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Thursday, 20 March 2014 18:41

ACA Update: Are Insurance Companies Ill-Equipped for ‘Obamacare’ Roll-Out?

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Since October 2013, Americans have been enrolling for health insurance under the Affordable Care Act (ACA) on Healthcare.gov or through insurance agents and brokers. With only a few weeks to go before the March 31, 2014 ACA enrollment deadline, the US Department of Health and Human Services has reported that more than 5 million Americans have enrolled for health insurance through the state-based exchanges.

Enrollment in the ACA and in expanded Medicaid has been patchy because states were given too much leeway regarding what care would be available, how people should enroll, and how much money and effort would be invested into educating residents about enrollment. Some states (like California) have well-developed online insurance exchanges of their own, while other states (like Arizona) allowed the federal government to create their ACA exchange websites and did little to educate residents about health insurance enrollment.

During the final weeks, non-profit groups and volunteers in Arizona have been http://www.publicnewsservice.org/2014-03-14/health-issues/nonprofit-groups-volunteers-hustle-to-meet-aca-deadline/a38149-1#sthash.Kzltxq0c.dpuf" href="http://www.publicnewsservice.org/2014-03-14/health-issues/nonprofit-groups-volunteers-hustle-to-meet-aca-deadline/a38149-1" target="_blank" style="line-height: inherit; border: 0px; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; color: rgb(142, 72, 26); text-decoration: none;">scrambling to enroll people, while the Arizona Republican Party is scrambling to spread misinformation to discourage enrollment– with multiple speaking engagements and mass distribution of an editorial entitled Obamacare: To Enroll Or Not To Enroll? That Is The Question by local doctor, Elizabeth Lee Vliet. And on the national level millions is being spent to dissuade Americans from enrolling, while Republicans in the House offer bait-and-switch alternatives to the ACA which would cost more and cover fewer people.

As both sides of the political spectrum work hard to sway the public, my question is: Are the insurance companies really up to the task of providing care for so many new enrollees? Although the mainstream media takes delight in reporting that fewer people than projected have enrolled through HealthCare.gov than projected, no one is reporting the number of new insurance enrollees who shopped the HealthCare.govwebsite but signed up for insurance through an agent or broker (as my employer did). Consequently, the true statement is that health insurance companies have recruited at least 5 million new customers since October, how can that be bad for business? Just look at the 27.6% increase in HealthNet’s stock price between November 8, 2013 and March 10, 2014 (graphic at the top). Big corporations are making big money on the ACA. Why are the Republicans fighting against it and campaigning against Obamacare as a wedge issue?

Poor Implementation of ACA by Insurance Companies

Were insurance companies betting that the Republicans could really repeal and replace Obamacare– if they threw enough money and media at it?

Nearly three months after enrollment, we are underwhelmed [being polite here] with the service that our employee group has gotten from HealthNet, our chosen insurance provider. What has transpired since my boss paid our first premium to HealthNet in December is an untold story. Today’s post is the rest of the story,

The slow service and multiple missteps by HealthNet have led me to believe that insurance companies were betting the Republicans could stop implementation of the ACA. Obviously, the GOP tried very hard to end insurance reform, with more than  50 repeal votes and many financial showdowns, like last fall’s government shutdown.

Individuals and employers who paid premiums on or before December 23, 2013 were supposed to have insurance coverage as of January 1, 2014. Since we had not received insurance cards by January 8, I contacted our insurance broker, who said:

Healthnet had an overwhelming amount of new groups for 1/1/2014 and they are running behind in installing new groups.They have recruited people from other departments to help in the process and are working diligently to enroll groups. Please pass this information on to the employees and please be in touch should you need to see a doctor in the next week or so. ID cards will be mailed ASAP once the group is enrolled.

Eight days into the plan year, we didn’t have the coverage we had paid for. Maybe HealthNet should have bulked up their staff to accommodate the new groups? They knew the deadlines and the expectations for months. Early in January, we also has not received our ACA authorization– which confirmed that my employer is in Arizona and does have employees who are eligible for insurance through the ACA exchanges. We received the authorization from the ACA on January 11 (long before we received insurance cards or a group number from HealthNet.)

Two weeks into the plan year, our broker said that HealthNet was beginning to catch-up, and she sent me a rate memo to sign for the medical benefits but not the vision and dental add-ons that everyone had purchased.

Three weeks after the premium was paid, we still didn’t have insurance cards or a group number. We were told that we could still go to the doctor and just tell them we had coverage [like that's gonna work], or we could pay for services and get a reimbursement [cuz getting money out of insurance companies is really easy... not].

Being a skeptical lot, none of us went to the doctor during January. As a group, we had just paid ~$2500 for one month of service we didn’t receive. At this point I submitted a constituent letter on Congressman Ron Barber’s website complaining about insurance company implementation of health insurance and suggesting he determine how many other Arizonans have paid premiums and not received services from HealthNet or other insurance companies. (Weeks later, I received a generic letter outlining Barber’s mostly Republican-leaning votes on the ACA; there was no indication that anyone had actually read– much less acted upon– my letter complaining about insurance company implementation of the ACA in Arizona.)

Paying for services we didn’t receive would really piss me off if HealthNet had ever sent us another bill. That’s right, we have not been billed for February or March. Ironically, Aetna, who we dumped and have not paid since early December, sent us all insurance cards and promos and continues to invoice my employer, despite the official cancellation letter we mailed to them. Obviously, neither HealthNet nor Aetna are keeping up with enrollments or cancellations. (The Republican bait-and-switchalternative would give health insurance companies more money and more powerbecause it would allow plans to cross state lines. Why should be give them more responsibility when they obviously can’t handle the flood of new enrollees, thanks to Obamacare and healthcare reform?)

One month after the initial payment, we finally got an email from the broker with our group number but were told that it could take 10-12 days before the number would be active in HealthNet’s system. In other words, if any of us had given the group number to a doctor at that point, the system may say the group didn’t exist.  To me, this nonsense smacks of incompetence or extreme understaffing or both. Again, insurance companies knew the deadlines, the expectations, and the potential impact in terms of new enrollees.

Still no cards but we had a group number, which helped employees feel confident enough to think about going to the doctor in the near future. That’s right. HealthNet’s snail speed caused all of us to delay care.

And then… excuse my French, but the real pisser came on January 28 when I found out that we really didn’t have dental or vision insurance– even though the employees had paid $20/person/plan/month for it. We were quoted the wrong price for the add-ons to the medical insurance plan. Great. The vision add-on ended up being much cheaper than the quoted price, but the dental plan was a HORRIBLE deal (~$50/person/month with a deductible, co-insurance, and a $1500 cap per year). Yuck.

Two months after enrollment, employees finally received these ultra-classy paper insurance “cards” on February 20. It’s a really good thing that none of us had a car accident or medical emergency while we were waiting for HealthNet to get its act together. A trip to the Target pharmacy with my new HealthNet card was an eye-opener at how screwed up the system is. My husband has two common prescriptions and has been enrolled in Target’s discount pharmacy program for a year. When I picked up his last prescription, I gave the pharmacy the HealthNet card and asked them what the cost would be with the health insurance. The HealthNet price was $20 for 30 pills. The Target discount price was $21 for 90 pills– one third the cost of the pills under the health insurance plan that I am paying ~$500 a month for!

Three months after enrollment, we still don’t have the vision and dental plans worked out, even though employees have been paying these premiums through payroll deduction. HealthNets’ incompetence will cause my employer to write checks to all employees to reimburse them for premiums paid. The latest wrinkle is that HealthNet said that our employees really are eligible for the cheaper vision plan because that’s only for new groups that sign up by January 1, 2014. Hello! We paid our premium on December 23, 2013, and all of the employees clearly checked the boxes for vision and dental coverage on the enrollment forms. How is that not enrollment by January 1?

Widespread Complaints by New HealthNet Enrollees

How many other Arizonans paid the first HealthNet premium and got no services? 100s? 1000s? A quick Internet search revealed that we are not the only consumers upset with HealthNet’s disorganization. Here are just a handful of scathing reviews of HealthNet service from the Consumer Affairs website. Almost 90% of the complaints on this website give HealthNet a one star rating. Note the recurring themes of poor customer service– waiting for hours on hold, misquotes on premiums, missing bills, switching doctors. How is waiting THREE hours on hold an acceptable level of service? HIRE some people; you obviously have the customers and the money. [Emphasis added.]

Irene from Green Valley, March 5, 2014
These are not ‘once in a while’ things. They are constant. Reaching claims department is an impossibility! I have been cut-off after holding for over 2 hours several times. I have NEVER YET been able to get through to the claims department to even ASK why they are denying claims. In the documents they tell me I only have to pay a $50 copay for an Urgent Care. So far the Urgent Care has charged me $70, and they are now asking for another $50. They say it is because HealthNet is not paying the claim. But of course, I can’t get through to HealthNet claims department to find out why. I have been on hold with customer service literally for hours and hours, but when you do finally get through, they can’t help you with anything – all they can do is transfer you to another department which is ALWAYS the wrong one!!!

Gerogina of California, March 10, 2014
I then contact Health Net on February 3rd to find out why I had not received a bill yet and they state that the bills were sent late and to just make the payment whenever I received the bill. I received the bill on Feb 5th with the wrong premium. I contact their office to find out why it was showing the wrong amount. I’m told that they never received the information from Covered CA and that they cannot contact them over the phone, nor could they take any paperwork from me that showed the correct premium. It had to come directly from Covered CA. Mind you I sat on hold for over 3 hours just to get someone on the phone.

I contact Covered CA and sit on hold for 3 hours and 22 minutes before someone answers and they state that the information is correct in their system and that it was already sent over to Health Net several times and what more did I expect him to do. I told him his job and to contact them by phone to get this handled… He refused and told me to just fax them my Summary page. I contacted Health Net again and sat on hold again for an hour and 56 minutes. The person tells me they cannot accept any faxes from me nor can they log into my Covered CA account to see my information as it has to come directly from Covered CA. They file a report with their ACA department and said I’d hear back from them.

As of today… 33 days later, I still have not heard back from them. I had to file a grievance with the California Department of Managed Health Care in order for Health Net to get in contact with Covered CA to fix my premium issue and I was finally able to make my February payment on March 6th. They still have not address my mailing address issue and now they’re saying Covered CA shows me as terminated for March and active for April. This doesn’t even make sense. Why would someone terminate coverage for one month? They wouldn’t. By the way, I never received notice of this.

Jaimie of California, March 14, 2014
The following letter is a re-telling of the ordeal that my wife has been through over the last several months as she has attempted to be seen by a doctor who is able to help her with the severe pain she has been experiencing in her right forearm.

In January we were rushed to sign up for a new health care plan because Health Net determined that we could not keep the PPO we had with them up to that point. Although it can be easy to blame the ACA for this need to change plans, it is clear to me that it was Health Net’s decision to not modify our plan to abide by the new laws even though it was within their means to do so. With no advice or ability to speak to an agent who could provide us with suggestions with regard to what plan was best for us (due to an overwhelming of the phone and online systems at that time), we opted into a Health Net HMO, the IFP Community care Silver plan. The cost of this plan was more than double what we were paying before.

Upon receiving the details of our selected plan, we noticed that the PCP that we had been assigned was very far away from our home. Subsequently we contacted Health Net directly to change our PCP to one that is closer to our home. On the first call (where we were waiting on hold for approximately 140 minutes) we were told that we did not have authorization to change the primary care doctor for our 3 children who are all under 6 years old. When we asked to speak to a supervisor to resolve this clearly inaccurate information we were told there was not one available and when we persisted we were disconnected from the call.

We called back again later on that same day and were successfully able to change our PCP to Dr. **. My wife was experiencing terrible pain in her right forearm so we contacted the PCP 4 full business days after we changed to this PCP and were told that we could not make an appointment because we did not yet have our new insurance cards. When I asked George the receptionist if he could contact the insurance company directly to confirm that we had switched to this new PCP, he said that he did not have the time and he hung up the phone.

Pete from Flagstaff, March 13, 2014
I purchased a $300 per month PPO plan through Health Net, which began at the beginning of March. Problems started immediately, as soon as I tried to update my insurance with my primary care Doc, (whom I have been well established with for years). I was very surprised when I was told that my primary does not accept Health Net.

I was simply told to get a list of doctors in their network, and see if they will accept new patients. Unfortunately there are no doctors close to my area that accept Health Net. I had also been scheduled to see a cardiologist, (who did accept Health Net), but the catch was they needed a referral from my primary, so I had to cancel. What is the point of having a PPO plan, I am canceling ASAP!!!

My conclusion? The health insurance is organized crime. The only problem with the ACA is its reliance on capitalism and the private health insurance industry for implementation. When will our government realize that Medicare for All is the best plan?

Link to original article from The Tucson Progressive

Read 5741 times Last modified on Thursday, 20 March 2014 18:47
Pamela Powers Hannley

I stand on the side of Love. I believe in kindness to all creatures on Earth--not just people who agree with me or look like me. I believe that people who promote religiosity but use violence, intimidation, and lies to force their ideas upon other people are not following the teachings of any religious leader.

I have a bachelor's degree in journalism from Ohio State University and a masters in public health from the University of Arizona. In addition to being a blogger, I am a published author, photographer, clay artist, mother, nana, and wife.

My Tucson Progressive blog and Facebook page feature large doses of liberal ideas, local, state, and national politics, and random bits of humor. I also blog at Blog for Arizona and the Huffington Post. I am a proud member of Progressive Democrats of America (PDA).

Trans Pacific Partnership Fast Track - Where Does Your Legislator Stand

Click your state to see your Senators and Representatives

Green = Most Legislators Oppose Fast Track, Yellow = Some Opposition, Orange = Oppose TPP, Gray = Unknown
DeLauro 13 - Signed 2013 DeLauro/Miller letter
Pocan - Signed Freshman Letter Opposing Fast Track
W/M - Signed Ways and Means Letter opposing TPP
Gibson - Signed Rep. Chris Gibson letter opposing TPP
SOPA - Oppose Stop Online Piracy Act - voted against
Currency - Oppose Currency Manipulation (Signed Michaud Letter)
Textile - Oppose changes to "First Yarn" (Signed Textile Industry Letter)

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  • Letters: More scrutiny of the TPP trade pact
    Letters: More scrutiny of the TPP trade pact The TPP also would extend trade preferences to such countries as Vietnam instead of holding them accountable for their deplorable human rights and worker records.  And the TPP would enable polluting corporations to challenge clean air and water policies if they interfered with expected profits.

    Written on Friday, 01 November 2013 15:15 Read more...
  • Trade Issues Remain Low-Profile in Congress
    Trade Issues Remain Low-Profile in Congress

    To hear lawmakers tell it, efforts to move trade legislation through the House Ways and Means Committee, while earnest and ongoing, have hit snags in the 113th Congress.

    Several big pieces of legislation are slowly winding their way through the committee, including bills dealing with trade-promotion authority and the proposed Trans-Pacific Partnership.

    Written on Thursday, 24 October 2013 15:45 Read more...
  • Trading You In
    Trading You In

    Ten score and thirteen years ago corporate forefathers began conquering wilderness, steam, gas, oil, electricity, transcontinental rails and airways communication, prospering by quenching America’s thirst for more, better, faster.  Now we who built it, want more, faster, so thinking locally, we trade globally.  Thus unlike you, we will always have money to eat.

    Written on Monday, 21 October 2013 00:00 Read more...
  • Will Obama Fast-Track the Trans-Pacific Partnership?
    Will Obama Fast-Track the Trans-Pacific Partnership?

    President Barack Obama has demanding a ‘trade promotion authority’ from the United States Congress to fast-track the Pacific Rim treaty, the Trans-Pacific Partnership.[1]

    The fast-track authority plays a pivotal role in determining the extent to which the United States Congress can engage in a critical review of trade agreements.[2]

    Written on Thursday, 17 October 2013 20:25 Read more...
  • There's an International Plan to Censor the Internet in the Works -- Let's Stop It in Its Tracks
    There's an International Plan to Censor the Internet in the Works -- Let's Stop It in Its Tracks

    How the Trans Pacific Partnership making its way through Washington seriously undermines citizens’ rights to participate in a free and open Internet. One month. That’s the time left before the Trans-Pacific Partnership (TPP) could become a finalized agreement.

    Written on Wednesday, 16 October 2013 00:05 Read more...
  • A Corporate Coup in Disguise
    A Corporate Coup in Disguise

    The Trans-Pacific Partnership would create a virtually permanent corporate rule over the people. What if our national leaders told us that communities across America had to eliminate such local programs as Buy Local, Buy American, Buy Green, etc. to allow foreign corporations to have the right to make the sale on any products purchased with our tax dollars?

    Written on Thursday, 03 October 2013 03:17 Read more...
  • 'Flush the TPP!': Protesters Scale Trade Building in Protest of Secretive Deal
    'Flush the TPP!': Protesters Scale Trade Building in Protest of Secretive Deal

    Protesters scaled the Office of the U.S. Trade Representative on Monday and dropped banners calling for greater transparency and an end to "corporatocracy" over the ongoing and secretive Trans-Pacific Partnership trade agreement currently in the works between the United States and several Pacific nations.

    Written on Tuesday, 24 September 2013 03:31 Read more...
  • Secretive Free Trade Agreement Puts Climate, Public Health at Risk
    Secretive Free Trade Agreement Puts Climate, Public Health at Risk

    New warnings on TPP, free trade 'regime' fostering 'global emergency situation'

    As secretive talks over the Trans Pacific Partnership (TPP)—the pending free trade agreement slammed as "NAFTA on steroids" and "a quiet coup for the investor class"—continue, new warnings highlight the corporate winners and global losers at stake.

    Written on Monday, 16 September 2013 02:45 Read more...
  • Stop the Trans Pacific Partnership Fast Track
    Stop the Trans Pacific Partnership Fast Track

    President Obama has asked Congress to provide “Fast Track” authorization for consideration of the Trans Pacific Partnership (TPP) a new “free trade” deal.

    The negotiations for this new “free trade” agreement have been conducted in secret. Members of Congress as well as the public have no factual information about the contents of this deal.

    Written on Sunday, 15 September 2013 17:36 Read more...
  • TPP Talking Points

    The Trans-Pacific Partnership (TPP) is a proposed agreement between the U.S. and 12 nations that do business throughout the Pacific Rim. TPP and its European cousin the Transatlantic Trade and Investment Partnership (aka TAFTA), are "free trade" agreements that do much more than the term implies.

    Written on Monday, 02 September 2013 00:00 Read more...
  • Obama's secret trade deal threatens prescription drug prices on global scale
    Obama's secret trade deal threatens prescription drug prices on global scale

    The US pharmaceutical industry has been shaping elements of the Obama administration’s secret Trans-Pacific Partnership trade agreement to favor their own profits. But the deal could also could cause the price of prescription drugs and some medical devices to soar on a global scale.

    Written on Saturday, 27 July 2013 00:00 Read more...
  • Pocan Calls for Increased Transparency on Trans-Pacific Partnership Free Trade Agreement to Protect American Jobs
    Pocan Calls for Increased Transparency on Trans-Pacific Partnership Free Trade Agreement to Protect American Jobs

    Pocan urges Congress not to give up its constitutional authority to oversee foreign trade agreements

    Written on Friday, 14 June 2013 00:00 Read more...
  • Alan Grayson On Trans-Pacific Partnership: Obama Secrecy Hides 'Assault On Democratic Government'
    Alan Grayson On Trans-Pacific Partnership: Obama Secrecy Hides 'Assault On Democratic Government'

    Progressive Democrats in Congress are ramping up pressure on the Obama administration to release the text of Trans-Pacific Partnership, a secretive free trade agreement with 10 other nations, amid intensifying controversy over the administration's transparency record and its treatment of classified information.

    Written on Thursday, 13 June 2013 00:00 Read more...

Join "Countdown to Coverage" Share TPP with your Daily Newspaper

CWA devised a simple plan for which they were uniquely suited: drag TPP out of the shadows and into the light - one city at a time - using a medium they understand intimately: Daily Newspapers!

Two CWA members - Dave Felice in Denver, CO and Madelyn Elder in Portland, OR have started the ball rolling. We just need to keep up the momentum leading up to a big day of petition deliveries.

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Step 1 is to send an Op-Ed to your Daily Newspaper.

Join our Twitter Storm

If you have a Twitter account you can help stop Fast Track on the TPP. Sign-in to your Twitter account and copy and paste the Tweets from our Twitter storm. Or you can copy your favorite Tweet and then click on the map and Tweet your legislator.

Twitter Storm Tweets for Tuesday, January 28th @ 9pm Eastern

Tweets for the special State of the Union Twitter Storm will be posted on January 28th at 8pm EST. Check back for the new Tweets.

Find Your Member of Congress

Click here to quickly find your member of Congress by putting in your home address. This site also features a one-click link to the same information in Spanish

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Then call and ask them to oppose Fast Track on the Trans Pacific Partnership.

Sample script is below.

Script

“I'm a constituent, and I am strongly opposed to my representative giving away Congress’ constitutional authority to control our trade policy. We send people to Congress to stand up for us, not give away their power to stop more American job offshoring and protect us from dangerous imported food that doesn’t meet our safety standards. This latest so-called trade deal, the Trans-Pacific Partnership (TPP), would not only do that - but also ban Buy American and increase our medicine prices. That’s why it’s crucial that Congress not give away its authority to make sure every provision of TPP is in our interest before this massive deal can be signed. Good trade deals don’t need to be railroaded through Congress using Fast Track. I hope my representative will commit to opposing this outrageous legislation.”

Email Your Senators and Rep - Say No On Fast Track and TPP

Send an email directly to your Senators and Representatives courtesy of our partners at CWA. Enter your zip code and your members are automatically selected.

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Sign the Petition - Sen. Sanders Run as a Democrat in 2016

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Report on your TPP Contact

Please let us know your legislator's stance on Fast Track Authorization for the Trans Pacific Partnership as well as their stance on the TPP in General. Click here to report the response.

The Trans Pacific Partnership: Corporate Global Domination

Lori Wallach on the TPP from PDA Progressive Roundtable

Progressive Roundtable with Reps. Ellison and Pocan and Lori Wallach on TPP

Lori Wallach Leaked TPP Documents (Democracy NOW)

TPP: The Biggest Threat to the Internet You've Probably Never Heard Of

Lori Wallach on Thom Hartmann (Great Minds) - The TPP

Flush the TPP

Congress only has one more week in session this year, the week of December 9. So far our pressure to stop the TPP has been working. Visit Flush the TPP for calling scripts and links to Members of the Ways and Means Committee.

Flush the TPP

TPP Downloads

The following documents are available from the Oppose TPP Downloads Folder

June 29th TPP Powerpoint

CWA TPP Jobs Report