Senate Majority Leader Harry Reid (D-Nev.) declared yesterday that all of the “horror stories” being told in relation to the federal health care law are false (Washington Post, 2/26/2014).
I have been an insurance broker for over a decade, and I can tell you I have never had to call the Illinois Department of Insurance for help regarding health insurance the entire time, that is until December of 2013. I think I have had a weekly phone call since for a variety of issues.
Let’s start with the cancelled policies. My personal policy was cancelled. The Affordable Care Act plan that was then offered to me raised the deductible from $5200 to $12,700 and was increasing the premium by over $100 per month. I was able to find another plan without having to convert to the ACA for now, still had to get a higher deductible and am still paying more than I was.
Now it is time to get serious. I wrote a plan for a client in late December. It was in Illinois. I will leave the carrier out of it, but the carrier had two networks, a full blown type PPO plan, and then they had one with a smaller network. Historically, the smaller network was fine in the Chicago Suburbs, but was limited in the City of Chicago. Whenever I wrote that plan, I took some extra time to be sure the client’s doctors and hospitals were part of the network. Well the ACA rolls out and they still have the same two networks and kind of the same territories limited in Chicago not bad in the suburbs. This plan by the way with the smaller network is priced about $200 per month less than the larger network.
Again the client was from New Lenox, Illinois. I checked her hospital and her doctors. All was good, so we wrote a Gold level plan. Well a few days later, they hear through the grapevine that their hospital will not be taking that plan after January 1, 2014. So we think about changing plans at that time, the realize there is another hospital only a few miles farther in the opposite direction that was known as a good hospital so they decide to stay put on that plan.
In January, they go to see their doctor and he no longer takes that network. Suddenly, they are diagnosed with a serious illness and guess what? February 1 this hospital dropped out of the network. Now we are still in open enrollment so we figure we can change, not big deal right? We call the insurance carrier, they say since you purchased it through the marketplace, you need to call the marketplace. You call the marketplace, they say, since you have already made a payment, you need to call the carrier. And so it goes. We call the Department of Insurance, they say this type of thing is happening in many areas and to many people. I read an article about the same thing happening in other states. Trust me this is not a lie.
Ok, client number two. Wanted to enroll their entire family, the marketplace wanted to put their kids on Medicaid, and the parents on a regular plan. Because they want to put the kids on Medicaid, they did not qualify for a subsidy. We wrote the plan off the marketplace without a subsidy, because the client did not want their kids on Medicaid.
Horror story number three… A client calls to order her diabetic fusion set. The company says they are no longer in the network, sorry we cannot help you. I had to track down a company that could help her.
These are real life horror stories. Not to mention those who were cancelled and could not find something similar to what they had previously.
We keep hearing it is the Republicans ( by the way none of them voted for the law) or it is Fox news, telling stories that are trying to destroy the law.
Here is the thing, the law is flawed, the problems are real, they need to be addressed. Thanks for reading!