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Access Health CT Looking Into North Haven Woman’s Policy Cancellation

by Christine Stuart | Jun 24, 2014 5:30am
(19) Comments | Commenting has expired
Posted to: Health Care

CTNJ file photo

Access Health CT’s storefront in New Britain

Gail Demartin of North Haven paid her monthly premiums for her insurance she purchased through Connecticut’s health insurance exchange, but she received notice that her plan was canceled on March 8.

She was told it was because funds were not available for her premium. However, along with the cancellation notice she received the check she sent to make her premium payment. Demartin, like 70 percent of those purchasing insurance through the exchange, receive a subsidy from the federal government for a portion of their monthly premium.

If she paid her portion of the bill is it possible Uncle Sam just failed to pay the difference?

Frustrated with the lack of answers she was getting from Access Health CT, Demartin reached out to her elected representatives, including Sen. Leonard Fasano.

Fasano and House Minority Leader Lawrence Cafero wrote Access Health CT’s CEO Kevin Counihan earlier this week asking for an explanation, because Demartin wasn’t the only constituent to inform them a plan had been canceled.

Unable to explain what had happened, Fasano and Cafero asked Counihan for an explanation.

“What is the source of the problem; how many people have been so affected; how will the issue be addressed so that coverage can be restore?” wrote Fasano and Cafero.

In a June 17 response, Counihan says his office has “received no such complaints of this sort.” Counihan was referring to the cancellation of policies due to the nonpayment of federal subsidies.

In a phone call last Friday, Counihan said they were looking into Demartin’s case file, but he said he didn’t have a good answer as to why her plan would have been canceled if she was paying her premium.

Demartin said that’s odd because she calls the Access Health CT offices on an almost daily basis seeking answers. She said she has never received a phone call back from the center, which she said seems to dutifully take your information and give you a reference number that you provide to them the next time you call.

Demartin said she has four unpaid doctor bills and a CAT scan, which was pre-authorized by her insurance carrier, Anthem. However, Anthem said she’s no longer insured so they won’t pay it. She has re-applied for insurance and was supposed to hear back.

CTNJ file photo A spokeswoman for Anthem said none of their clients who are subsidized by the federal government have been canceled.

But what about Demartin?

It’s possible the form Access Health CT sent over to Anthem detailing the amount of the subsidy the company would receive from the federal government was wrong.

The income data a client gives to Access Health CT is verified with the Internal Revenue Service before the information is sent over to the insurance carrier. There have been some problems with the way in which the information is transmitted to the insurance carriers, but the two other insurance carriers participating in the exchange say they aren’t experiencing the same problems.

“Anthem has not and would not cancel a member entitled to a federal subsidy on the basis of not receiving the applicable subsidy payment from the federal government,” Sarah Yeager, an Anthem spokeswoman, said in an emailed statement last week.

Yeager continued: “Members may be cancelled on the basis of a member’s failure to pay their portion of any premium due after the expiration of the applicable grace period. On the occasion that we have subsequently received updated information indicating that the member was entitled to a federal subsidy, we have worked quickly and diligently to reinstate the member and cover them retroactively.”

It’s possible Anthem had no idea Demartin was supposed to be receiving a subsidy based on the information it received from Access Health CT.

Connecticut Republican leaders, who have been critical of Obamacare, want to know how many more residents are in the same situation as Demartin.

State Healthcare Advocate Victoria Veltri said Monday that she didn’t think the situation was widespread. However, there have been cases where the wrong subsidy amount was reported to the insurance carrier or no subsidy was reported to the carrier and the client was billed for the wrong amount.

Counihan admitted that it could happen where a wrong amount was reported, because every time a change is made to an application it generates a new 834 form. But he maintained that he hasn’t heard of anyone losing coverage because the federal government failed to pay the subsidy to the carrier.

Counihan said he would look into Demartin’s case and talk with the carrier to try and figure out what’s happening.

“If you’re Gail you don’t care about how widespread the problem is you just want it solved,” Counihan said.

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(19) Comments

posted by: art vandelay | June 24, 2014  6:01am

art vandelay

Why am I not surprised. Government getting involved in something it shouldn’t. The IRS involved in healthcare OMG! It conveniently looses e-mails between Lois Learner & the White House, and now it’s involved with your health care.  Can the Government do any better than the private sector?  I think not. Obama & Obamacare needs to go ASAP!

posted by: jim black | June 24, 2014  9:16am

Connecticut’s exchange was touted to be the model for the country. Now the model is falling apart because of substandard glue. Wait till all the others start to crumble. Not news. Besides the military, the government can’t run a carnival.

posted by: GBear423 | June 24, 2014  10:24am

GBear423

hmmm don’t see the Obama Fanboys coming to tell us this is the best thing for the country… anyone out there?

/crickets

Government being a middle man between customer and insurance company and between customer and Dr is only going to end in epic failure. An INTENTIONAL epic failure.

posted by: Michele | June 24, 2014  12:16pm

Thank you for reporting on this. I look forward to follow-up reports with explanations as to why this woman’s insurance policy was cancelled.

posted by: Scott68ct | June 24, 2014  4:20pm

Looks like that change everyone voted for is working out good.  Hope your happy

posted by: gutbomb86 | June 24, 2014  4:53pm

gutbomb86

One person’s Anthem policy through the exchange is canceled by accident and you’re all crowing? Really? Where were you when we were all routinely being denied coverage?

Crickets indeed.

posted by: Sarah Darer Littman | June 24, 2014  5:23pm

Exactly, Gutbomb. Where were all of you when my insurer decided that consumables (covered at 80%) were suddenly medical devices (covered at 50%)? Where were all of you when I had to keep fighting for coverage for mental health services, even though I’d paid my premiums every month? You’re saying the GOVERNMENT gets between a doctor and a patient? My insurance company has denied prescriptions that my orthopedic surgeon has prescribed for my wrist problems - had to go through three different prescriptions before we found something that they would cover. So please, spare me the freaking propaganda.

posted by: GBear423 | June 24, 2014  8:18pm

GBear423

not ONE case gutbomb, there are many. And this is not one of the worst exchanges, its the Best.

Problem is that its reliant on the bungled federal system. Wake up, the fed is incompetent.  Its not paranoia when you see them unable to store 6 months of email cause a hard drive crashed. Which is a load of crap, but hey if they are not incompetent then they are…

Some people should spare us their conjecture.  Some people should take personal responsibility and pay their own medical bills instead of relying on the village to pay for it. and why should anyone pay for your pre existing condition??? You gamble with your health then YOU pay the bill, seriously who expects others to cover their poor judgment?

Maybe if people paid their own bills instead of relying on a corrupt insurance system that we all mindlessly pay into and when the over-priced bills arrive we shrug our shoulders and say “Insurance will pay for it” perhaps we wouldn’t have sky rocketing health costs. Look at the Medical Bill, its ridiculous.  We are all responsible for letting it get this way. Don’t deny it, nobody looks at the bill anymore, its just passed to insurance.  Heck the bills are coded, so as to keep consumers ignorant, its blissful yes? i had to take time off work, go to medical records at a hospital 30 miles away from where i got care, just to see what I was being billed for!!

Gets a little old that when conservatives comment about obamacare you socialist think we are a sponsor of Insurance.

Read my text based communication: ****insurance is a scam******, and the American public let themselves get screwed. 30 years ago there should have been Nationwide Legislation to protect consumers, allow tax free savings accounts dedicated for medical purpose (HSA’s) and Tort Reform, Insurance needed to be kept in check, apparently they were left to run wild.  There is a solution, and obamacare is not it. Its only designed to speed the present system into the ground. Heaping more costs on insurers and shoving more mandated capital into their coffers.  You think Insurers are gonna cut their profits???  You think the Medical community will take a pay cut??  Ya i don’t think so.  Its gonna collapse. thanks Barry!

posted by: GuilfordResident | June 25, 2014  8:09am

Had health insurance all of my life. If I was between jobs, I paid into COBRA. I’ve had a few emergencies here and there. I’ve never have had a family member denied coverage. The feds spent $9B at least on administration of Obamacare. I had an employee opt-out of heath insurance b/c she didn’t want to spend $150/month on premiums. I don’t know one first hand account of friends or acquaintances ever being denied care. Now, my deductible is $3000. I’m a vet and I steer clear of the VA ... probably good care but the administration of it is awful. Single payer (which this will become) is going to be a lot like the VA system.

posted by: Bulldog1 | June 25, 2014  9:25am

@ Bear:  Lots of noise there but once through the dust the question remains:  How do those terrible Socialist countries in Europe and even Singapore (!!) cover all of their citizens at half the price? Which means that their economies are not distored by healthcare costs as is ours.

And no, when conservatives comment on the ACA we think you’re supporting the corporate model whose purpose is to extract the most from the consumer while providing the least possible service.

I guess you dislike the notion of community but when it comes to insurance a group apporach protects those who may experience a healthcare catastrophe so care can be provided.  Regardless of their political perspective.

And this whole mess (we agree on that) was created long before BHO.  Corporations began to get the upper hand in the 1980’s when who was President?

posted by: Sarah Darer Littman | June 25, 2014  9:29am

You’ve never had a family member denied coverage - well LUCKY YOU! When I moved back from the UK in 1989, my entire family was denied coverage, despite the fact that we had private insurance in the UK on top of the NHS. But go ahead and extrapolate your experience on to that of everyone in the entire United States, why don’t you? You’ve got yours, buddy, so screw everyone else.

posted by: GBear423 | June 25, 2014  10:07am

GBear423

Bulldog your question has been answered in all the noise.  connect the dots. The socialist systems was Europe’s response to our capitalist system. Wayyy back in the industrial age they have had socialist policies.  It works for them.

meanwhile in the USA, the Insurance and medical and government lawyers and lobbyist made it possible to scam the American consumer. decades of fraud waste and abuse has created an over priced healthcare system.  Just the other day I looked at the bill for some medical equipment I had delivered. A filter for a breathing machine (think of an airfilter in a lawn mower or even a CPU) a foamy material, about 1 inch x 1/2 inch and about 1/4 inch thick. They charged $50.00 for it. When I informed them I am a cash paying customer, they reduced the price to $18.00 I haggled them to $10.00.

Thing is, they bill that to the Insurance company… which likely has its own negotiated lower cost we do not see.
That is just a small minor example of WHY the American Health Industry is more costly than the European model.  I AGREE that ours is broken in regards to the fraudulent hyped up expense that is passed to the consumer in the form of Premiums and deductibles.

posted by: GBear423 | June 25, 2014  10:54am

GBear423

@SDL-  I think it is very wise to foster the idea of savings to our kids. That life throws curveballs at you and its best to have “cushion” when that happens. I think as someone that is so close to education of young children, you may help future generations avoid the debt hole our generation is stuck in.

It is also a good idea to foster family bonds. Family is a relative term, but any group of people bonded by blood or oath, should commit to looking out for one another’s welfare. That is what insulates us when all else fails.

Trusting that some private company out there will have the product you “need” is a gamble. If there is a market for it and a business model is made then you’re golden. Otherwise you have to go with what is on the shelf.  Accusing me of some imagined selfishness serves no purpose. I wish you only well.

That said,  I do not think using the Law to force me to pay my earnings to some corrupt insurance company is right. Because others choose to buy $600 IPhones and Fashionable clothes, cars etc when I buy $20 flip phone, spend $12 on jeans, drive an old pick-up and have the sense to create a savings account for medical expenses and emergencies, that is where I say: screw everyone else. You have no right to my earned money, that is for my family.

posted by: Sarah Darer Littman | June 25, 2014  12:07pm

Gbear - Wow. You have chutzpah beyond my wildest imagining lecturing me about “fostering family bonds” and “fostering the idea of savings to our kids”. If you’re a Republican, perhaps you should talk to Doug Hageman. He knows my “family bonds” and how my brother and I planned financially so my dad was looked after in the best possible way. You really disgust me with your prejudices and assumptions. Just because I know the healthcare system wasn’t working as it was, doesn’t mean I am bringing up my kids to be profligate, or that I am choosing “$600 iPhones” instead of necessities. Seriously. This is the last time I’m responding to you.

posted by: JeffHall | June 25, 2014  2:13pm

@Sarah:  your shrill and nasty personal attacks on people who have different opinions really don’t help your cause very much. 

Just think:  would you spend any time considering the opinions of anyone who treat you the way you treat dissenters?  Why should they feel differently?

posted by: Sarah Darer Littman | June 25, 2014  4:00pm

@JeffHall - Oh, you mean like the CTNJ “dissenter” who told me to “take my meds” on a completely different piece after I wrote a column about mental health coverage? That kind of constructive, non personal attack? Let me ask you, Jeff, would you call that person “shrill” or do you just reserve that just for women? That particular comment (which was deleted for being way over the line) is the subject of this Friday’s op-ed.

I have constructive, useful dialogues on any number of issues with many thoughtful people on all sides of the political debate. Sadly, most of the regular commenters on CTNJ don’t appear to be looking for that, which is why I’m going to stop commenting, and save my political conversations for real life, with people who are brave enough to use their real names, and say these things to my face.

posted by: Joebigjoe | June 25, 2014  9:53pm

Sarah you said “I have constructive, useful dialogues on any number of issues with many thoughtful people on all sides of the political debate. Sadly, most of the regular commenters on CTNJ don’t appear to be looking for that, which is why I’m going to stop commenting,..”

what is this new thing with Politijoe and now shockingly you, making that threat? Fight for what you believe. Just as shockingly I have more respect for people like Joe and Gutbomb that will get into the fight vs people that just dont want to talk politics because it upsets them or its their way that the other side doesnt feel comfortable in expressing their opinion on very serious issues. Don’t fall into that category as you have too much to offer.

posted by: GBear423 | June 26, 2014  7:08am

GBear423

@Sarah- I was not at all referencing you personally, I used “us” and “we” in my response. Those pronouns were regarding “Americans/Our Society”.

  I was speaking generally. As a culture America has relied on social programs and some market products (insurance in this example) to replace the family unit. I do not think anyone can disagree with that.

  I certainly was not expecting very personal life situations to be brought into a policy discussion. It’s one thing to cite an example to illustrate a point, a whole other ball game to call into question another’s personal situation. I can see why the mix up occurred. I am very sorry I was not distinct in my response. I will clarify with the actual subject of my critique in future writings.

posted by: dano860 | June 27, 2014  8:25am

Tort reform would drastically lower costs.
When I look at my brother in laws annual malpractice insurance, alone, I’m shocked but I know who is paying for it.
Things usually go better w/o lawyers.