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drwexI do not imagine anyone reads my journal and does not think we ought to have at a minimum a single-payer option and mandatory paid sick leave. This entry isn't an argument, it's to document the hilarity.
Our story starts with getting laid off. Cigna health insurance will end, I'm told, at the end of March. Must have health insurance so on the 24th I go online to the Connector and apply.
First problem - they want "proof of income". Eventually I figure out (this is my fault for not following all the links and reading carefully) that a tax return will do, but since we're married filing jointly I have no way to tell them that this tax return should be used to figure Pygment's income and not mine.
Fortunately, I get on the phone with them and speak to the first of three extremely helpful human beings. I literally could not have navigated this maze without their help, as we shall see. So Helpful Human 1 tells me she can put the info into the system that I cannot so they will only use that return for Pygment.
Problem 2: how do I supply a proof of income when I have none? HH1 tells me I can scan and upload the letter that I get from the Dept of Unemployment Insurance (yes, DUI please don't ask). I explain that I do not have such a letter; DUI is just doing things online. Eventually we figure out that there's a web page inside the DUI system I can screenshot and upload as my proof of income. Please also do not ask why State Agency 1 (MassHealth) cannot get this info directly from State Agency 2 (DUI).
Problem 3 arises a few days later when I get mail (oh lord I have gotten SO MUCH paper in this process; what a terrible waste.No, there is no "go paperless" option to select, anywhere Actually it turns out there is, which I just found out today with yet another set of mail which tells you where to navigate to in the site to find it). In this mail is a notice saying that Thing 2 is covered under MassHealth but Thing 1 is rejected, because age 19. BUH? Aren't we supposed to be able to keep our kids on our insurance until they're 25 now?
I won't bore you with more details; phone conversations with HH2 indicate that what has happened is that Thing 2 has qualified for Mass Health, which is Medicaid with facepaint. The rest of the family has qualified for (subsidized) health insurance programs through private insurers, which is a separate program called The Connector. The fact that you apply one time for the whole mishegos is confusing AF. The bottom line is that the Feds pay for Medicaid and the state subsidizes the Connector programs so they want everyone on Mass Health who can qualify.
Problem 3a: Thing 2 being forced onto Mass Health means at least one of their main providers won't take it. We specifically picked plans way back in Step 1 to get coverage for this provider but NOOOO.
Mass Health covers up until age 20. Thing 1 is not yet 20, but since she'll turn 20 during this year she can't get on the program. If she was already on it, she could stay until the program renewed, but whatever. She'll be on our insurance, which we've qualified for. Everything is fine until we get the next round of paper mail a few days later...
Problem 4: our insurance is set to start May 1. Why? Because there's a (hidden) deadline. You have to apply by the 23rd of the month to get coverage for the following month. Note the date above when I applied. Hilarious. However, HH3 tells me that they have a (not mentioned on the site) special "retroactive" insurance clause if I have a qualifying event. Being laid off counts, so she does the "back office work" to put in for a retro insurance start for us. So we'll be covered as of April 1. We've now entered the retro future and just have to wait for our health and dental carriers to mail us cards. Because EVERYONE uses physical mail these days; no, they cannot just email us the numbers we need to give our providers. I can't even.
Problem 5: We get a "we will not cover this expense" letter from Cigna. And when I say "letter" I actually mean "sheaf of paper". Seems they don't like that my PCP tested for Vit D deficiency. Never mind that I've a diagnosis of Vit D deficiency for years and get tested at each annual. So I get on the phone with Cigna, who do NOT have Helpful Humans working for them.
We begin by having Unhelpful Human explain to me what's in the letter. Yes, I read it, but apparently that's what his script says he has to do. I ask why they won't cover this test. He explains that as of August last year they've determined they won't pay for this test more than once per year unless it's needed for a specific diagnosis.
I say the words "preexisting condition" to him a couple times, along with "the last time I got this test was in January 2019 and also by the way I haven't HAD your craptastic insurance for more than a year so there's no way you could've paid for this more than once". Actually I did not say the word 'craptastic' to him because I try not to abuse front-line peons, but you get the gist. Also, I explain, I want to talk to a supervisor. Who he then goes to get.
Unhelpful Human returns to the phone saying he's spoken with his supervisor and actually the rule is Cigna won't pay for this test at all so the once/year thing he said before never mind that. I explain that I want to talk to his supervisor, at which point he tells me that I don't have to pay for this ('no charge to the patient'). BUH? Why couldn't you just say that like half an hour ago?
This sheaf of papers is merely an explanation; the provider is responsible for this amount and I get paper just in case the provider comes after me for it. Which I expect, but seriously WHY? I expect Problem 5a will crop up in a week or two and I'll have to argue with Lahey about it, but that's a problem for Future Me.
Problem 6 appeared with another day's mail (I'm sensing a theme here) in which Mass Health complained to us that Thing 2 appears still to have insurance coverage. It's April 10 now and while talking to UH I ask wtf and he explains that my insurance with Cigna is set to end April 17. Because Reasons, which is to say he doesn't know. Apparently my workplace was wrong when they said March 31 because why should they know any more than I do.
Back on the phone to Mass Health, I get another Helpful Human who explains that he doesn't have the power to note that my other insurance will end in the future so I have to call him back the next business day after the insurance ends and he'll update the records then.
So that's somewhere between 6 and 8 problems, depending on how you math, four humans I've needed to speak to, and I've long ago lost track of the number of hours this has consumed. And it's only been two and a half weeks. But remember, folks, socialized medicine is bad and wasteful and our system is just fine and dandy and not at all wasteful.
Our story starts with getting laid off. Cigna health insurance will end, I'm told, at the end of March. Must have health insurance so on the 24th I go online to the Connector and apply.
First problem - they want "proof of income". Eventually I figure out (this is my fault for not following all the links and reading carefully) that a tax return will do, but since we're married filing jointly I have no way to tell them that this tax return should be used to figure Pygment's income and not mine.
Fortunately, I get on the phone with them and speak to the first of three extremely helpful human beings. I literally could not have navigated this maze without their help, as we shall see. So Helpful Human 1 tells me she can put the info into the system that I cannot so they will only use that return for Pygment.
Problem 2: how do I supply a proof of income when I have none? HH1 tells me I can scan and upload the letter that I get from the Dept of Unemployment Insurance (yes, DUI please don't ask). I explain that I do not have such a letter; DUI is just doing things online. Eventually we figure out that there's a web page inside the DUI system I can screenshot and upload as my proof of income. Please also do not ask why State Agency 1 (MassHealth) cannot get this info directly from State Agency 2 (DUI).
Problem 3 arises a few days later when I get mail (oh lord I have gotten SO MUCH paper in this process; what a terrible waste.
I won't bore you with more details; phone conversations with HH2 indicate that what has happened is that Thing 2 has qualified for Mass Health, which is Medicaid with facepaint. The rest of the family has qualified for (subsidized) health insurance programs through private insurers, which is a separate program called The Connector. The fact that you apply one time for the whole mishegos is confusing AF. The bottom line is that the Feds pay for Medicaid and the state subsidizes the Connector programs so they want everyone on Mass Health who can qualify.
Problem 3a: Thing 2 being forced onto Mass Health means at least one of their main providers won't take it. We specifically picked plans way back in Step 1 to get coverage for this provider but NOOOO.
Mass Health covers up until age 20. Thing 1 is not yet 20, but since she'll turn 20 during this year she can't get on the program. If she was already on it, she could stay until the program renewed, but whatever. She'll be on our insurance, which we've qualified for. Everything is fine until we get the next round of paper mail a few days later...
Problem 4: our insurance is set to start May 1. Why? Because there's a (hidden) deadline. You have to apply by the 23rd of the month to get coverage for the following month. Note the date above when I applied. Hilarious. However, HH3 tells me that they have a (not mentioned on the site) special "retroactive" insurance clause if I have a qualifying event. Being laid off counts, so she does the "back office work" to put in for a retro insurance start for us. So we'll be covered as of April 1. We've now entered the retro future and just have to wait for our health and dental carriers to mail us cards. Because EVERYONE uses physical mail these days; no, they cannot just email us the numbers we need to give our providers. I can't even.
Problem 5: We get a "we will not cover this expense" letter from Cigna. And when I say "letter" I actually mean "sheaf of paper". Seems they don't like that my PCP tested for Vit D deficiency. Never mind that I've a diagnosis of Vit D deficiency for years and get tested at each annual. So I get on the phone with Cigna, who do NOT have Helpful Humans working for them.
We begin by having Unhelpful Human explain to me what's in the letter. Yes, I read it, but apparently that's what his script says he has to do. I ask why they won't cover this test. He explains that as of August last year they've determined they won't pay for this test more than once per year unless it's needed for a specific diagnosis.
I say the words "preexisting condition" to him a couple times, along with "the last time I got this test was in January 2019 and also by the way I haven't HAD your craptastic insurance for more than a year so there's no way you could've paid for this more than once". Actually I did not say the word 'craptastic' to him because I try not to abuse front-line peons, but you get the gist. Also, I explain, I want to talk to a supervisor. Who he then goes to get.
Unhelpful Human returns to the phone saying he's spoken with his supervisor and actually the rule is Cigna won't pay for this test at all so the once/year thing he said before never mind that. I explain that I want to talk to his supervisor, at which point he tells me that I don't have to pay for this ('no charge to the patient'). BUH? Why couldn't you just say that like half an hour ago?
This sheaf of papers is merely an explanation; the provider is responsible for this amount and I get paper just in case the provider comes after me for it. Which I expect, but seriously WHY? I expect Problem 5a will crop up in a week or two and I'll have to argue with Lahey about it, but that's a problem for Future Me.
Problem 6 appeared with another day's mail (I'm sensing a theme here) in which Mass Health complained to us that Thing 2 appears still to have insurance coverage. It's April 10 now and while talking to UH I ask wtf and he explains that my insurance with Cigna is set to end April 17. Because Reasons, which is to say he doesn't know. Apparently my workplace was wrong when they said March 31 because why should they know any more than I do.
Back on the phone to Mass Health, I get another Helpful Human who explains that he doesn't have the power to note that my other insurance will end in the future so I have to call him back the next business day after the insurance ends and he'll update the records then.
So that's somewhere between 6 and 8 problems, depending on how you math, four humans I've needed to speak to, and I've long ago lost track of the number of hours this has consumed. And it's only been two and a half weeks. But remember, folks, socialized medicine is bad and wasteful and our system is just fine and dandy and not at all wasteful.
