Health insurance (incorrectly) cancelled for non-payment

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petesamprs
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Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

My mother has a sticky health insurance situation that I could use some advice on. As background, my parents are married - dad is 72 and mom is 63.

Dad’s job previously covered both of them, but he retired in April 2016 and since then he has had insurance through medicare. Mom is too young to be eligible for Medicare, so when my dad retired they purchased insurance for her through the NY health marketplace (insurer was Affinity). Her premium payments were set to autopay on her credit card each month.

She renewed coverage for 2017 in December 2016 and re-established autopay for the new 2017 monthly premium.

Here’s the problem: for some unknown reason, the January payment was never taken. In the middle of February, they notified her that she missed her January payment and hence her 2017 coverage was now cancelled for non-payment. Ironically the February payment hit her credit card as expected, but they didn’t apply it because they said the missed Jan payment had already resulted in cancellation.

We called both Affiinity and NY state of health, but each is pointing at the other. They said they will conduct a review but it will take up to 10 business days for an answer.

We are past the Jan 31 open enrollment deadline, and a special enrollment period exception doesn’t apply, so if they decline to reinstate coverage after the 10 day review she will be uninsured for 2017 which is not acceptable.

Does anyone have suggestions on how to tackle this issue? One option is to try to purchase insurance privately outside of the health exchange, but I’m not sure where to start for that.

Thanks.
Vanguard Fan 1367
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by Vanguard Fan 1367 »

I just want to sympathize with your autopay thing. I scheduled my auto insurance to get paid the date that the Bank said it would get there and unfortunately the auto insurance folks said it didn't get there that date, but 2 or 3 days later so they cancelled my auto insurance. Auto pay is nice but it isn't bug free.
Upton Sinclair: "It is difficult to get a man to understand something when his salary depends on his not understanding it."
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midareff
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by midareff »

It seems to me that if your autopay to credit card was established on a timely basis, and they didn't execute it the problem should be theirs. Are you able to prove the autopay was executed on a timely basis?
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dm200
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by dm200 »

petesamprs wrote:My mother has a sticky health insurance situation that I could use some advice on. As background, my parents are married - dad is 72 and mom is 63.
Dad’s job previously covered both of them, but he retired in April 2016 and since then he has had insurance through medicare. Mom is too young to be eligible for Medicare, so when my dad retired they purchased insurance for her through the NY health marketplace (insurer was Affinity). Her premium payments were set to autopay on her credit card each month.
She renewed coverage for 2017 in December 2016 and re-established autopay for the new 2017 monthly premium.
Here’s the problem: for some unknown reason, the January payment was never taken. In the middle of February, they notified her that she missed her January payment and hence her 2017 coverage was now cancelled for non-payment. Ironically the February payment hit her credit card as expected, but they didn’t apply it because they said the missed Jan payment had already resulted in cancellation.
We called both Affiinity and NY state of health, but each is pointing at the other. They said they will conduct a review but it will take up to 10 business days for an answer.
We are past the Jan 31 open enrollment deadline, and a special enrollment period exception doesn’t apply, so if they decline to reinstate coverage after the 10 day review she will be uninsured for 2017 which is not acceptable.
Does anyone have suggestions on how to tackle this issue? One option is to try to purchase insurance privately outside of the health exchange, but I’m not sure where to start for that.
Thanks.
My wife was on an Obamacare individual plan for several years before being eligible for Medicare. While her coverage was never cancelled, there were numerous enrollment and billing screwups - and she had to be on the phone, complaining, many times for many hours. Just keep complaining and citing that she renewed.

I thought (could be wrong) that there was a (much) longer period for being cancelled for (alleged) non-payment?

Here is what I do not understand: Wouldn't renewal from 2016 to 2017 be automatic? Did she take action that forced her to re-enroll?
pintail07
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by pintail07 »

I spent much of yesterday on the same issue for a client I helped sign up for in December. I talked to the Marketplace and explained the situation with no help. I asked for a supervisor and we requested an exemption that will be reviewed and will be notified within 30 days. The supervisor assured me it would be overturned because this has happened with many folks. Be patient and ask for a supervisor.
mickroark
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by mickroark »

Seems to me that state law gives you a 30-day grace period, for these type of instances.
Topic Author
petesamprs
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

It clearly is their fault, especially since the Feb payment went through on time (which shows the autopay was in place), but they are being difficult. It doesn't seem there was any grace period and there was no notification that the Jan payment didn't hit.

Pintail - they did the same for us. Opened a case, said they will review, which could take 10-30 days. That seems like a long time to risk not having insurance, especially if the outcome is not in our favor. We were not given any assurance it would be overturned as you were.
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petesamprs
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

mickroark wrote:Seems to me that state law gives you a 30-day grace period, for these type of instances.
Thanks - do you know if there is something specific I can point them to?
Last edited by petesamprs on Wed Feb 22, 2017 9:57 am, edited 1 time in total.
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susa
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by susa »

Is "..NY health marketplace.." via healthcare.gov ?

if Yes, then marketplace has a method "to reset" the insurance retroactively with the company, that means, without a new policy using existing plan.

Is "Autopay" set up with the Insurance company (a) or the credit card issuing bank (b) ?

if (a) then the next question is what was the date schedule -- normally this is the 1st of the current month, ie. March is billed on Mar 1, 2017.

It should be simple to log on both to the (your Mom) marketplace account AND to the insurance company account to verify this and of course phone support works but this time, if calling the insurance company ask immediately to speak to a Supervisor. Do not give up, yet maintain a polite and firm tone of conversation. It is always good to compliment before a complaint and end with a compliment (that means, more than just "Thank you").
Topic Author
petesamprs
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

Yes NY state of health is NY's health website via healthcare.gov (obamacare).

Actually let me correct something after talking to her - she thinks she may have set up the 2017 autopay sometime in early Jan (on the affinity website), so therefore it may have waited to make the first payment in Feb and hence Jan would have gotten skipped. That would suggest it may be partially her fault for not realizing the Jan payment would get skipped with this payment method.

They are saying the grace period doesn't apply for the first payment, which is what is tripping us up.
mickroark
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by mickroark »

petesamprs wrote:
mickroark wrote:Seems to me that state law gives you a 30-day grace period, for these type of instances.
Thanks - do you know if there is something specific I can point them to?
You should call your state insurance commissioners office.
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susa
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by susa »

petesamprs wrote: she thinks she may have set up the 2017 autopay sometime in early Jan (on the affinity website), so therefore it may have waited to make the first payment in Feb and hence Jan would have gotten skipped..
Issue is clear now.

You (or Mom) would have to ask forgiveness, as the error is not on the side of marketplace or the insurance company.

They certainly can make an exception, ask for an Escalation case and a Supervisor and plead your (this would have to be Mom as they will not speak with you unless you have a POA) case, fully admitting the error.
pintail07
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by pintail07 »

Yes it is an escalation pleading. Should have a case officer assigned within a week. One of the issues is that the marketplace won't take payment information must be done through insurance company. Assuming an exception is made, they will reimburse any expenses accrued during the non coverage period. So many errors with folks that signed up this year.
Topic Author
petesamprs
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

Ok thanks everyone - agree that we should be thinking about this as asking for forgiveness for an oversight. The lack of grace period for an honest mistake is frustrating.

The problem is we are uncomfortable waiting for up to 30 days for an answer to our appeal, since the answer could be against us and she would not have coverage at all during this time. Therefore any expenses incurred right now are at risk. Luckily she is in good health with no preexisting conditions, but you never know!

Should we just give up on the existing plan and sign up for private insurance away from the market? Does private insurance have the same open enrollment period requirements, and does it satisfy the healthcare coverage requirement for tax purposes? The private insurance options I see right now are more expensive ($600-700/month for Gold HMO vs. same premium for Platinum PPO plan she signed up for with marketplace), but better than nothing.
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dm200
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by dm200 »

petesamprs wrote:Yes NY state of health is NY's health website via healthcare.gov (obamacare).
Actually let me correct something after talking to her - she thinks she may have set up the 2017 autopay sometime in early Jan (on the affinity website), so therefore it may have waited to make the first payment in Feb and hence Jan would have gotten skipped. That would suggest it may be partially her fault for not realizing the Jan payment would get skipped with this payment method.
They are saying the grace period doesn't apply for the first payment, which is what is tripping us up.
Since she was enrolled in 2016, couldn't this not be interpreted as the "first payment"?
pintail07
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by pintail07 »

If she has no pre existing conditions she could sign up for a short term policy, up to 11 months.
Topic Author
petesamprs
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

dm200 wrote:
petesamprs wrote:Yes NY state of health is NY's health website via healthcare.gov (obamacare).
Actually let me correct something after talking to her - she thinks she may have set up the 2017 autopay sometime in early Jan (on the affinity website), so therefore it may have waited to make the first payment in Feb and hence Jan would have gotten skipped. That would suggest it may be partially her fault for not realizing the Jan payment would get skipped with this payment method.
They are saying the grace period doesn't apply for the first payment, which is what is tripping us up.
Since she was enrolled in 2016, couldn't this not be interpreted as the "first payment"?

Apparently not. Seems like everything restarts with the calendar year. Her plan did not change from the 2016 (Affinity platinum plan), but the premium increased for 2017.
Last edited by petesamprs on Wed Feb 22, 2017 12:01 pm, edited 1 time in total.
Topic Author
petesamprs
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

pintail07 wrote:If she has no pre existing conditions she could sign up for a short term policy, up to 11 months.
That could work if it satisfies the obamacare minimum coverage need to avoid a tax penalty. Is there an advisor or other knowledgeable broker that would be able to find a plan that provides the coverage she needs and satisfies the requirement to avoid a tax penalty?
pintail07
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by pintail07 »

Won't satisfy MEB, depends on your state the policies available. Can avoid the penalty by buying a low cost sharing benefit for 45 a month plus the STM.
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petesamprs
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by petesamprs »

So after further research it looks like NY is one of the few states that does not allow short term health policies. This means if you are out of the open enrollment window, and don't have a qualifying event for special enrollment, you have no ability to get health insurance for the rest of the year.

Our only option now is to hope the appeal with NY's marketplace is decided in our favor. We have contacted our local state senator and his office is helping. I just don't have any way of handicapping how willing they are during the appeals process to forgive an honest mistake vs. sticking by the letter of the law.

Another hail mary option is to just have her move out of the county (e.g., to one of her children's houses) which would allow a special enrollment period. She would need to make that happen in next few days, since you need to prove you had coverage within 60 days of the move, which means it needs to be within 60 days of 12/31/16 when her coverage ended. Anyone have any experience with this.
pintail07
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Re: Health insurance (incorrectly) cancelled for non-payment

Post by pintail07 »

I have seen that done in the past.
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