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ObamaCare Clusterfuck: Be sure to record EVERYTHING when you talk to your insurance company rep AND your ACA marketplace rep

Here's cheerful little horror story (and little horror stories are all we've got right now, because heaven forfend HHS or CMS or our famously free press or even Congress gather any aggregate data about quality of service). And do note the only reasons this citizen got any satisfaction is that (a) he recorded both flavors of weasel, the ObamaCare rep who did the sales job, and the health insurance rep who tried to deny the care, and (b) he could go to the press, once he had the recordings. So how many others are there out there who are more gullible trusting, and who don't have the gumption to get their stories on TV?[1] Via WISH TV in Muncie, Indiana:

GREENWOOD, Ind. (WISH) – A Greenwood man says he has dental work that needs to be done. Zachery Lacefield signed up for the Affordable Care Act earlier this year. His coverage went into effect March 1, 2014. Now that it’s time to use the insurance for some major dental repairs the marketplace call center is telling him one thing and his insurance company, Anthem Blue Cross and Blue Shield, is saying another.

Wait, wait. You mean health insurance isn't the same thing as health care?

“As of right now at least one of my teeth could possibly break,” said Lacefield.

This is important not only for sheer humanity, but important in class terms: Teeth are a class marker. (That's why your betters smile all the time on TV, besides being predators.) Bad teeth mean lower class. Bad teeth mean it's harder to get a job. Bad teeth mean you get looked down on. That's one reason I got my teeth fixed in Thailand, so I could keep passing for middle class!

Lacefield says someone at the ACA marketplace told him effective March 1 he would have full coverage and be able to use it how he pleases.

“Now that I’ve actually run into a problem and I need to use the healthcare they’re telling me that I’m denied. I can’t actually use any of it,” said Lacefield.

He’s recorded several conversations throughout his battle. First he recorded a call to Anthem after he was denied coverage.

“As of September 1 we will cover your fillings. Root canals have a twelve month wait,” said the Anthem call representative.

A root canal has a 12-month wait?! Why, because people are going to the dentist to get a root canal for frivolous reasons? This is rank sadism!

But, when he calls the marketplace, he’s given a different story.

“There’s no waiting period?” Lacefield asked.

“Right. The start date is effective March 1 and you will be effective all the way until December 31st,” said the Marketplace representative.

“But, my plan itself, there is no waiting period?” Lacefield asked another Marketplace rep.

“That’s correct. You can go to the doctor today,” she said.

Not one Marketplace representative that he talked to could confirm that he had a waiting period tied to his coverage plan.

“So, I can use it anytime. I don’t have to wait six months to a year or anything like that? I can use it immediately,” Lacefield asked another Marketplace rep.

“Right. You’re covered,” said the rep.

Tasha Bradley with Health and Human Services explains [ha] it’s easy to see on the website where plans detail the waiting period.

What a crock. If it's all that "easy" to see, how come the ACA rep didn't see it?

On the website when a viewer first looks at it, there’s no mention of coverage waiting periods in the quick rundown. Someone must click on plan details and then it’s clearly stated at the top of the coverage plan.

Another crock. Any web designer will tell you there's a substantial drop-off of users every time a click-through is required. And how many screens did Lacefield have to click through before he got to the one he thought was the last one?

Lacefield says since the site was down the day he registered, he had no idea. Now, he’s having a hard time finding out who’s behind, what he calls, a major miscommunication.

Yep. I wonder if he thought he could keep his doctor.

One of the biggest problems I’ve run into is everyone is blaming what’s going on, on someone else,” said Lacefield.

Yep. And that one goes all the way to the top.

The work Lacefield needs will cost him thousands of dollars out of pocket on top of the insurance premium he’s already paying. Now, he says, he’s stuck. He says he just wants to make sure others know what they’re really getting when they sign up.

And now the co-pays and deductibles kick in. Let's just hope the "out-of-network" feature bug doesn't bite him!

“If you filled out for insurance and you haven’t used it, oh please call and check. You might be very surprised that you’re not covered when you were told that you were,” said Lacefield.

Yep. Of course, Lacefield is stupid for trusting people, and especially for trusting anybody who got a job selling ObamaCare on the marketplace, let alone a health insurance company. Because you see, consumers should be smart shoppers and invest hours and hours of their own time poring through the fine print of reams and reams of health insurance company polices to figure out what their policy really covers. That, and continuously checking the website, if it's up, to see if something has changed.

Anthem Blue Cross and Blue Shield sent us this statement:

“There is no waiting period for dental exams, X-rays or cleanings. Major dental services such as restorations or oral surgery are subject to a 12 month waiting period, which is standard for all insurers who sell individual dental plans.”

Spokesman, Tony Felts, says the waiting period is to keep premiums affordable so someone doesn’t sign up, get an expensive procedure then cancel coverage.

Bradley says she will go over details with employees at the call center to make sure information that’s going out isn’t confusing.

BWA-HA-HA-HA-HA-HA!!!! The whole program is confusing. By design! It's complexified and crapified to deny people care!

NOTE [1] Muncie was, famously, "Middletown," the typical small American city. So, if Muncie is typical, the answer to "How many?" is "Lots." Granted, the story is from Greenwood, a little south of Indianapolis, where Muncie is a little northeast.

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Rainbow Girl's picture
Submitted by Rainbow Girl on

I wish Gallup or some reputable polling outfit would do a giant survey asking people with ACA Plans that include fake dental the question:

"Do you know if major dental services such as restorations or oral surgery are subject to a 12 month waiting period, which is standard for all insurers who sell individual dental plans?"

Actually, given the gravity of the situation and the fact that it affects possibly millions of marks consumers of ACA plans, all major newspapers should print full-page public service announcements on this issue, and all prime-time anchors should be required to make special announcements (at prime time) for a month (the kind where they have that alarm beep to signal that it's an urgent situation) - and/or, have a running message on the screen while all the crap product placements and official-line parroting news is being covered - especially during sports coverage.

To quote Lambert, I crack myself up sometimes.