HealthCare.gov Can’t Handle Appeals of Enrollment Errors

[RayNY]

I was told today by Coventry that once the policy is picked and subsidies applied a change can not be made until next enrollment. Had a Clint choose a silver plan and then was diagnosed and medications cost $800 a month. Now,they want to change to a gold plan because it would,save them about$400 a month. But Coventry said nope. Can't do it tell next year...

Go over their heads. Move via the exchange portal, not the carrier. If that doesn't work, just term & reapply. Not like they can deny you...

I've moved clients with subsidy already. It's certainly allowed and possible (at least within OEP.) I know it's a different state, but we're all following the same laws.

 

[Duaine]

Go over their heads. Move via the exchange portal, not the carrier. If that doesn't work, just term & reapply. Not like they can deny you...

I've moved clients with subsidy already. It's certainly allowed and possible (at least within OEP.) I know it's a different state, but we're all following the same laws.

I've tried to move folks enrolled in a plan. That will work IF they haven't paid their first premium. If they have your out-of-luck.


That said I did get one moved after paid premium by using the "life-threating" argument with the client on the phone with me. Problem is still that someone higher-up in the "Advanced Resolution Unit" must give their ok to roll back the effective date to 1/1/14. If they don't then the next effective date is 3/1/14 which puts the client out of pocket on expenses from 1/1/14.


You must find a supervisor who knows how to work the system and then "PUSH" them to help you. This is God-Awful mess....

 

[hamben]

Thanks for the help guys. But I have pushed as high as I can it's an absalute no fromthe market and the carrier. I can cancel the Coventry and apply to the blues but because there subsidy was locked in they would not get the subsidy tell tax time for,the blues...I guess I can just recommend they get divorced and just live together....just think of all the problems navigators are causing...

 

[cadylou]

So, they cannot move to a different company once the premium has been paid? I have someone who is just now finding out that the plan she chose (by herself on healthcare.gov) has a "narrow network" and will be pretty useless to her. She wants to move to a Blue Cross plan that has a wider network. We only have 2 carriers on exchange here. She told me that she's paid one premium for her existing plan. If she cancels and applies for a new plan "on-exchange" - you all are saying she won't be able to get the subsidy applied for the new insurance?

 

[Yagents]

So, they cannot move to a different company once the premium has been paid? I have someone who is just now finding out that the plan she chose (by herself on healthcare.gov) has a "narrow network" and will be pretty useless to her. She wants to move to a Blue Cross plan that has a wider network. We only have 2 carriers on exchange here. She told me that she's paid one premium for her existing plan. If she cancels and applies for a new plan "on-exchange" - you all are saying she won't be able to get the subsidy applied for the new insurance?

If the reason is to change to a broader network, they CAN change plans to a broader network as long as it's with the same metal category, same insurance company, and can keep the subsidy.

 

[cadylou]

Well, they can't stay with the same company if they want a broader network - the company they chose, Coventry, only offers the narrow network on exchange. They would have to purchase from Blue Cross to get the wider network. Unreal . . . no one is allowed to switch once they find out they've been hosed?

 

[Duaine]

Note my earlier thread about how you can now change plans during open enrollment.


http://www.insurance-forums.net/for...new-rules-its-whole-new-ball-game-t61885.html

 

[AllenChicago]

Well, they can't stay with the same company if they want a broader network - the company they chose, Coventry, only offers the narrow network on exchange. They would have to purchase from Blue Cross to get the wider network. Unreal . . . no one is allowed to switch once they find out they've been hosed?

CadyLou, I helped a family earlier this week that had the same problem. They were enrolled into a Coventry plan with a Jan 1st effective date, but the Network was too narrow. The Jan/Feb premium to Coventry had/has been paid. Was not EFT/PAC...was manually paid by writing a check.

1. We used a new E-mail account and registered with HC.gov from scratch, and received a subsidy determination.
2. Enrolled at BCBS-IL for a plan that has the widest PPO network in the state, with the subsidy applied to reduce the premium.
3. Was approved today for a 3/1/2014 effective date . Client called Coventry and cancelled that plan, effective 2/28/2014.
4. End Result = Satisfied Client
ac

 

[RayNY]

AC,

Exactly what I said to do (with a lot more detail). It works, and there isn't anything they can do to stop it. The only downside is the loss of any OOP expense towards deductible (as applicable) since companies won't honor payments made to another carrier.

But, clients that need to move to a plan with a usable network could care less from my experience. They just want out...

 

[cadylou]

Thank you all for your help on this. I will proceed with the client & get her moved.