Thursday, November 12, 2015

Obamacare (the ACA) and the coverage chaos we are presently dealing with.

So, we just got a call from CTCA. They verified Penny is back on "Traditional Medicaid" (WOOHOO...
as that means CTCA will accept that as it is NOT a "HMO/ManagedCare" insurance). However, that means Penny is no longer with Aetna Better health. HUH????? I don't recall that being part of the ACA Open Enrollment decision last year (for Aetna to "opt out" of covering Penny before the end of the year). What this means, is that CTCA will now again accept Penny for future care (including the Cystoscopy that is due this month). But wait, now we find Penny's account is on a "Financial Hold".
So, I went over the latest statements from CTCA and we've noticed that we still have over $52,000 in billing that Aetna has not acted on yet (from June, care that they authorized).

So we are now completely befuddled as Aetna won't answer our questions.... nor will Medicaid (as Aetna was still the provider at that time). Also, just how the heck do we handle Penny's Open Enrollment this year (as she is given zero options in the Federal Marketplace after being punted there from the Illinois GetCovered website). Its a good thing I have a 3 ringed binder from last years enrollment (where I printed everything off) so I have proof nobody on our end screwed up.... and I also have this years printed out.
Listen folks, I am on top of this (I used to work for MetLife and have a general understanding of insurance in and outs) and even I am having trouble traversing this anarchy/chaos.... can you imagine what other people are going through trying to figure all of this out?
How does what is called an Insurance Plan through a legitimate Insurance Company (Aetna, one of FIVE plans handling Medicaid this year via the MarketPlace) all of a sudden stop paying bills, no longer cover a person and punt that person back to the original state plan.... and not put ANYTHING in writing to notify us of this.
I am wondering if this is happening to more people in Illinois than just us (and I wonder if former Representative Joe Walsh should inquire with those people "in the know" that he knows if this is indeed happening). If it is, why isn't the news media all over this issue? I am punting an email to him as we speak to see if he knows anything about this and if not, if he can find out if this is an issue many in Illinois are dealing with.
Uff and Da. =(