Wednesday, July 8, 2015

Paid up but Uncovered: Insurer Cites "Rate" Glitch in City Woman's Policy

Michelle Lamb, a 39-year-old West Oak Lane day care teacher, made three monthly premium payments at more than three times the subsidized rate she should have been paying just to make sure she was covered. And her insurance has still been canceled three times - for nonpayment.

Paid up but Uncovered: Insurer Cites "Rate" Glitch in City Woman's Policy

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Michelle Lamb, a 39-year-old West Oak Lane day care teacher, made three monthly premium payments at more than three times the subsidized rate she should have been paying just to make sure she was covered. And her insurance has still been canceled three times – for nonpayment.

Her case may be an outlier.  But some people are still getting lost in the download between the government and the insurer.

Since she complained to The Inquirer, Lamb said, the insurer has promised to “straighten everything out. I’m pleased with the conversation but nothing has been done yet.”

To read more of the story, click here.

We asked the blog’s board of contributors for their thoughts:

“Unfortunately, Michelle Lamb’s story reveals an ugly side to the Affordable Care Act (ACA)—complexity is a feature, not a bug. Obamacare’s health reforms are built on a complicated health insurance infrastructure. In order to minimize disruption of coverage for those who already have it, the ACA essentially subsidizes the purchase of health insurance from private companies through health insurance exchanges. 

Michelle is one of the many unfortunate souls bounced around the purgatory that is health insurance in the US. The effect is magnified by the structures created to purchase health insurance and the increasing number of people who now have the means to purchase in this market.

There were two alternative proposals that could have alleviated some of these administrative challenges. First, a government-run plan like Medicare could have been made available to everyone as one of the choices on the exchange — the so-called public option. Or, everyone — insured and uninsured — could simply be moved into one new federal plan—single payer. Neither was included in the final bill because both significantly diminished the private insurer’s role. Single payer, in particular, would prohibit the purchase of private health insurance and require the 80+% of the population with coverage to get a new insurance plan.

In essence, Michelle’s troubles are partly the result of the political compromise necessary to create the ACA in the first place.” Drew Harris, DPM, MPH


“We do not know how many highly motivated consumers, like Ms. Lamb, have been unable to “seal the deal” with their health insurer to get an insurance card. 

Ms. Lamb had no difficulty on the so-called “front end” of the enrollment process (using the marketplace to sign-up and select a health insurer). It’s the back end—i.e., receiving an insurance card—which is key to getting non-emergency medical care, which has been tortuous.  She’s doing everything we advise: keep proof of correspondence with and payments to health insurers.  

We hope Independence Blue Cross resolves her situation quickly so she can get treatment for any current illnesses or chronic condition.”Laval Miller-Wilson

What are your thoughts about Obamacare enrollment difficulties?

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About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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