Overlapping Insurance

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By: 
Michelle Phillips

For over a decade my husband and I did not have employer subsidized health care insurance and have been at the mercy of the Health Care Marketplace, an entity that formed after the American Care Act (ACA), also known as Obamacare, was put in place. Prior to the marketplace, before my husband and I were married, he had insurance through work, and I bought a private policy because I could not be on his coverage if we weren’t married. 

When I had the private policy, I paid a couple of hundred dollars a month and had good coverage with prescription, dental and optical. I had many options for insurance companies, and I was, for the most part happy with the coverage. But, alas, with the marketplace, independent plans were eliminated, and the choice was reduced to two or three companies in each state. This is not the case with any other type of insurance–car, life, homeowners–they give you many options. By this time, my husband had left the job with insurance and had his own company, forcing both of us to use the marketplace.

Up until February, we had been paying $1,200 a month through the marketplace with horrible coverage. My husband took a job that provided us with health insurance, paying 90 percent of his premium and 50 percent of mine. We were thrilled to reduce that expense. The new insurance kicked in on Feb. 1 and our old policy was cancelled on Feb. 12. Meaning they overlapped a bit.

We are pretty healthy, for the most part, and I have one prescription that I pick up once a month. With the old insurance, the $120 prescription was reduced to $40, which I had been paying for several months. 

This month I forgot to order the prescription until I really needed it and called it into Walgreens. I told the woman on the other line that I had new insurance. She replied that it was still showing the old insurance and to bring the card with me when I picked it up. 

I get to Walgreens and they are telling me that the old insurance is my “primary” insurance and that they will not pay for the prescription because I no longer have coverage with them. I told the woman that it had changed, and there was not a “primary” and “secondary” insurance because the original policy was indeed cancelled. 

At that point she told me they would call the insurance company and to come back in half an hour. I left and before I made it home, Walgreens was calling me. I pulled over to take the call and was informed by a man on the other end that the primary insurance was cancelled and would not pay, but that they could not override it to charge the secondary insurance. He also informed me that if I could not afford the prescription, he could give me a few pills and use a “hardship grant” to cover the cost. 

I had $120, but I would be damned if I were going to pay the full amount. I also couldn’t take hardship money, because I was not in a situation of hardship–aside from dealing with the insurance companies. 

I called my new provider and talked to a very nice woman who undoubtedly deals with angry customers like myself all day long. She told me that, yes, she could see on her computer that my coverage had been cancelled on Feb. 12 with the old company. She then called her company’s prescription coverage carrier and came back to tell me they had not received the memo that the old insurance was cancelled, and she could start the process to change it, but it would take two to four business days to confirm. However, if I wanted to contact the old company, get a verification letter and send it to them, they could expedite the matter.

Now I was even more angry because the new premiums are more than $1,200 total and it really was not my responsibility to fix the problem. Furthermore, they had information that I had cancelled the old insurance right in front of them. But I went home and called the old insurance company.

“Ohhhh, I see there was some overlap there,” the woman on the phone told me with concern in her voice. Apparently, the mighty insurance companies cannot figure out that when you cancel the policy, you are also cancelling the prescription portion, which I didn’t even know was a separate entity. 

Then she says, “Let me just double check with our prescription carrier.”

When she comes back, she tells me that she has had them update the information. Now I ask if she can send me a cancellation letter reflecting that change. 

Of course, she can’t. That must be handled by yet another person, the almighty writer of verification letters. 

I need the prescription, I tell her, and can’t wait for their scribe to cast it in stone. She is not amused, and I end up apologizing for my sarcasm.

It will take up to 24 hours before someone can draft the letter, she says.

Later that evening I receive the letter and send it to the generic email address given to me by the new insurance company. I receive an auto generated response that tells me I will be contacted within the next 2 business days. This was unacceptable to me, so in the morning I called the new company and told my story for the 10th time.

This woman tells me she will see if the letter has been received. When she comes back, she tells me they have gotten it and she will have the change made with the prescription company and tells me to hold. Finally, the correction is made, and Walgreens sends me another email reminder (number four) to come get my prescription. So, I call them to make sure everything is good to go before leaving the house. 

It took me and six other people a day and a half to figure out my prescription coverage because I had the audacity to have overlapping insurance policies. If there is a more inefficient industry in this country, or world, I have never seen it. And I am just one person with a seemingly easy to solve problem. Just imagine all of the other inefficiencies in the insurance industry, I can think of several examples off the top of my head. It seems to be a baffle ‘em with BS kind of policy they are running on.

Back in 2017 I got sick while vacationing in Peru. We were supposed to go to Machu Picchu and I had been sick for about three days, barely able to get out of bed or eat. I was not missing out on Machu Picchu, though, and my husband suggested I see a doctor when we got to Aguas Calientes, the town nearest Machu Picchu. I agreed and we set about looking for a clinic. 

When we got inside, it was bare bones, with a triage desk, a small waiting area and an examining room. There was a pharmacy separating the adult office and pediatrician’s office. I waited for a couple of minutes for triage and a couple more for the doctor. She told me what was wrong, showed me a photo in a medical guide to make sure I understood, and wrote me prescriptions for an antibiotics and Tylenol. When it was all said and done, I paid $28 for the visit both prescriptions and was done in less than 30 minutes.

This incident several years before my encounter last week had already made me a proponent of single payer health care. Let’s face it, the ACA was just a giveaway to the insurance companies, and something I will rally against until we have single payer or I am dead, whichever comes first. 

As for the prescription cost for from my new insurance company last week–$1.78. When I was told the price the pharmacy tech said, “one seventy-eight.” 

“One dollar and seventy-eight cents,” I asked, thinking she might mean $178. 

“Yes,” she said. 

Well, I thought I better check.

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