up on EFT). This occurred about 10 days after submitting the app, it had to be a paper app so things moved a little slower.

Today, I got a call from the client (good friend of mine) saying that he called in to BCBS with a question and was told that his son no longer had coverage. We found out in the end that the bank draft was returned to his bank 5 days after it occurred so they cancelled the policy due to non-payment. Additionally, the will not reinstate the policy because they claim that there is no 90 day grace period because the policy was never technically put in force to begin with.

We were never notified as an agency that this occurred until just now, the son's policy showed up in our electronic portal as "termed" there was never a lapse notice sent out or any attempt to reach out to us in any way during this time.

They claim they left the client a voicemail about the matter, the client says he never heard it. Now, I know him personally and he is a very attentive individual and good with money, although perhaps not as anal as some people about staying on top of things. From speaking with BlueCross AND his bank, no one knows why the money was returned to his account and neither is claiming responsibility, the bank account had sufficient funds at the time of the draft. BCBS is saying that they didn't do it and refuse to re-instate the coverage, now is son has no coverage, his post birth care was extremely expensive (in the mid six figure range) and the insurance company says we have zero recourse.

Are we already at the "hire an attorney" stage? What are we supposed to do as an agency to make sure this never happens? Beyond making sure the policy is put in force and the first draft occurs, I can't babysit every single policy to make sure it is all working, especially when there is no system in place to notify me of these occurrences until after it is too late.

 

[AllenChicago]

Redeemed, your overall experience sounds similar to something I experienced with our BCBS last year. I helped my client submit a plea/complaint to BCBSIL headquarters and her issue was resolved. Took about 45 days though.

You're right. The ObamaScare crush of rules and restrictions have devastated important, time-sensitive communications from carrier to insured, and carrier to agent.

 

[MaryDallas]

I went through 'every' BC/BS IL policy six (6) times to check, check, and double check that the premium was paid and EFT properly set up. I had heard that BC/BS had a terrible billing system and had people calling me that never did get insurance in 2014 because of billing.

Yes, it was very annoying: and every time I went through the file again I found errors on top of errors. It was so frustrating because I needed to move on to new clients and kept having to deal with the walk-through on what I had written.

It was difficult to believe how bad it was.

 

[ARus]

I went through 'every' BC/BS IL policy six (6) times to check, check, and double check that the premium was paid and EFT properly set up. I had heard that BC/BS had a terrible billing system and had people calling me that never did get insurance in 2014 because of billing.

Yes, it was very annoying: and every time I went through the file again I found errors on top of errors. It was so frustrating because I needed to move on to new clients and kept having to deal with the walk-through on what I had written.

It was difficult to believe how bad it was.

Do you think BCBS IL may miscalculate our commissions based on what you wrote above? I never checked

 

[kgmom219]

Do you think BCBS IL may miscalculate our commissions based on what you wrote above? I never checked

They have shorted me 25% for Jan and Feb. Its not pretty.

 

[MaryDallas]

It is my understanding the initial premium has to be paid before the 1st of the month to pay. On these the agent/broker is allowed to call in the first month's premium. Sometimes I was told we could not set up the EFT, and sometimes I was told we could. If I was told no, I called back in to set up the EFT as well just to make sure the billing didn't fall through the cracks (with the permission of the client, of course).

It was easy to pay the initial premium. The problem was in setting up EFT. This is where I had to call in repeatedly to make sure it was done.

Commission is paid on those policies that are paid prior to or on the 1st. In January I was paid exactly 1/2 of what I had written, which surprised me. I wasn't expecting anything until February. In February 'ALL' of the February commissions were paid but not the first 1/2 of January.

Immediately I called and turned in a ticket and have not heard a word. I've called numerous times and the ticket is open but no response. And Commissions does not talk to 'us'. It is a ticket system. So I am waiting to see if the 1/2 from January is on the check next week plus the ones paid for March. I have a few on Direct Bill and about 7 did not pay prior to the 1st. I'm sure there will always be a few stragglers. We'll see how next week goes.

Yes, you have to 'really' watch the billing especially the initial setup is critical.
I felt a bit OCD and could not believe how difficult it was to get the billing right. I was watching very closely because of stories I had heard from other agents and clients about BC/BS billing.

 

[kgmom219]

It is my understanding the initial premium has to be paid before the 1st of the month to pay. On these the agent/broker is allowed to call in the first month's premium. Sometimes I was told we could not set up the EFT, and sometimes I was told we could. If I was told no, I called back in to set up the EFT as well just to make sure the billing didn't fall through the cracks (with the permission of the client, of course).

It was easy to pay the initial premium. The problem was in setting up EFT. This is where I had to call in repeatedly to make sure it was done.

Commission is paid on those policies that are paid prior to or on the 1st. In January I was paid exactly 1/2 of what I had written, which surprised me. I wasn't expecting anything until February. In February 'ALL' of the February commissions were paid but not the first 1/2 of January.

Immediately I called and turned in a ticket and have not heard a word. I've called numerous times and the ticket is open but no response. And Commissions does not talk to 'us'. It is a ticket system. So I am waiting to see if the 1/2 from January is on the check next week plus the ones paid for March. I have a few on Direct Bill and about 7 did not pay prior to the 1st. I'm sure there will always be a few stragglers. We'll see how next week goes.

Yes, you have to 'really' watch the billing especially the initial setup is critical.
I felt a bit OCD and could not believe how difficult it was to get the billing right. I was watching very closely because of stories I had heard from other agents and clients about BC/BS billing.

A couple of hints....

1. Your issue is THE issue. But there are other glitches, one being people on ACA policies OFF Ex in 2014, who went ON Ex in 2015. The migrated policies are not as bad. (Though I had some of those, too) You need to email them a spreadsheet with names and account numbers, if you haven't already. You will get better results if you've done half the work.

2. The best way to get an EFT form done is via document submission at Hallmark. Plan on 2 billing cycles before it takes effect. Helpful hint...if the 1st falls on a weekend (or a Monday of a 3 day weekend) it normally comes out on the Thursday prior. (But not always. Nov 2014 pulled on 1st. Dec 2014 pulled on the 30th. So the Nov commission statement was UGLY. Dec was double).

Billing (thus commissions) is a disaster right now and they know it. I have been assured that this is their #1 IT priority. We shall see....

 

[MaryDallas]

A couple of hints....

1. Your issue is THE issue. But there are other glitches, one being people on ACA policies OFF Ex in 2014, who went ON Ex in 2015. The migrated policies are not as bad. (Though I had some of those, too) You need to email them a spreadsheet with names and account numbers, if you haven't already. You will get better results if you've done half the work.

2. The best way to get an EFT form done is via document submission at Hallmark. Plan on 2 billing cycles before it takes effect. Helpful hint...if the 1st falls on a weekend (or a Monday of a 3 day weekend) it normally comes out on the Thursday prior. (But not always. Nov 2014 pulled on 1st. Dec 2014 pulled on the 30th. So the Nov commission statement was UGLY. Dec was double).

Billing (thus commissions) is a disaster right now and they know it. I have been assured that this is their #1 IT priority. We shall see....

Yes, I had some double bills, also. I did send in a spreadsheet with name, account number, etc. Thank you for the tips.

I will tell you this: BC/BS IL is far better than Cigna will ever be. They really messed with their brokers this year. I had a block of business on the books with Cigna so I'm thinking this 2015 season would be better: boy, did they prove us wrong. Slammed us big time with nonpayment, and these were people I was leaving alone from 2014. I may never forgive them; will probably move those people for 2016. They were just: bad!

 

[ARus]

I didn't hear anything from Land Of Lincoln Health. This year they are 30% from my new book and I don't know what to expect. Today had a short conversation with a client who has ongoing claim - physical therapy with them. He is happy sins using them.
Any other experience with LLH?

 

[MaryDallas]

I didn't hear anything from Land Of Lincoln Health. This year they are 30% from my new book and I don't know what to expect. Today had a short conversation with a client who has ongoing claim - physical therapy with them. He is happy sins using them.
Any other experience with LLH?

I know nothing about Land of Lincoln Health: they are not in Texas. I had a 'navigator' tell me they had filed bankruptcy ... and I don't even know who they are. I'm sure that's not true: just interesting what they toss out there.