Rush rash

I’m trying to understand the logic…erm, no. The reasoning…uh, uh. The thinking…

Well, I mean to say that I’m trying to imagine the ratiocination construct that lies below Rush Limbaugh’s recent verbal vomit about Sandra Fluke. You know, the Georgetown student who testified before a Congressional committee on why contraceptives should be part of any health insurance. I’m at a bit of a disadvantage, because I’ve heard neither Fluke’s nor Limbaugh’s full spiel, but here’s my understanding.

Fluke, a third-year law student, went before the committee to represent other women who depend on Georgetown’s health coverage, but have to pay for contraception out of pocket because the plan doesn’t include it. She pointed out that birth control pills can be prescribed for medical conditions outside actual prevention of pregnancy. (These include irregular menstrual periods, acne, endometriosis, Polycystic Ovary syndrome, amenorrhea and some others.) Refusing out of hand to cover any contraception means that women who are diagnosed with these conditions don’t have access to these therapies.

Ignoring that, Limbaugh went on the attack, claiming, “She wants to be plaid to have sex. She’s having so much sex she can’t afford the contraception. She wants you and me & the taxpayers to pay her to have sex.”

So, I have some questions about this. Maybe you can help me out with some answers.

Who’s the “us” he’s talking about? He objects to “us” paying for Fluke’s alleged sexual activities. (And, by extension, that of all women. But evidently he’s not opposed to men, you know, screwing. Except probably men having sex with other men. I’m just spitballing, here; but I’m guessing that as a conservative flag waver, he’s probably not down with that.)

But unless “we” are an actual, you know, insurance plan (or the employer that might be contributing to that plan’s costs), then “we’re” not paying for anything: not for treating the consequences of sex, smoking, skydiving or any other social behavior.

Could he be talking about “us” in the sense that “we” are also major shareholders in, say, GM? As in “we the taxpaying people”? Meaning “a single-payer health policy supported by our taxes”?

Hmm, I shouldn’t have thought so from the mouth-foaming tenor of conservatives' opposition to the Affordable Care Act. But I suppose I could be wrong.

Is he saying health plans shouldn’t cover pregnancy—since sexual activity is the most common cause of pregnancy and Limbaugh seems opposed to the price tag of contraception? I have to say that compared with pre- and post-natal obstetrical treatments, even a normal childbirth and a couple of decades of pediatric care, the cost of contraceptives is quite the bargain. I won ‘t go into the considerable non-medical burden of social services required to deal with children whose parents are ill-equipped to raise their offspring.

(Although, in fairness, it’s been my observation that conservatives’ interest in the moral imperative of protecting the sanctity of life pretty much stops, uh, dead at the moment of birth. They’re disinclined to fund anything that would help that creature so sacred in utero have a life of dignity outside the womb. So those costs wouldn’t figure in any cost-benefit analysis run by the right.)

And finally, is Limbaugh going to go ballistic about funding Viagra, Cialis and all the rest of the erectile dysfunction meds that big pharma can’t produce fast enough to meet the demand of middle-aged men? Since (as I understand it) men wouldn’t need Vitamin V unless they specifically intend to engage in, you know, sexual activity in the immediate future?

Or would the possible alternative therapeutic uses—for hypertension, Raynaud’s phenomenon or heart disease—be his ticket out. “Oh, get stuffed, liberal pinko scum. Men need these pills for very serious conditions. Not like birth control pills for women.”

Well, look—in Limbaughland, that sort of argument not only holds water, it’s a mainstay of all discourse.

Another staple of Planet Rush is the grudging, forced non-apology. (Forced, in this case, because several ad sponsors of his show have cut him off.) He’s made this to Fluke via a statement that said he never intended that calling her a slut and a prostitute would be construed as a personal attack.

I think his own meds are due for adjustment.

A COBRA worse than snakes, Part 3

In recounting my COBRA nightmare saga, I want to mention that one of the more decent experiences I had was with the billing people at a couple of the providers’ offices. (In addition to ET at the DOL, of course. And RN, who got me set right to begin with.)

I spoke with Rita at the surgical center and Nancy, of the anesthesiologist’s office. (Don’t know why the surgeon never contacted me—the Explanation of Benefits form I got denying it said his fee was $7000.)

Both of them were professional and polite. And--moreover—understanding, reasonable and helpful.

This was in marked contrast to Towers & Watson, the COBRA administrator and the pay-no-attention-to-the-man-behind-the-curtain stealth operation of the ex-employer.

It occurs to me that Rita and Nancy have one of the lousier jobs in our healthcare system: managing billing for providers. Think about it—the only people they deal with are insurance companies (with all the myriad coverage and payment types, regulations and what-all) and patients who may or may not have the money to pay for the medical services.

Including those who, like me, have been hung out to dry by their insurance carrier and are facing tens of thousands of dollars in unexpected fees.

So it’s really remarkable to me that Rita and Nancy were so, you know, human. Even though I really dreaded the calls, when I actually spoke with them, I felt like I was dealing with human beings and that, even in the worst case, I’d be able to manage something workable.

COBRA snakes—you could really learn a lesson here.

A COBRA worse than snakes, Part 2a

In response to my post of yesterday (about the Department of Labor weighing in with my ex-employer on the termination of my COBRA coverage), I got an email from my friend, the Pundit's Apprentice. He picked up on my statement on learning my lesson when it comes to checking that payments have cleared my bank account, and added:

"I hope you've also learned that the Federal government 'bureaucrats' are more reliable and more honest."

Yes, I have. I apologize for thinking stereotypically about ET, and for doubting that he would have any sort of effect on the corporation. He was thorough and conscientious and there is absolutely no doubt in my mind that it was his inquiry alone that caused the company to reverse its initial denial.

He went to work on it within 24 hours of receiving my email and he kept at it. And he got results. And he followed up.

That's our tax dollars well and truly at work.

A COBRA worse than snakes, Part 2

As I said yesterday, being told by my COBRA administrator that they’d retroactively terminated my health coverage back a month and a half, to five days before I had surgery, was one of the worst things ever to happen to me.

I mean—in the cosmic scheme of things, it’s not as bad as, say, being bombed out of my home or having to plan the funeral of a child or grandchild. I recognize that—it’s only money. But it was a whole lot of it, it was unexpected, and I felt like an idiot for not having noticed that one of my premium payments hadn’t been applied.

Also, Towers & Watson, the COBRA administrator, did everything they possibly could to stonewall me. No individual I could discuss the situation with; nothing but a PO box and a phone center number.

Their “notification” of termination was as close to stealth as it’s possible to get—an ordinary “Certificate of Group Health Coverage” notice. Nothing indicating that this was something completely out-of-the-ordinary. If I hadn’t had a pharmacy question a week after receiving that notice (sent to the wrong address to further delay my receipt), I wouldn’t have known there was a problem until the period of appeal had expired. (I had to throttle the information out of them that I had 30 days from the date of that Certificate of Group Health Coverage notification to file an appeal.)

Even their appeal denial letter had no signature. Just:

Now, keep in mind that, although the denial was postmarked 23 January, one business day after I spoke with their rep on the phone, it was actually dated 6 January. Meaning two days after they logged my actual appeal into their system on 4 January. So I wondered how it was possible that anyone had engaged in a “thorough review” in two days, as their denial stated:

(Also, please note that final sentence; I’ll return to it later.)

I expect that the only thing that got reviewed was the cost-benefit analysis that determined that if they upheld the termination, they’d save themselves $100,000.

At any rate—before I actually received this letter, I’d blurted out my predicament to MDC, the leader of a careers workshop I’m taking. I hadn’t intended to do that, because I felt so sick about the whole thing. But for some reason, I did.

We were at a Saturday morning career support meeting sponsored by the Menlo Park Presbyterian Church. MDC immediately said, “Let’s talk to AH.” He’s the executive director of the organization. AH said, “The best thing is probably to see if a lawyer will take this on pro bono. Let me make some phone calls.”

I didn’t see how a lawyer would help, but I did feel somewhat better knowing that a couple of people who really know how to make things happen thought I should be entitled to help. They both thought this situation was inherently wrong; MDC actually said, “They did wrong by you.”

On Tuesday 24 January I picked up a voicemail from a woman, RN, who works for an insurance organization. An attorney AH had contacted had forwarded his email to her and within three hours she’d reached out to me. When I spoke with her she absolutely hummed with both energy and outrage. Although she’s VP of business development for an insurance brokerage, she took down my story, rooted out a contact at the US Department of Labor and drafted a letter for me to email to this guy to get him on the case.

RN contended that no employer wants the DOL on their back, and an inquiry by them would elicit immediate attention and rectification by the corporation.

She contacted me the next morning—before 0800—to make sure I’d received her draft and to give me guidance on how to get in touch with the DOL guy. At that point I still hadn’t received the denial letter from T&W, and she wanted me to get my email off before that came, to reinforce the idea that they’d been negligent in sending me any communication.

I have to say that I didn’t see how a bureaucrat was going to help. I mean, my former employer, the decision-maker in this process, snacks on the SEC and DOJ and it bitch-slaps the EU’s European Commission. However, I PDFed all the correspondence I’d received up to that time from the administrator and emailed it all off to ET at the DOL.

It was a bit of a shock to get a call from him the next day. I mean—we are talking the federal government here, the wheels of which grind exceedingly slow. He took down some information and told me he would contact the employer—he doesn’t mess with the administrator or the insurance company. The employer is the responsible party in these things; especially in this case, as my ex-employer self-insures.

I was a little downcast, as ET didn’t seem to be able to make it through the corporation’s phone tree. He called me the following day to say he couldn’t reach the office of the General Counsel (RN said that the corporate counsel would really take notice of a call from DOL). I went online to Hoover’s and found the VP of HR (or “Chief People Officer”—like that makes a difference) and the VP for employee benefits. He said he’d speak with someone there and “have them do some research.”

A couple of days later RN sent me a document that outlines federal regulations for the employer’s responsibility in COBRA administration:

Now, this was a massive surprise to me because the COBRA administrator’s whole point in the termination was that it was up to me to ensure that they received full payment and they weren’t obliged to notify me that there was any problem. To wit:

 

Well—so maybe just because they said they didn’t have to notify me doesn’t mean that in fact that was true? That they were just saying that to, um, defraud me?

The following week, ET contacted me to let me know that he was in touch with a person at the corporation’s benefits department. She was “doing some research” on my case. I asked what, exactly, that meant. He replied that she needed to research “all records of payments” to see if they could find out what happened to the April one, verify whether they accepted all my payments subsequent to that but didn’t notify that it was missing.

I liked the way that was headed, so I let him carry on.

And then, on 9 February, ET called again. I was still at the stage where I hated hearing the phone ring, dreading that it might be medical providers wanting to know where their payments were. ET said that this benefits woman had left him a voice mail saying they’d sent me a letter and she was faxing him a copy of it, but he hadn’t received the fax, so did I have the letter.

Well, that morning I’d actually found an envelope from the COBRA administrator in my mail box (sent to the wrong address again, & forwarded), but hadn’t wanted to look at it. However, with ET on the line, I ripped the envelope open and found that on 3 February they’d grudgingly decided…well, let them say it:

Now, this “explanation” they were accepting would be the same one they’d rejected less than a month before. So I knew it was the inquiry by the DOL that caused the turnaround.

They said that if they received premium payments for November and December (they claimed they’d refunded the latter, though more on that later) by 3 March they’d cover me for that period. They didn’t say where to send the payment and I hadn’t actually received a refund. So I had to call the T&W number to find out the particulars from Latayia.

And it turns out that, although their letter of 6 January said they’d processed a refund for December’s payment, they had in fact not even requested a refund until 8 January. And “it takes six to eight weeks for that to be processed.” So more prevarication from them.

However, rather than expect them to draw the logical conclusion, or conversely to risk them finding another excuse to deny me coverage, the next morning I sent them full payment, via registered mail. I figured I’ll get the overpayment back later.

The payment was signed for at 0333 on 14 February, and the check cleared my bank on 15 February. (So—they can actually move in a timely manner when it suits them. Or when they think the DOL is watching.)

Last week I checked with the insurance provider. Their rep told me that they showed there’d never been a break in coverage. In fact, he said, I’m still covered.

Uh, no; coverage ended 23 December. Oh. Um.

Anyhow, I spent 27 minutes on the phone with Roy at Premera Blue Cross, going through every claim from the November/December coverage period. Every one has been resubmitted, although he did say it could take up to 30 days for that. So I’ll be checking back, since I’m taking nothing for granted now.

Yesterday ET, the DOL guy, called to see if the claims have been paid. Seriously—follow-up from the fed! RN has also checked in—and she was absolutely ecstatic when I called with the reinstatement news.

I feel so fortunate in the sequence of events since that awful Friday when T&W told me I was stuck for all the bills. People I barely knew stepped up for me, guided me to people who could put pressure on my ex-employer and get them to do the right thing. My providers are going to be paid what they expected to be paid. I’ve had a dreadful weight lifted from me.

And I’ve learned my lesson about checking that payments have cleared.

A COBRA worse than snakes

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 19^th 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 20^th 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—I apologize for not telling you. But you have your own burdens and I just couldn't add mine to yours. I know you'd have worried way too much.)

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.

Boing therapy

If you're needing a break from putting together your tax information, or you're stuck in yet another meeting...put your device on mute & enjoy.

(If you're at a loss, click on the frisnic.)