13 Jun, 2019 → by ClaimboUser424488
Unpredictable 6 day notice policy switch on me — could have wiped me out financially if I were in the hospital or on vacation when it came

1

The Health Connector switched off the insurance that I was relying on, and had fully paid by autopay, with no bounces or anything, with 6 days notice. That is, I was notified, completely unexpectedly and unpredictably to me, 5/25/19 that my Health Connector on-exchange Health New England policy would be out of effect 5/31/19. There was a switched-to MA Health coverage, which required a time-consuming subplan selection and PPO-available research procedure in order to activate a network of hospitals and providers and a primary care provider in the area. Apparently, the Health Connector thinks these sudden switcheroos on people are OK, and will not stop from doing them. (This is the feedback I have from the Health Connector ombudsman staff.) They are not OK, because, for one, they can bankrupt a person by leaving care uncovered. You can be in the hospital X for 2 weeks, with procedures approved at a hospital in network for insurance plan A that you were relying on to pay the bills, and when you come out, you discover the day after you went in, the Connector switched you to insurance plan B, for which hospital X is out of network, and your procedures are unapproved. You can be travelling, get into an emergency, and whoops--the insurance card that you thought you could use in an emergency is no good. (Technical, for those wanting to trace and see the way this happened to me, and see its systemic, not one-off nature. Obamacare insurance splits into two completely different sets of coverage: expanded Medicaid = Mass Health though 138% of Federal Poverty Level (FPL), and an on-exchange plan at 138% FPL and above. I was just above the crossover, at 138.9% of FPL. This was Using the 2018 tax year, filled out Feb 2019 1040, that the Health Connector requested I send in, and did send in, 3 months prior, in Feb 2019. They used that 138.9% FPL number to give me my Health New England on-exchange plan. What happened was MA Health decided, for some reason, to redetermine MA Health eligibility in the middle of the year using new Federal Poverty Level income levels, about 2% higher. A chunk of new people become MA Health eligible. Then this runs through their systems, and any old on-exchange plan is cancelled, at the speed of light, with little or perhaps negative number of days of notice to the people relying on the policy. My guess is this may have happened to about 1500 people using the Connector for insurance, with incomes in that sensitive zone.) I was able to figure out what happened and get accurate information from the Health Connector ombudsman staff. (This bunch of people is small, but they are some of the few people that actually know how the computer system works over there.) The person I spoke with at the ombudsperson office gave the clear explanation above, but indicated that there is no way they will stop this sort of thing. She suggested that to prevent this from happening to me in the future, I, at next open enrollment, decline any subsidy for an on-exchange plan, and select "don't need any help from the government paying for the insurance". (This could work because it disconnects MA Health eligibility as an exclusion for on-exchange plans.) I'll probably have to do this, even though I lose like a $5000 a year subsidy. Thus, I have to assert that, even at this point under Gov. Baker ("The New Health Connector" you hear on the phone), where there have been some notable improvements, but health insurance provided by the Health Connector is still dangerous, because it can completely wipe you out financially with one of the gaps in coverage it gives you. (My assertion is consistent with numerous other Yelp reviews here.) (I had had 2 gaps in coverage due to Connector incompetence about 4 years ago under early Gov. Baker. I had hoped things were improved to at least the point where there are no coverage gaps, but apparently no.) ------ Further: both MA Health agents, and Connector agents often give incorrect information, and will not direct you to any people who can solve your problem, or get you correct information. In my own situation with the 6 day notice coverage switch, I got misinformation from 3 agents in a row. Both MA Health and the Health Connector will point you to multi-week-in-the-future "fair hearing" type procedures, presumably in front of someone who knows as little as the phone agents about what's going on. (There are, actually, two groups of ombudsman people, one for the Connector, and one for MA health, which are small, but do seem to have about the only available people who understand what the computer systems are doing. But neither MA Health agents, nor the Connector agents, will point you to them. Only to their "fair hearing" procedures. )
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