Need Advice on Escalation

[Nikita]

I have been tearing my hair out trying to help a client get this issue resolved, and would appreciate any feedback/help/guidance etc.

FACTS: Client had ACA coverage in 2014, with premium subsidy and cost sharing. She did not get her proof of income documentation submitted by the deadline so the FFM took away her subsidy and cost sharing, resulting in thousands of dollars in bills (due to her increased deductible.)
She did get her documentation submitted later in November and in December she called in to the marketplace and requested an escalation to get her subsidy and cost sharing reinstated. After numerous attempts to escalate and over 25 phone calls, she has gotten no where. I have tried also to no avail. I also tried calling the regional office the Dept of HHS but no one answers the phone there.

I can't believe how frustrating this is and I have no idea what else to try. Has anyone else encountered this and been successful in getting it resolved?

 

[Sherota1]

Getting a resolution to a difficult escalation is like gambling. You keep repeating the process and maybe down the road you will find someone who actually listens to you.
In some cases a 2014 issue will resurrect itself and cause problems with the 2015 enrollments. There are no delete buttons that will erase the problems that need to go away. If your issue was not resolved successfully during Open Enrollment and they do not blame your client for the problems they are having the could possibly qualify for an SEP.
This happened with one of my clients finally by the end of March the CSR that I spoke with agreed that he did qualify for an SEP and finally gave it to him.
Check the SEP list for exceptional circumstances to see if one applies to your client. Be patient because it could take several calls to get to a person who is not a script reader. Hope it works out.