I got myself into a bit of a pickle a while ago. Well “a bit of a pickle” in the sense that “I was facing financial catastrophe.”
It’s a long story, so settle in.
After I left my employer in Seattle to move here, I moved onto COBRA health coverage. You’re entitled to it for 18 months following your termination date, and even paying the full premium freight, it was still the best health coverage I’ve ever had in my life.
Basically, I had no co-pays and no deductible, on either medical services or medications. I dare anyone outside of senior corporate management in any organization to make that claim. It was amazing, and I really appreciated it, both while I was employed (when I also paid no premiums) and afterward. It was so good that when I went to work for the Mickey Mouse agency as a contractor, I declined their coverage until my COBRA ran out. Why would I trade in a Bentley for a Corolla?
This is not to say they make it easy—you have to make your monthly premium payments by check: scratch out the whole thing with a pen, put it in an envelope with the coupon for that month, stick a stamp on it and mail it to some place in Chicago. No automatic electronic payment; completely 19th century.
It was the only regular payment I made that way—everything else (rent, utilities, credit cards) I do online. But I dutifully scratched out the check every month. And, when I misplaced my coupons in the move down to San José, I called the administrator to find out what I needed to do to make the payments on time until they could send me new coupons. I did not want to do anything to risk losing it.
I was truly grateful to have this coverage, especially when it became apparent I needed the surgery on both my knees. Everyone in the medical supply chain was happy, too: with my coverage, they’d get paid a pretty good negotiated rate, &and in a timely manner. I had the surgery on 4 November and went through twice-weekly physical therapy and a number of post-op visits for the next six weeks.
The timing was good, as my COBRA benefits were set to end on 23 December. (And, since the Mickey Mouse agency’s policy would only pick me up on the first of any month, I bought an interim policy to cover me for the period between 24 December 2011 and 1 January 2012. You don’t want to be without health insurance in this country for 12 seconds.) I was making very good progress and was glad I’d got it taken care of while I still had such good insurance.
So imagine my feelings when I called the pharmacy benefit supplier on 22 December to ask a question and was told that my benefits had been terminated as of 31 October. I called the insurance company; they confirmed this and told me to call the COBRA administrator.
And here’s where the gates of hell opened.
COBRA administrators (in this case, Towers & Watson; but I’m sure that all administrators serve the same function and operate in the same way) do their best to block you from any human contact, much less an accountable human. They want you to do everything by snail mail. And if you have any questions outside your monthly premium constraints, you have only a call center, staffed with call center people. And you don’t even get a human until you’ve waited through the phone tree. On every call.
So I called the center and got Tenaya. She looked up my records and at first agreed that I’d paid November’s full-month premium, and December’s pro-rated premium; so she was going to correct my account and then reinstate my coverage.
But then she called back later and left a message to the effect that, having consulted with her supervisor, I had a shortfall in my payments and the termination stood. It took a couple of calls that day, each time to the general number and getting whoever was in the queue, to sort out what had happened.
And that was that they’d either not received or not applied the payment I’d sent on 28 March, for April’s premium. They didn’t notify me that the payment was missing and I didn’t notice that the check hadn’t been cashed. They just took every subsequent payment, applied it to the previous month (since it was received within the 30-day grace period) without telling me that there was a break.
And then, come December, my partial payment (in the amount stipulated on the December coupon, which accompanied it) wasn’t the full amount for November, which is where they were applying it. So—again, without any notification to me—they decided I was short for November and retroactively terminated my coverage as of 31 October.
The only “notification” they sent me was the “Statement of continuous coverage”, dated 12 December. You know—that little form letter that protects you from being declined individual coverage due to “previous conditions”. I’d expected to get that and I didn’t pay any attention to the date of coverage. But even if I had done, it wouldn’t have done me any good, because (as one of the T&W call center persons cheerfully informed me), by that time I was already beyond the grace period for November and couldn’t have done anything about it.
My only recourse at that point, I was told, was to send them a letter of appeal, explaining the circumstances and asking them to reinstate coverage. I knew it was a longshot, both because the T&W staffer told me he couldn’t tell me what percentage of appeals were successful and because by denying it they would save themselves the roughly $100,000 in medical bill reimbursements.
I sent my letter of appeal on 23 December, and when they still didn’t have its receipt on record by 3 January, I resent, by registered mail. Their process is to scan the appeal into the system & forward on to the employer, who makes the decision. Later that day, they phoned to say they’d received my letter. So, I waited.
They denied the appeal—in a letter unsigned by any human, dated 6 January but postmarked 23 January and sent to my old address (even though they had my new one), they basically said that it was all on me; I should have made up the missing payment on my own, they said all along that they would not notify anyone of any shortfall in payment, so too bad. (They did actually call me on the 20th to let me know.)
I spoke with yet another of their reps, but he was carefully indifferent. No, there was no one I could speak with about this. As the letter said, “BenefitConnect/COBRA’s determination on your appeal is final. You cannot appeal further.” (Although the rep told me that I could make a second appeal, but they’d made their decision and they wouldn’t change it.)
You cannot imagine my distress. It was as though I were carrying the weight of a house. I dreaded phone calls, worrying they might be providers, wanting payment of the bills. Ditto my opening my mailbox. Even if I’d been working, $100,000 is an onerous burden. It’s a house, for God’s sake. (Well, not around here, but in many places.) I felt like I’d never get out from under it. I had no intention of stiffing the providers, but still--$100,000.
& I was so embarrassed that it was my fault—for not noticing the uncashed remittance. I have a thing about finances and I write so few checks that the only thing I check up on is that I’ve got plenty of money in my account to cover electronic and paper payments. I made a mistake, no doubt about it. But to end up owing $100,000 because of it…well, I couldn’t tell anyone about it.
In fact, I mentioned it only to three people, my sister, my friend who would have driven me to the surgery and one other. I couldn’t tell anyone because it was too awful—it was like I’d committed a crime. Compounded by my own stupidity. (MLD and LW
But the day after I had that conversation, on 21 January, I blurted it out to someone, who connected me with someone else. And that someone else jumped in like the Archangel Michael.
I’ll tell you about that tomorrow. But—as I prayed every day since 23 December, it was resolved without my ruination.
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