Thursday, March 13, 2014

ACA fun...

My week so far...

■ One client called. Her daughter has cystic fibrosis.  In 2013, two of her meds had a 30% copay, with a $200 cap per Rx.  In 2014, the cap was eliminated and the price went to $3600 when she went to fill it.  She can't afford them and her daughter hasn't had her meds since early January.  Appeals to Blue Shield for reclassification of her meds outside of Tier 4 had been declined.  I (finally) found out that the Genentech and Novartis discount programs weren't being applied correctly.

■ Four hours were spent on-hold at Anthem; three at Blue Shield.  CoveredCA has a "we're too busy right now, try using the web site" message...followed by hanging-up. That happened six times.

■ Several clients called because their doctors are no longer in-network for their  individual policies...the worst case had all five of her doctors disappear.  Even more fun, if you search by name, they show up as in-network because they take some, but not all, of the carrier's plans.  I caution anyone I talk to to check, but there are a lot of people that don't bother.  It'll be fun once March 31 rolls around and people are really stuck.

■ Three small business clients discontinued their group policies.

■ One small business client wants a refund for a years worth of premiums for duplicate dental coverage.  Unbeknownst to me, he'd checked the "Delta Dental" box on a form he sent into Kaiser at his last renewal...he already had a direct Delta Dental policy.  Kaiser promptly also signed him up with Delta.  Since Kaiser invoices don't list lines of business separately, he didn't notice until he received this year's renewal.

You know, there was a time that I really liked this business...

No comments:

Post a Comment