The New York State of Health “Marketplace” is where uninsured New Yorkers are mandated, by the PPACA, to buy health insurance.   The place is staffed by undertrained, underpaid reps who will give you several completely different answers to the same question.   The regulations of the PPACA are complicated, mistakes are common and there is no quick mechanism to fix the many mistakes made by the NYSOH Marketplace.   The director of the NYSOH has ordered her reps not to give out her name, she does not want a flood of calls and mail about the many mistakes her agency routinely makes.   If you were Donna Frescatore, appointed director of the NYSOH Marketplace, you might feel the same way.

The onus, as always, is on the customer.   If you don’t buy health insurance within the mandated arbitrary several week period from just before Christmas to just after New Years you will be uninsured for the following year, or at least for the first few months of that year.  All this is to be expected when you leave the foxes, for-profit health industry corporations, in charge of the hen house.  Only in America, folks.

As a result of a mistake at the NYSOH Marketplace I was preemptively denied, in December 2016, the subsidy I was entitled to in 2017.  The subsidy reduced my monthly premium by almost 50%.  I was required to pay the full premium until I could have an appeal. Three weeks after the telephone appeal (in June) I got a well-written legally complex ruling from the adjudicator.  The ruling stated that I was entitled to the subsidy the on-line calculator showed me I was entitled to, retroactive to February 1, when the current insurance year started.

When I got my invoice from Healthfirst for July it claimed I owed the full premium.  It suggested if I did not pay two months (the current month and one month in advance) I was in danger of losing my health care.  When I called I was told that Healthfirst had received the subsidy money, that credit from my overpayment had been applied and that I had a balance of $876 going forward.   The rep worked through the calculations with me and I was satisfied that the amount of remaining credit was about right.

In August I got a bill for $28.  The letter stated that if I didn’t pay this amount immediately my health insurance would be cut off.   When I called Healthfirst the rep could not tell me why I’d received this bill, but confirmed that I had a good deal of credit from past overpayments.  He applied the credit to my August payment.  He couldn’t tell me exactly how much credit I had left, but he offered to do the math with me again.   I told him snippily that I’d already spent 36 minutes on the phone, had done this same calculation in July and was unwilling to do this every month.  He apparently took offense, putting me on hold until I eventually hung up.    

A few weeks later I got another demand for this phantom $28, accompanied by the same threat.  I have a fairly serious kidney disease and new cancer cells on my nose, I can’t afford to be without health care at the moment.  I called to straighten this out.  It was a naive thing to do.  

The rep saw on her screen that I owed $38, and was confused by this discrepancy.  She also saw that I had overpaid by more than a thousand dollars and still had credit.  I asked her how much credit remained.  She was unable to say.  She placed me on hold.  She was nice.  She tried to be helpful.   I told her I wanted a written accounting of what I’d paid, what subsidy had been paid on my behalf and how much credit I currently had left.  She gave me an “escalation number” meaning she was sending my request up the corporate chain.  She also promised to follow my “case” and update me as soon as she had information.  I told her the main thing was to get me a written accounting, she promised she would.

Almost a month has passed, I got no accounting, nor any update from the nice rep, but I did get this the other day:

Somebody else would bite the bullet and spend the twenty or thirty minutes on the phone to try to straighten this out.  It is the least a customer can do every month, is it not?  I don’t know why I am such a stubbornly bitter bastid.

In a system where there is no regulation, no law, no procedure for adjudicating corporate chicanery, no impartial office investigating health care-related fraud and no consequence for even blatantly fraudulent billing practices, scoundrels nonchalantly generate arbitrary bills and threaten consumers if the bills are not paid.  It’s their nature, who could expect them to resist?

USA!  USA!!!!