Since Thad retired two years ago, there has been a tradition. On December 31st our health insurance coverage gets dropped. We usually find out by going for a doctor’s appointment or picking up prescriptions from the pharmacy and are told our insurance has been cancelled. We are not sure why it happens or even how it happens; but I am beginning to wonder whether “they” know something we don’t. Like, are we dead and just didn’t get the memo?
You would think that a phone call to the health insurance company would straighten it out quickly but….alas, today health insurance is extremely convoluted and even if you have a PhD in health administration, it makes no sense. It amazes me how many people and companies it takes for two people to have health insurance.
When Thad retired we continued our Blue Cross Blue Shield coverage that had been provided by his employer through COBRA. COBRA stands for Consolidated Omnibus Budget Reconciliation Act. Oh, that clears it all up, right? COBRA is the federal law that provides many workers with the right to continue coverage in a group health plan.
OK, simple enough, right? No, because COBRA is often handled by middle-man companies such as Benefit Strategies. They work with the employer and the insurance company to continue our group benefits.
Last year, we were dropped off the rolls either by the employer, the middle-man company, or Blue Cross, Blue Shield. We could not trace it back to anyone particular company or person, but it took several layers of people, and all three companies to put us back on the rolls.
Thad turned 65 last July and went on Medicare. However, he retained the COBRA for his dental and eye care. I remained on COBRA for all my healthcare needs. Sounds simple enough but keeping track of payments to Medicare A, B & D, Blue Cross, Blue Shield Supplemental and my COBRA Blue Cross, Blue Shield through the middle-man company has me inquiring about classes at the community college in accounting.
The tradition continued again this year when on January 5th, 2015 the pharmacy told us that I did not have coverage and we had to pay out of pocket.
Thad took hold of this issue because I was down with the flu and cold and would not have shown anyone grace or patience. No, Thad knew he needed to handle it. And he did. He called the middle-man company who could not find a reason for the cancellation and was surprised when we told them that they had cashed our check for January 2015. They told him they would check into it. Have you heard from them? We have not. Thank goodness Thad decided to do an end run around them and called Blue Cross Blue Shield who also had no clue as to why I was cancelled. They referred him to his past employer who was very surprised as well and could only state that they had recently gone to a national plan for COBRA and this may have been the culprit. It took three days’ worth of phone calls and emails to get back on the system.
I have to add that everyone at the middle-man company, Blue Cross Blue Shield and his previous employer was most kind, apologetic and willing to help solve the problem. Each of the three companies switched him from one geographic office to another (CT, NH, Maine, NJ, Indianapolis and back to CT), dropped a few calls, all in the attempt to help him resolve this problem. Throughout these three days Thad remained calm and full of grace, even inquiring as to where his call was being received from and “How is the weather?” “Really? I’ll tell them how the weather is!” I thought. “It’s cloudy, raining and a tornado’s brewing right here in Boca Raton, FL!” With sniffles, aching muscles and a head that felt like concrete, I was listening to all this while madly gesturing like an Italian policeman directing traffic in the middle of a busy piazza in Rome. I was growling and keeping a running commentary on all that I was hearing. In the end, they fixed it. Accept in the process of getting my insurance reinstated they dropped Thad from his COBRA dental coverage! Yup! So Thad got back on the phone – more time- and more patience than I will ever have even on a good and healthy day and got the problem solved. I am so blessed to be married to a man who displays a Godly character and I need to have him give me a few lessons on patience and perseverance.
How can the average person cope with this? Thad and I have a background filled with medical issues and are well versed in navigating through the healthcare industry, but even I have to scratch my head and resist the urge to gouge someone’s eyes out. How do the elderly or the sick cope?
My suggestions are:
- Keep good records. Write down the name of every company and person you called along with the date of the call.
- Write down everything they say they will do, when they will have it completed, and what they want you to do.
- Understand your insurance coverage. Don’t be afraid to ask questions. And if more than one company is involved create an organizational chart if you have to, but do it!
- If you are not making any headway, ask to speak to a supervisor.
- Call a friend or family member that has experience or patience to help you. Even enlist the help of your healthcare professional’s business manager if need be.
- Have patience, keep your calm, and don’t shoot the messenger (the poor guy or gal on the receiving end of your confusion, frustration, and fear).
I have not gone to a doctor since this year’s tradition occurred but I do have an appointment with both my cardiologist and internist next week. I have a temporary card which I received via email with the promise of a “hard” card within 7-10 business days. If all goes well I should be covered. At least until December 31, 2015.
I am just a little nervous.
But the seed on good soil stands for those with a noble and good heart, who hear the word, retain it, and by persevering produce a crop. Luke 8:15 NIV