When the new federal healthcare marketplace promised to offer health coverage for families and individuals who didn't have access to group coverage, I thought it worth a look. After all, I have kids – and that means kiddo illnesses, checkups, and tons of opportunities for visits that cost 250% or more of what insurers pay if accessed without some kind of group discount. (Mind you, physicians and hospitals participate in shoving people into groups that abuse physicians and hospitals: in charging me extra to pay cash up front, instead of giving me a cash discount for saving the physician from repeated billing transactions and months of delays, medical care providers help insure that the only people with market power are the third party intermediaries.)
So the first thing I did was to make sure the plan I picked would include my kids' existing pediatrician. As a plus, I wanted to ensure a doc I wanted to see for a physical would be covered by the plan. Else, why bother? So I used the HealthCare.gov tool for searching physicians on plans and was confirmed: Blue Cross Blue Shield of Texas confirmed that Steve Alley participated in Blue Advantage plans. My doc, too. Cool, huh?
The coverage was about what I was paying on my own for an individual plan from another insurer, but it promised to be free of some exclusions common in the individual health coverage market. So, what the hell? I clicked yes.
But I wasn't covered yet. I had to figure out how to pay for the first month, before it began. It was March, and I was in a race. Every tool for paying for coverage required numbers that Blue Cross hadn't mailed me yet. I became nervous. Finally, the week before coverage started, I got a packet with the numbers. Fighting my way through the web site to make a payment finally became possible.
I say "oops" because the minute the coverage went active and I could see what Blue Cross was willing to tell active subscribers, it seemed I and my children had been randomly assigned to some joker I'd never heard of, whose claimed credentials were of a kind I make a practice to avoid. So I tried to change their assigned doc to their pediatrician … only to discover Steve Alley wasn't available through my Blue Advantage plan. Nor my own doc.
After an hour and a half on the phone I reached someone who told me it was my fault for signing up with the wrong plan, and did I want to pay more for a plan that included Steve Alley and my own doc? Now, before you dismiss the hour-and-a-half as the rantings of an unhappy customer who hasn't bothered to wind his watch, I'll digress a little. The number on all the Blue Cross paperwork I had led me to a bank of people who – after I'd been on hold a while – offered to walk me through some kind of orientation to the health plan. None of them claimed to know anything about the physicians actually available through any of the plans and how to fix the problems I had signing my kids up for their pediatrician. And none of them seemed to want to let me go without the orientation. Several eventually allowed themselves to be persuaded to transfer me someplace else, but the hold queue felt oppressive and I was disconnected once and when I finally got to a human in a department that claimed to be in the know, I spent a long time repeating my story while getting escalated. During this escalation I suffered repeated accusations that I somehow was at fault for failing to discern that when Blue Cross represented Steve Alley was covered on Blue Advantage plans, my specific plan was excluded. I was even asked whether I used the HealthCare.gov marketplace portal search tool or Blue Cross', and honestly I had no idea where I'd been led by the link I clicked to search from HealthCare.gov – so I tried using its tools to search plans.
I was barred: HealthCare.gov decided that since it thought I had a plan, I didn't need access to information about any plans in the marketplace. Access forbidden.
So, who knows whose database steered me astray? It's hard to believe HealthCare.gov would offer anything but an interface to Blue Cross' database, or a link to Blue Cross, so I figured the problem was Blue Cross'. It's not like I didn't look at the list of covered plans listed for each doc and try to work out whether the list did or didn't include mine. They both said Blue Advantage, though – just like the cards Blue Cross finally sent. And that's why it was an hour and a half before I worked out Blue Cross never had any intention of allowing my kids to see their pediatrician under the plan it sold me through the healthcare.gov marketplace. At least, not that it'd pay a cent to support.
And did I want to pay Blue Cross for having successfully duped me with a bait-and-switch?
Well, no. I'd started out with a plan that included Steve Alley and my own doc. I didn't need to pay more to someone willing to waste my time like this. I was told I'd have to cancel online.
So I went to the web site where the physician database existed, hunted for the way to do it. Finally I found a place that purported to allow secure communication with Blue Cross. I briefly laid out the bait-and-switch, pointed out that the policy hadn't come into force yet, and gave a clear and unambiguous instruction to take any steps required to cancel the policy: I gave notice of cancellation.
I didn't hear back. A few days later I tried to verify the cancellation and saw I'd been given a form letter that didn't address my problem. I stated bluntly that I hadn't "asked about" changing policies or the like, I'd given a cancellation order. My only request was that Blue Cross confirm the cancellation.
What could be simpler?
So imagine my surprise the weekend the coverage was supposed to begin, when – never having been contacted by email or phone – I checked Blue Cross' web site to verify the cancellation. I figured verification would take the form of inability to log in: the cancelled account would cancel my login credentials. The idiots hadn't bothered to communicate with me using any medium that didn't require an active Blue Cross account to access. But, the login worked. Once I dug around and found the tool for "secure" communication with Blue Cross, I hunted down its latest note.
Blue Cross refused to cancel the coverage, or communicate my cancellation to anyone who could do it. And it didn't see fit to warn me it would do this before the weekend coverage was due to start. Instead, Blue Cross had silently posted a notification accessible only though its own site, about which it never sent me a notice or called, despite the obviously time-sensitive nature of my concern.
At this point, you can see I wasn't happy with Blue Cross. But in its note, Blue Cross blamed HealthCare.gov: I needed to cancel a marketplace-purchased plan through the marketplace. This is a crock; the marketplace never in fact sold me anythnig – I had a minor war figuring out how to pay, and it wasn't through HealthCare.gov. But, fine. I struggled to work out how to log back into HealthCare.gov and then struggled through the site combing for some clue how to cancel. When I stumbled onto it, it felt like dumb luck.
But then I had it: after a few screens, a page that said "Statis: Cancelled". It gave an effective date one day into the coverage term, which irritated me. But, I was finally done.
Or, was I?
I kept getting invoices. I kept getting packets. I even got a packet demanding I sign a waiver acknowledging that the coverage through the Blue Cross plan marketed through the federal healthcare marketplace did not include coverage for mandatory services the Texas Department of Insurance or a state statute required in every health insurance plan issued in the state. Just sign to acknowledge and accept the inadequacy of the policy sold through HealthCare.gov.
I called back. Damn long hold, but I got a human who said the coverage wasn't cancelled, that it was active, that it was a marketplace plan and could only be cancelled through the marketplace.
"No, if you did we'd have been sent a notification."
"I'm looking at a PDF of it. Where do you want it faxed?"
I took down the number.
"If I fax this, will that do it?"
"Oh, yes. It may take a few days."
I faxed it.
But, no: another invoice. More than a thousand bucks, demanded for a bait-and-switch I'd cancelled as unacceptable before delivery.
By this time, I'd worked out the number to call. After only sixteen and a half minutes of abysmal hold music interrupted by a recorded voice, I had a human on the phone who told me I had purchased the plan through the marketplace and could only be cancelled through the marketplace.
"I did that. And I faxed you the confirmation."
"We need to get it from the marketplace."
"You did. And you got it from me. What more do you want?"
Apparently, to put me on the phone with HealthCare.gov. I almost laughed. A human had never been available to me when I'd tried HealthCare.gov – and I'd looked. Blue Cross needed me on the phone to tell HealthCare.gov it was okay for HealthCare.gov to send Blue Cross the cancellation I'd entered on HealthCare.gov to cancel coverage with Blue Cross. I kid you not. After thirty minutes on hold with HealthCare.gov we were connected with someone who required I recite my Social Security number, address, birthdate … then put us on hold while checking into the account. Did I have an application number?
"Where would I find an application number?"
"I don't know."
"Is it this number on the cancellation form I'm looking at? Called an ID#?"
"Read that to me."
I did. Then, Blue Cross and I got put on hold. I can't tell you how long we were on hold before we were disconnected. Blue Cross, thankfully, called me back. Blue Cross: "Somehow I just got disconnected with them, so I'll have to call them back." Then, back on hold. After another 16 minutes I was made to recite my Social Security number, my address, my birthdate, a number from the cancellation form (that nobody told me to save from March when I saw it on HealthCare.gov and had the good sense to save as a PDF), and then placed on hold while the attendant "reached out" to a "supervisor" who apparently told her she could confirm to Blue Cross the cancellation date of the coverage. This, of course, was useless: I'd told Blue Cross the date too, but they needed The Magic Form sent to whatever system processes cancellations from "the marketplace". Blue Cross confirmed it was true: they needed the cancellation transaction conformation sent through some king of purpose-built channel for it to work, because there was apparently no human at Blue Cross with the authority to process it.
At 24 minutes into the next hold of the day, the healthcare marketplace came back to the phone to confirm my phone number. So that in thirty days, a case worker can call me about it. They still won't assure me it's over.
My advice? If you have no existing coverage, or don't care who your doc is, this may be a step in the right direction. But it's not what anyone would expect after dealing with an insurance agent who expects to be paid for successfully concluding transactions.