Insurance Insanity

More insurance insanity. I don’t know if anyone is interested in what I’m writing. It’s all I can think about today. Maybe it’s a good case study. Our insurance situation is so complex that I can’t explain it fully here. The short version is that my wife no longer has a job, so we’ve been using the COBRA [1] law to keep our health insurance with Humana, the insurance company used by her former employer. The COBRA law says that you must be allowed to keep your insurance for 18 months after you leave a job or lose a job.

At one point it seemed that I was going to have to leave Humana and lose my mental health benefits. That’s when I told you [2] that I was trying to figure out how to buy Wellbutrin, the drug I take for depression, online.

This is one of the hard things about trying to figure out insurance. Things change all the time. Jeanene had to break away from our family plan because she needed some yearly examinations. We were worried that if the doctors found anything, she wouldn’t be able to get insurance later, when we have to leave Humana. Technically that’s true for all of us. However, my middle daughter has no other option but to remain with Humana until that coverage runs out. We’ve decided it makes better sense for me to stay on that plan with her and the other two girls. So I’ll have mental health benefits for another year or so. That means I can buy Wellbutrin with a reasonable co-payment.

Now there has been a colossal SNAFU with our insurance company. When Jeanene left Humana in March, they mistakenly cancelled the policy for our entire family. No one told us. We got no cancellation notice. I went to the pharmacy to pick up my prescription two weeks ago and was told that my insurance had been cancelled. I knew a mistake had been made because we’ve never been late with a payment.

As I continue with this story, keep that in mind. We’ve paid these people. They have our money.

You would think this would be a simple matter to fix. I would call Humana and the Humana person would say, “I’m sorry Mr. Atkinson. You’ve paid us. Let me update the computer...done. You’re covered again.”

Only this is the world of insurance in the United States. Even if you pay them, nothing is easy or simple.

You see, with COBRA there is often a third-party involved. In our case, a company called Conexis collects our insurance payment, then notifies Humana that we have paid. This is because most employers don’t want to handle the insurance paperwork for people who no longer work for them. I certainly don’t blame them for that.

In theory, Conexis’ job seems easy enough. We pay them our health insurance premium online. They notify Humana that we have paid and our insurance continues.

Apparently this transaction isn’t so simple.

The first thing we did when we heard our insurance was cancelled was to call Humana. The person we spoke with couldn’t explain anything. She simply said that our insurance had been cancelled back in March. (We've deduced that all of this happened when Jeanene left our family insurance. Humana has never been clear about that.)

“But we’ve been paying all along. We paid for March and April.”

“Well, then Conexis hasn’t been notifying us of those payments. We have no record of them.”

Ah, so it’s the fault of Conexis. We called them with what seemed like a reasonable question. “Why have you been taking our online payments and not notifying Humana to that effect?” They didn’t dispute that we had paid. They said, “But we HAVE been notifying Humana. Humana does this all the time. We notify them, but they don’t update their system. Then your insurance gets cancelled.”

Okay, so it’s Humana’s fault. We called them back.

“No no no,” Humana said. “We have no record that Conexis has contacted us. Conexis does this all the time. You need to contact Conexis and demand that they do an emergency notification update. They will email us a record of your payment, and your insurance will be re-instated in 72 hours.

“72 hours? All of this is done by computer and email but it will take you 72 hours?”

“Sorry,” the Humana person said. “That’s the way the system works.”

So we called Conexis, angry now. They denied that the problem was on their end. “We’ve sent them the update,” they said.

“Okay fine, whatever. Will you just send it again?” They agreed. The Conexis rep said, “You know it will take Humana about 72 hours to get this updated. There’s nothing we can do about that.”

“Yeah, so we heard.”

Four days later I called the pharmacy, hoping to be able to pick up my prescription. I was informed that Humana was still denying that we we had insurance with them. By this time I had run out of Wellbutrin.

We called Conexis once again.

“Well, we notified Humana,” they said defensively, You know it sometimes takes up to 72 hours for the system to update.”

“Yes, so we’ve been told. But it’s been four days. Are you sure you notified them?”

“Absolutely. They’ve been notified of your payment. It’s their fault.”

We called Humana. They denied getting any notification from Conexis. “Call them back and ask them if they sent us an edi form by email. That’s what they’re supposed to send us. Now keep in mind that when we finally do get it, it will be...”

“We know. 72 hours.”

Okay, I think that’s probably enough. You get the picture. Let me go on record and say that I think this whole 72 hours thing is pure bullshit. It gives everyone a nice excuse. The people who are supposed to send notices can just tell you they were sent, but the system hasn’t been updated. You wait three or four days and then are told the notice was never sent. Do you see how this can drag on for weeks? In our case, 2 weeks.

AND ALL THIS TIME, THEY HAD OUR MONEY!

It’s funny, at times I felt like I hadn’t paid them. I felt like I was asking these people to do me a favor. And that’s how a lot of the people at Humana and Conexis talk to you. Like this is somehow your fault. We’ve paid them thousands of dollars over the last half a year, and this is how they treat us?

Meanwhile I was out of Wellbutrin and my daughter, whose medication is much more critical, was down to two days supply.

You know, I had been wondering if I really needed to be on Wellbutrin. When you’re on a medication for depression, sometimes you wonder what would happen if you just stopped taking it. I found out. I’ll tell you about that tomorrow. It’s a whole story of its own.

For today, let me say that Jeanene and I dedicated Monday and Tuesday to getting this worked out. Two educated adults, determined and intelligent, working diligently to get to the bottom of things, took two entire days to get one company to notify another company that we had paid them two weeks ago.

It’s insane, I tell you. Insanity. Do you know how we solved this problem? We took names and notes. We stopped asking if “they” had sent things and demanded to know who sent them, when, and to what email address. If we talked to someone we found out their name and their phone extension. If that person said, “This will be done in an hour or so,” in an hour or so we called them back. Every time. We badgered them and would not go away. With both of us tag-teaming on the phones, it took two full days for Humana to update our records to show that we had indeed paid them two weeks before.

This morning at 11:00 am, our insurance was reinstated. I drove straight to the Walgreens Pharmacy, got my medication, and took a dose. It will take a few days for this medication to get back into my system, but at least I have medication for the next month.

So what actually happened? There’s no way to tell for sure. We think that when Humana mistakenly cancelled our family policy, they notified Conexis but Conexis did not tell us, and they continued to take our money. This is one of the crazy things about the system. If you are one day late with a payment, alarms go off up and down the computer network. Everyone from Humana to Walgreens immediately knows that your insurance has lapsed. On the other hand, if they cancel your policy by mistake, somehow you can continue to make payments online and no one notices or says anything. If I hadn’t had to buy medication, how long do you suppose Conexis would have continued to take our money in spite of the fact that our policy had been cancelled?

I’m guessing they would have taken every penny until one of us got sick and found out in the emergency room that we had no insurance.

Note: The reason this isn't criminal is that the insurance company agrees that when you finally get it worked out, you are covered retroactively. So if one of us had gotten sick during this time, we would have eventually been reimbursed. So legally, they are fine. In the meantime, people who need medicine run out while they get jerked around by these companies.

One last thing.

Our next payment is due April 30th. We’ll pay them before the due date. However, if there is any mistake on their end, if Conexis does not notify Humana, or if Humana gets the notification but does not update their system, our policy will be cancelled. When you're on COBRA, they cancel you the day after your payment is due. There is no grace. If anything goes wrong, we’ll be doing this all over again.

The good news is, we understand the system now, and we have a bunch of names, phone numbers, and email addresses. If we have any trouble, I bet we can get it worked out in, I don't know, 72 hours or so.

rlp