Health Care Five Years Ago Today

denied-env

“Odious” health insurance is now “MODA” as in “MODA Center” where 
the Portland Trailblazers play with other NBA teams when they’re home.

Ted is about to find out that he can’t enroll until next year. Like me.

Ted Cruz to sign up for government health care
Jennifer Jacobs / Des Moines Register

Ted Cruz, one of the loudest critics of Obamacare, will soon be using it for health insurance coverage.  —  “We will presumably go on the exchange and sign up for health care and we’re in the process of transitioning over to do that,” Cruz …

It is an irony of history that five years ago, today, I was writing Speaker Pelosi and President Obama to thank them for ACA and to note that ODS (now MODA) had kicked me off my health insurance for a “pre-existing condition.” (With photos of the actual correspondence.)

deniedcoverage

Denied health coverage for four very common conditions
in American life. Actual letter from 3-22-2010 to Hart Williams.

For four years, I lived each day with the nausea that I experience again today, You see, ODS (now MODA) has kicked me off my health insurance again on the slightest technicality: a clerical error committed by them, but I am the party punished.

This is what happened:

I went through the first year of  Cover Oregon (our Oregon state exchange) by circumventing the $30 million website and going through an insurance broker. We chose MODA because my pharmacy out-of-pocket costs eat our household budget alive.

The first year went fine. My primary care physician took an early retirement to “find himself” and I had to face what millions of other Americans faced: finding a new primary physician “in network” and thence the jittery first meeting with a doctor who only knows you from your metrics.

All well and good. I didn’t even need the second “covered” doctor’s visit. MODA did well by me. I didn’t have the complimentary colonoscopy, either. More $$ for MODA.

And then this year, the mess.

OLYMPUS DIGITAL CAMERA

On Friday the 13th of March, completely out of diabetic medication, I went down to the pharmacy to pick up my new medication. I was informed that MODA had rejected me.  I stood there bewildered, while they called MODA. MODA was out of the office and the weekend help couldn’t. Help that is.;

I found out after a long phone call that MODA claimed I had not paid my March premium and had cancelled me.

Cancelled me without notification (but had been able to send me an April bill AND, yesterday, sent me an email saying

from: CustomerService@modahealth.com
to: [Hart Williams]
date: Mon, Mar 23, 2015 at 12:16 PM
subject: Your EOB is available to be viewed online
mailed-by: modahealth.com

Dear Hart Williams,

Your most recent medical Explanation of Benefits (EOB) is ready for viewing in myModa, your personalized member website. While in myModa, make sure to check out all the health tools and resources available to help you get well sooner and live well longer.

If you have any questions regarding your EOB, benefits or this e-mail, please do not respond to this message using the Reply button. Please visit your myModa account, visit our website or call Moda Health Customer Service.

Moda Health Customer Service
https://www.modahealth.com

Isn’t that ODD? I mean, don’t THEY know that I was “cancelled”?

I say this because the entire “dispute” revolves around MODA’s contention that they COULD NOT MAKE A CLERICAL ERROR.

Why?

puppy

From the get-go, the second year of ACA was screwed up. Cover Oregon was deep-sixed for wasting $30 million without ever working. The Federal Exchange was SUPPOSED to be what I was signing up on. But the agent or MODA (not sure which) enrolled us in the WRONG plan and after we paid for January, we were issued a second CORRECTED plan, and sent new MODA insurance cards with the same insurance ID but a different group number.

To show just how screwed up this all was, I was involuntarily signed up for and received the Oregon Health Plan for lower income Oregonians, and I had to spend an hour on the phone cancelling THAT coverage. I don’t make so little as to qualify, but this gives you a notion of what a mess my second year of ACA coverage has been.

Incompetence or sabotage? Not enough data to rule either out or in. Sorry.

We paid for February, as MODA’s website confirms.

typewriter

And then we received TWO invoices for March. FOR BOTH ACCOUNTS, even though MODA never makes any clerical errors — as they have explained at length to both my wife and myself. TWICE.

My wife, who prepares tax returns, did not have time to set up auto-pay for the remainder of the year (as we had done the first year) even though we had deposited the ENTIRE YEAR’S worth of premiums in that account. She paid one of the invoices and continued to live on three hours of sleep a night. We would set up auto-pay another, less stressful day.

MODA evidently decided that she had paid the WRONG account and …

This is where a diabetic in his sixtieth year is abused by a clerk or automated system and everyone from the weekend help to the highest levels I’ve been able to penetrate feels that they must defend the clerical error TO THE DEATH, because, as you can see above, no one at MODA has ever made an error of any kind.

I spent the better part of an hour with a MODA customer service rep named Dennis, who, with me, called the Federal Health Exchange helpline and we found that I have NOT been kicked off of ACA. MODA evidently hadn’t gotten around to informing them yet, even though, as they maintain, MODA never makes clerical errors.

And, had they informed me that they had a problem, March might have been corrected.

My wife had paid the March bill.

blogger

MODA quietly decided NOT to process it, and now claims no bill was ever paid.

Dennis almost sneered on the phone saying  “I’ve never heard of an insurance company never taking money.” Well, Dennis, you have now. A check with our bank account revealed that the payment had never been processed.

And left me to find out on a Friday night WITHOUT THE MONEY TO PAY FOR MY LIFE-SAVING MEDICATION to stand, humiliated at my pharmacy.

The next day, luckily, we scraped up the cash and bought the medication at FULL retail price.

Ouch. Beans for lunch that week.

I spent the hour with Dennis trying to sort things out, as my wife had spent HER hour days earlier being reduced to tears by an insistent, almost robotic Catch 22: We didn’t process the payment, therefore we didn’t receive the payment, therefore you didn’t pay us, therefore you are KICKED OFF COVERAGE and there is NO WAY THAT YOU CAN BE REINSTATED.

This was the same answer I received after we had gotten all the way through the entire mess and called the Federal Health Exchange, etcetera. Dennis was ready to help and called the whatever department and returned in full Catch 22 mode. We do not make clerical errors. We are blameless. You did not pay. You are kicked off health coverage.

One little problem: In March, I HAD VISITED MY DOCTOR.

xmaspresents

I had health coverage! Or so I thought.

Remember, we had “paid” one of our double invoices for March, and continued in good faith, thinking we were up to date. And not only had MODA cancelled me, but they couldn’t be bothered to INFORM me that they had done so. Gee. They could send two other emails (thanking me, prominently on each for “going Green”).

Thinking that I had health coverage for my visit, I went to see my doctor. (Good news. Blood pressure finally within safe limits AND my cholesterol was now in safe territory after years of working on it.)

But MODA had already kicked me off coverage--without informing me, in their Orwellian world of “responsibility. Odd, that. They were able to bill me for April. They sent me YESTERDAY, my new “explanation of benefits” just “log into your account.” Which I have. Still works, even though I am “kicked off.”

Do you begin to understand the nightmare that Insurance Company abuse has created in my life? I am sick to my stomach over this. Soon an angry invoice will appear from my doctor’s office, saying something like ‘MODA has rejected all charges because you are not insured with them.”

And, retail, it’s going to hurt. It is going to screw up our finances for at least a month if not for several thereafter.

copywriter

And I am going to have to find a NEW health care insurer. (No guarantee that my doctor will be in the “network” so, probably a NEW search for a new doctor. Rinse Blather. Repeat.)

Which means that I will, in all probability, be kicked OUT of ACA, screwing up my tax situation, etcetera.

THANKS, MODA.

You see, an insurance company only needs three departments: sales, payout, and fraud investigation. Naturally, all insurers like to promise everything and deliver as little of anything as possible, to puff up their bottom line.

No on at MODA is interested in working with us. Which means, in all probability, that as soon as I sent this letter and cc our attorney, we will have to file suit against MODA to recover the cash we’re stuck with paying out because of the bad faith and failure to notify us of cancellation on MODA’s part.

signing-ceremony

The ACA signing ceremony, so that law could stop the kind of insurance
abuses I’m currently experiencing, seemingly. Hey, at least I HAD insurance.

It seems a pretty straight up liability case, but you never know. Fortunately we won’t have to pay attorney’s fees for reasons I won’t go into here. But MODA has messed up my life, threatened my very survival and claims that because (implicitly) they NEVER screw up that I’m SOL —  S*** Out oOf Luck, as they say.

WHY it had to come to this is something that only MODA can answer. So I am sending this letter to them.

Let’s see what they have to say, shall we?

They claim that they will respond to this within 24 hours. Let’s see if even THAT is true.

And think, five years ago to the day, I was kicked off ODS Health Insurance (now MODA) and thanked the President and Speaker Pelosi for ACA and potentially saving my life from vultures LIKE MODA.

Businessman running away from Businessdevil.

So, do you think that there is a secret policy at MODA to find any excuse to cancel coverage for those they don’t want to actually insure? The blog from five years ago that opens this piece certainly proves that I am in that class. Does this explain why no one at MODA will work with us or speak to us, other than to robotically intone “NO PAYMENT RECORDED; YOU ARE CANCELLED. NO RETROACTIVE ACTION POSSIBLE. HAVE A NICE DAY”?

Inquiring minds want to know. Writers without health insurance want to live. Lawyers don’t want to sue, but will if no other option presents itself.

Ironic, don’t you think?

mymoda

Thus far, MY MODA

Courage.

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