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ObamaCare in California

by JEFF SHER

The morning of January 6th I received maybe my fourth warning email, all in the last week or so, from Covered California, the state agency that administers the exchange where individuals can now buy health plans under the Affordable Care Act, otherwise known as Obamacare.

First they congratulated me for signing up for a new health insurance plan through Covered California. Then the punch line: “In order for your health care coverage to take effect, you need to pay your premium.”

This is a bit disconcerting, because at the same time that Covered California is filling up my inbox with warnings to PAY MY BILL, the insurance company I am supposed to pay hasn’t sent me a bill yet, and they won’t answer my phone calls due to unusually heavy call volume associated “to” the Affordable Care Act.

Meanwhile, my old insurance company, which cancelled my previous insurance plan effective January 1 precisely because Obamacare was scheduled to take effect on that date, is sending me bills for a much more expensive plan to replace the one they cancelled, only I never applied to them for a replacement plan.

Maybe I’m taking these pay-up warnings the wrong way, but the message seems to be that I’m the fly in the ointment, the monkey wrench in the finely oiled machine, the reprobate who is refusing to hold up his end of the deal and pay the nice insurance company for the excellent service they are providing to me.

I get it. It’s on me. If I get hit by a bus next week and don’t have health insurance, it’s going to be my fault, and the new insurance company I selected through the exchange, Anthem (the conglomerate that swallowed what used to be Blue Cross of California), will have valid reason not to pay my claims.

I understand. I’ve heard about “consumer driven health care,” a core principle of Obamacare. You know, it’s the idea that the reason health care costs are so high is because for too long health care consumers have had too big a share of their costs paid by their employers. Low co-pays and deductibles have led consumers to over-consume. If they have to spend more of their own money, they will make better health care decisions. Like they do when they shop for shoes, or flat screen TV’s. It’s just good solid free market logic.

Consumers are responsible for high-health care costs, not insurance companies, doctors, hospitals and pharmaceutical companies. That’s why Obamacare in a few years will impose harsh penalties for any insurance plans (provided by corporations or unions, for instance) that are too good, so called “cadillac health care plans”. You know, that’s the kind of plan that has low deductibles and co-pays, under which you can actually afford to go see your doctor and consult with him about how you should manage your health. How old school is that, what with all the info available on the internet, Web MD and all that. You can make your own health care decisions now.

So I’m pretty clear by now that I if something goes wrong it’s going to be my fault and not the fault of my insurance company. So I’m getting a little nervous, despite the fact that I’ve been a health insurance consultant for over 20 years, and I’m supposed to know how to work this system.

You see, I’d like to pay Anthem for my first month’s (January) coverage.  It’s not a lot of money, seeing as how it’s subsidized by the federal government in order to enable more people to afford the prohibitively expensive products on offer from the four-headed insurance/doctor/hospital/pharmaceutical Cerebrus that guards the gates to the Hades that our health insurance system has become. By the way, Cerebrus’s job was not to keep people out of Hades. It was to prevent those who had entered from escaping.

Problem is, I can’t pay my bill because Anthem hasn’t sent me a bill. January 6th was the original deadline for paying January bills for the exchange plans. Well, that deadline has been extended now by Anthem to January 15.  Will Anthem send me a bill before then?  Do I have health insurance now?

Covered California instructed me that if I hadn’t received a bill yet,  I should contact the insurance company I selected. They provided a link to a special page that explained what my options were for contacting and paying each company.

For Anthem I can either pay by telephone – and they gave me a phone number to call – or I can pay by mail. How do you pay by mail? You put a check in an envelope and send it to a P.O. Box in Oxnard, CA. O, and make sure you attach the application number assigned to you by the exchange to your check, along with the primary subscriber’s name. That way Anthem will be sure to know exactly who you are and everything will be just fine. No forms, no plan name, no other identifiers. Just a check in an envelope.

Not being real confident with that approach, I called the Anthem phone number. I worked my way through the phone tree, until the moment I identified myself as an applicant, following which I was immediately informed that Anthem would not be able to take my call at this time because they were experiencing unusually high call volume associated “to” the Affordable Care Act. They told me to call back later.

Perhaps you are thinking I got myself into this fix because I was late in filing my application for Obamacare coverage. On the contrary, I signed up for Obamacare and selected my insurance plan and company way back in October.

That was after my friends at Blue Shield of California (not the same organization as Blue Cross in the State of California) informed me in September that the insurance plan I had at the time was going to be cancelled effective January 1, 2014. Of course they offered me alternatives, I could go to the exchange or I could sign up for a Blue Shield plan outside the exchange comparable to the one I already had – with one slight change. The premium for the new, almost the same, plan, would increase from $436 to a cool $709.87 per month.

Same plan more or less. Same person. Same health status. Same age, 63. The only difference: a new player had entered the market. So Blue Shield decided the appropriate price for my plan had increased by 62.8%. Who am I to ask questions? I couldn’t possibly understand. Just the mysterious ways of the free market as divined by the oracles in the Blue Shield underwriting department.

So I went to the exchange and ordered up my comparable and much less expensive plan and just sat back to enjoy the warm glow of knowing that I would have coverage come January 1, 2014.

Along about December I started to hear rumors that maybe the insurance companies were not going to be able to get the bills out on time to enable people to comply with the January 6 deadline for payment.

So I called Covered California again on December 17, and after waiting on hold for about 96 minutes, I spoke with an agent who assured me that yes, the exchange had sent my information to Anthem and I could be expecting a bill. Not to worry, I would be covered Jan. 1 as far as the exchange was concerned. But of course I would still have to pay my bill.

Yes, the agent said, he had heard about the billing problems. He explained that the insurance companies were dealing with a huge number of applications from the exchange. He wasn’t exactly sure when my application had been sent over to Anthem, because the exchange had held up a lot of the early applications until late November because they weren’t sure the insurance companies were ready to accept them before that.

I insisted that the agent provide documentation that our call had taken place and that he had assured me that I would have coverage and that all my information had been sent to Anthem sometime before Dec. 17. He gave me an incident number which he said would be added to my record with all the details of our call.

I thanked him and told him that with his help, if I got hit by a bus sometime after January 1 but before Anthem billed me and I could pay, I was confident I would be able to win the lawsuit that would ensue when Anthem tried to claim I did not have valid coverage at the time of my accident. Not that they would mind you. Insurance companies in this country are notoriously liberal in their efforts to go that extra mile to take into account all extenuating circumstances when paying claims. They really are not known for trying to evade responsibility on the basis of technicalities. I mean, except for that recisions thing a few years back.

For now, I’m trying to stay off the streets and out of harm’s way. I’ll hold out for a couple more days, hoping a bill arrives from Anthem, and then I’ll follow instructions and put a check in an envelope and hope it gets to the right place. Maybe I should send it registered mail.

Maybe I’m not confident because Anthem has had years to prepare for the coming of Obamacare but couldn’t quite get a handle on this highly complicated billing thing. You know, where one agency collects information and confirms applications and eligibility then sends that information to you, and you enter it into your database and generate a bill and send it out. This insurance stuff is really complicated.

Remember, Anthem and the other insurance companies are from the private sector, which is constantly harping at us about how government can’t do anything right and the private sector always does it better.

I find it hard to believe Anthem (and the other companies) didn’t expect an unusually large number of applications, or unusually high call volume for that matter. Remember, Obamacare mandates that millions of people who didn’t have health insurance before have to buy it now.

Perhaps a more reasonable explanation for this administrative mess is that the insurance companies weren’t really all that invested in delivering a successful launch to Obamacare. Which is surprising, since Obamacare is going to deliver them more customers and greater profits than ever before.

Or maybe the explanation runs a little deeper than that: it’s probably been 20 years since health insurance have really focused any energy on delivering good service to their customers. Why should they? There’s very little competition in the industry. The few companies that remain are going to get their share of customers, no matter how poorly they perform. And after all, they are for-profit companies and their primary responsibility is to deliver profits for their shareholders. It’s not really their business to guarantee that people get high quality health care or a system that functions smoothly.

Please don’t think I just have it in for Anthem. That’s just the carrier I chose for my coverage, so it’s the carrier whose system I have had to try to navigate.

My old friends from Blue Shield aren’t much different. They cancelled my old plan effective January 1. But they kept offering me their new, more expensive substitute plan, and even though I never responded to any of their offers, not long before January 1 they sent me a letter thanking me for my application and telling me how much I owed them for my new, more expensive plan.

In other words, they put the burden on me (the reprobate) to call them (only a 30-something minute wait on hold) to cancel a plan I never asked for in the first place.

I don’t see how that’s much different from Anthem putting the onus on me to pay a bill that they haven’t yet bothered to send me.

JEFF SHER lives in the Bay Area. He can be reached at:jeffsher@sbcglobal.net

 

 

Jeff Sher is a journalist specializing in the health care industry. He lives in San Francisco.

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