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Fully paid up but still no coverage

Apr 17, 2014

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Michelle Lamb recalls it being "pretty easy" buying health insurance on the Affordable Care Act marketplace last December.

But using her Independence Blue Cross plan has been maddening.

The 39-year-old West Oak Lane day care teacher has made three monthly premium payments at more than three times her subsidized rate just to make sure she was covered. That's a steep price for insurance that has been canceled three times - for nonpayment.

"I paid my first premium payment in January and have not received a statement since," she said.

Lamb's case may be an outlier. But some people are still getting lost in the download between the government and the insurer.

"In this kind of new market, it's pretty complex," said Brian Lobley, Independence's senior vice president of marketing and consumer business.

Lamb left the site thinking she had insurance for herself and her daughter. Her subsidy cut the $90.70 monthly premium for the Keystone HMO Proactive plan to $25. The ACA customer rep told her the insurer would send her an invoice.

Sure enough, Lamb got a bill in January with a premium of $90.70, the pre-subsidy amount. Worried about being uninsured - or worse yet, about mucking up the system - Lamb paid the full freight and hoped to get the premium figured out later.

She didn't receive a February invoice. But later that month when Lamb went to pick up a prescription, the pharmacy said it had no record of her plan. Even if Lamb did not pay her February premium, the law states that after making an initial premium payment, an individual's policy cannot be canceled until two more consecutive payments are missed.

After being on hold for two hours on Independence's customer service line, she went to its Market Street headquarters. A rep there confirmed that her account had been suspended for nonpayment.

"She couldn't tell me why there was a hold on my account," Lamb said. "But she said I should make a payment because it could happen again."

Lamb plunked down another $90.70 on the spot.

March roared in sans invoice. Concerned, Lamb called Independence to ascertain that her account was fine and that she was covered. It wasn't. She wasn't. Her policy had again been canceled, even though she had paid - in person - a few weeks earlier.

That payment, the phone rep said, covered February's premium. But under the two-consecutive-missed-payments rule, Lamb's policy should still have been active. "So I made another $90.70 payment over the phone," she said. "That's where I'm at. I haven't paid anything for April."

Since she complained to The Inquirer, Lamb said, the insurer has promised to "straighten everything out. I'm pleased with the conversation but nothing has been done yet."

Though privacy laws forbid Lobley from discussing members, he said cases like Lamb's were rare. Those that do occur often are traced to communication mix-ups between the marketplace and insurer.

Only the government can set an individual's subsidy, he said.

The insurer keeps wrestling with other issues like members' multiple enrollments. Some need "hand-to-hand research."

"We have to fix our model in how we respond to customers," he said. "We want to make sure we're using situations, as lessons learned, to improve."

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