- Posted December 14, 2013 by
This iReport is part of an assignment:
Obamacare: Your story
Obamacare Marketplace Denies Health Coverage for Two Healthy Children, System still broken, 9 days left to enroll
Allow me to introduce to you Allyson Badman, a 15 year old healthy scholar athlete at Palisades High School located in Kintnersville, PA who is not eligible for ANY health insurance coverage. According to the eligibility letter dated December 4, 2013 sent from the Health Insurance Marketplace. Allyson “ might be able to get health care at a lower cost. The health care law has expanded funding to community health centers, which provide primary care for millions of Americans. These centers provide services on a sliding scale based on your income. Learn more about getting care at a community health center on HealthCare.gov.”No information was provided as to what the next step should be or the reason for the denial of any ability to purchase healthcare coverage for Allyson.
Allyson's sister Stacey will also not be insured after December 31, 2013, because the Marketplace sent her application to the state of Pennsylvania. Stacey is a 12 year old scholar athlete at Palisades Middle School located in Kintnersville, PA. The eligibility letter states
“You will receive a final decision from the Pennsylvania Department of Insurance. If you qualify for Pennsylvania CHIP, you won't qualify for a tax credit and lower copayments, coinsurance, and deductibles for Health Insurance Marketplace coverage.” When the state CHIP department was contacted to find out the status of Stacey’s application for coverage, the representative, stated that no application could be found in the system yet for Stacey, it could take at least 30 days for applications to be processed.
Currently both Allyson and Stacey have Keystone Health Plan East HMO health insurance purchased by their self employed parents. Keystone Health Plan East will be phasing out the current health plan on December 31, 2013. The family must enroll and pay for a new health insurance program by December 23, 2013 in order to have coverage starting on January 1, 2014.
On December 4, 2013, the Badman family selected the Keystone Health Plan East Platinum HMO plan. Only Steve and Wendy, parents of Allyson and Stacey, were accepted into the plan. Numerous telephone calls were placed in regards to the exclusion of coverage for Allyson and the marketplace decision to send Stacey’s application erroneously to the PA CHIP program. The first marketplace associate contacted stated she would delete the original application, it would take 24 hours to clear the system, then a new application could be filled out. As of December 14, 2013, the original application is still in the system. A marketplace supervisor contacted stated that once an application is completed, it cannot be deleted, even if payment for the plan has not been sent to the insurance company. Marketplace employees and supervisors stated an appeal would need to be processed for Allyson and Stacey, appeals are time sensitive, however no where on the website is the timeline listed. The appeal form as well as the marketplace website state appeals can be filed by calling the Marketplace at 1-800-318-2596. Each time an appeal was attempted by calling the Marketplace telephone number, the employees and supervisors stated it was not possible to file an appeal on the telephone or on the website. Appeals could take up to 90 days to be processed. There is no telephone number at the appeal office to contact to inquire about appeals filed and no link to view the status of an appeal on the marketplace website. The appeals form has a telephone help line number for Questions, “You can also find out how to talk to someone in person, online, or through the help line,” “call 1-800-318-2596”. When contacted, Marketplace employees and supervisors state all appeals must be filed using the appeal form and mailed to London, KY. https://www.healthcare.gov/downloads/marketplace-appeal-request-form-pa-wy.pdf
According to a press release from RHD, dated August 16, 2013, a Federal grant totaling “$953,176 was awarded to RHD on August 15th, as Health and Human Services Secretary Kathleen Sebelius announced a total of $67 million in awards to 105 Navigator applicants in 34 Federally-facilitated and State Partnership Marketplaces.” http://www.rhd.org/News/13-08-16/RHD_to_Champion_Health_Insurance_Coverage_with_award_of_federal_Navigator_grant.aspx “These Navigator grantees and their staff will serve as an in-person resource for Americans who want additional assistance in shopping for and enrolling in plans in the federally-run Health Insurance Marketplace beginning this fall.”
A Marketplace employee advised contacting the Philadelphia Marketplace for assistance with the appeal process. An enrollment navigator at the Philadelphia Marketplace was contacted on December 5, she explained she can only help enroll people, she cannot help with appeals and didn’t know why her number keeps being given out to help people already in the system. A call placed on December 10, to an enrollment navigator for the Upper Bucks Marketplace went directly to voicemail, a message was left, requesting assistance and a return phone call. As of December 14, no return phone call was made to the Badman family from the Upper Bucks navigator office. A subsequent call placed to the Upper Bucks navigator went directly to voicemail as well on the following day.
Keystone Health Plan East does not have the ability to enroll people who qualify for tax credits that reduce the cost of the monthly fees to purchase health insurance. Anyone who qualifies for a discounted insurance plan must apply via the Healthcare.gov website.
Congressman FItzpatrick’s office was contacted for assistance in fixing the computer glitch in the Marketplace. The constituent coordinator said that the Congressman cannot help, that no Congressional liaison has been assigned to the Health and Human Services department for Marketplace enrollment issues. She advised to document the difficulties experienced. PA State Representative Quinn’s district office was contacted to assistance with the PA CHIP application process. The constituent service coordinator said problems with the Marketplace Insurance process was a Federal problem, the state cannot help. Senator Robert Casey’s office was contacted for assistance in getting a resolution since there is a tight deadline before enrollment opportunities expire. The constituent services coordinator stated a privacy release form must be filled out first. The form also had a section to describe the problem, another section for information on what has been done to attempt to resolve the problem and a final section asking what specifically you are asking the Senator to do to help resolve the problem. After the form and supporting documents were sent to Senator Casey via email and fax, a confirmation email was sent on December 13 stating: “I received your information and it will be forwarded to our Congressional Liaison, as soon as we can prepare our letter to them.”
Less than 9 days remain to enroll in the Marketplace Health Insurance Plan deadline of December 23, 2013. If Ally and Stacey are not enrolled in a new plan by that date, they will not have health insurance on January 1, 2014. If Ally and Stacey are enrolled in a Health Insurance plan outside of the Marketplace, while their cases are being appealed, tax credits totaling approximately $3,552.00 will be forfeited according to a licensed representative at Keystone Health Plan East. “Tax credits are not retro fitted”. Can you help get Allyson & Stacey enrolled in their family’s Marketplace Health Insurance Plan before the deadline of December 23, 2013?
Official Appeal Form: https://www.healthcare.gov/downloads/marketplace-appeal-request-form-pa-wy.pdf
Link to PR reporting $67 MILLION grant for Navigator program to help enroll Americans into Health Care Program
#ObamaCare #HealtcareReform #Marketplace #ACA #HealthInsurance #InsureAlly #InsureStacey