My embrace of democracy does not make my recent experiences with losing government-provided health insurance three times in the last eighteen months any less bitter. The first time my health insurance was cancelled, and I lost the corporate internal appeal at the insurance company, it turned out my insurance had been cancelled illegally.
An on-line complaint to the NYS Department of Finance resulted in the corporation instantly reversing its irreversible decision, restoring my health insurance. I even got an apology for their “mistake,” unlike the probably tens of thousands of others who lose their health insurance every year in the same “unappealable” scam all insurance companies routinely use to cull their lowest paying, most expensive customers.
The supremely maddening part of that first gratuitous fucking is that, even as a long-time lawyer who spent weeks in research, speaking and writing to every expert in the state and federal bureaucracy, I was unable (as was every expert) to find the law the company had clearly violated. Not part of the “Patient Protection (and Affordable Care) Act”. Not discoverable in New York State Insurance Law or in any administrative code. Makes me angry just thinking about it now. No agency I spoke to was even aware of the existence (let alone amazing efficiency) of the Department of Finance online complaint form [1].
If a law that protects a low-income Americans from the illegal act of a corporation providing affordable health care, under the Patient Protection Act, cannot be found, even by determined lawyers, there is no fucking law.
The opacity and unfariness of that burns me to this day, even as a learned, well-meaning former friend kept assuring me I was wrong to be so angry, that I should just be happy I got lucky and saved my own healthcare. As for those with limited English proficiency, struggling to get by, who’d had their ACA insurance illegally cancelled in this manner? Fuck ’em, not your problem, pal (spoken by this dick head like the Great Communicator himself).
The second time my insurance was abruptly terminated (during the second month of the pandemic, which raged uncontrolled in NYC), it was a matter of one document I’d “failed” to upload to a website in a timely manner. There was no actual notice to me of this failure, or its hard consequence, (and fixing it on-line took about three minutes, once I knew about it), my insurance was legally cancelled, according to New York State Law, for my failure to timely provide the document I wasn’t told needed to be provided.
During the window of time we are required to re-apply for ACA insurance in NYS this tax document is not yet available. A reminder email would have been nice (and I had numerous survey emails from this same agency), but is apparently not required under unappealable NYS law. Although NYS informed my insurance company of this fatal failure of mine, with enough time for me to fix the problem, neither entity had any obligation to inform me that my insurance was in jeopardy, until after it was irrevocably cancelled. This time there was no appeal, I had to wait a month to be insured again, trying not to inhale too deeply any time I left the house.
Then we have Medicare, the Great Society program that is the American gold standard for health insurance. “Medicare for All”, is the rallying cry of liberals and socialists alike. I recently turned 65 and learned, over the course of several months, how complicated the public-private Medicare partnership actually is. Do this first or irrevocably lose the right to that, and so forth.
Accepted by virtually all doctors and hospitals, Medicare leaves a potentially gigantic bill for the patient to pay, as 20% of medical visits is not covered. One can, of course, spend thousands a year on private insurance “Medicare Advantage” (there are many plans of all different prices in our “Free Market”), to avoid these possibly huge bills falling on the old person who gets sick. Medicare is infinitely better than no Medicare, but, again, complex and not without tremendous problems, at least based on my initial experiences.
Fortunately, the law gives a person six months, three before the 65th birthday and three after, to learn about this complicated program and sign up (though you will get no communication from Medicare itself and Medicare itself cannot help you in any way until you are officially on Medicare). I was finally able to speak to a knowledgeable volunteer (at the NYC Department for the Aging) who spent over an hour warning me of pitfalls and giving me important information. She found me a prescription drug plan for $8 a month (or something like that) among many that are ten times or more that price. You see, that’s part of our freedom here in the USA — the right to choose!
Two weeks before my 65th birthday I got a notice from my insurance company informing me that ACA insurance ends when you turn 65. Goodbye three month window to apply for Medicare after you turn 65, you will be uninsured until you apply and get approved for Medicare.
Here my beef is not as much with “government” (a legal requirement for actual notice, with enough time to act before your health plan is terminated, would be good) as with how thoroughly corporate “culture” has affected the workings of government. This adoption of corporate practices stems from the idiotic and frequently disproven 40 year myth about the superiority of “private enterprise” over “government”, a big talking point of right-wingers like Louie DeJoy and other “Free Market” defenders.
Part of corporate culture is the thorough segmentation of the “corporate brain” such that one side of it cannot communicate with the other. You cannot get information you need from the consumer side, because they have no way to interact with the provider side — which can answer the question– for example.
We also now commonly see “third parties” with contracts to do government work, like collecting debt, sending bills, providing “notice” and so forth. If I requested something a month ago that is typically available in five business days, and call weeks later to find out the status, I am as likely to get a bored, underpaid, bitter “third party” subcontractor giving me a surly answer pulled directly from his ass as I am to talk to a well-informed government agent ready, willing and able to solve my problem.
In the case of Medicare, I was assured when I applied on June 17 (after a ten business day delay to get a new PIN sent to me by US Mail when I was unable to log-in) that everything was in order, that my application would be approved within two weeks or so and that my Medicare, whenever officially granted, would be effective July 1.
You can’t reach anyone on the phone to find out why it is now three weeks later and the website shows the same 2/3 on the status bar. You read that your application is in process, but there has been no discernible movement in three weeks.
For most people, you read, this review takes 2 to 4 weeks. For you, asshole? Hah!
The first three times you call you are subjected to an endless loop of “Thank you for holding. We appreciate your patience, we’re currently assisting other people and will help you as soon as we possibly can.” The loop about helping you plays until your call is eventually cut off. This is a universal corporate trick that enhances the bottom line, why hire extra workers to answer phones when you can simply play this recorded loop until the call is automatically terminated?
My fourth call was the charm, I was connected to a woman who assured me I simply had to wait, everything was in order, everything that could be done was being done. The Social Security Administration website continued to tell another story.
My next call, a few days later, also got through, this time the guy impatiently told me to forget what the website said, the review ALWAYS takes 60 to 90 days to complete and I’m only slowing it down by trying to call all the time. And, yes, the recording says that if your need is crucial you can schedule a face-to-face meeting (NYC branches of federal government offices are apparently still closed for the pandemic), but merely being uninsured does not qualify as crucial and there are no face-to-face meetings because … Covid. You just have to be patient, asshole.
My next couple of calls put me in that endless loop of thanking me for my patience and eventually disconnecting my call. When I got through next, just the other day, Ms. Estevez was very helpful. The guy who told me 60 to 90 days? He had no idea what he was talking about, he was completely wrong, said Ms. Estevez with great disgust. She looked over my stalled application, found no reason it was being held up. Approved it on the spot.
The next day, with only two or three hours of work, I was able to get my Medicare ID number read to me over the phone. Now, the only things I have to worry about is getting this cancer scare checked out before September, and how much 20% of my doctor’s bill will be (it will certainly be far less than the full retail $885, excluding tests, I was scheduled to pay “out of pocket” in September).
Say it with me, boys and girls:
USA! USA!!!
[1]
I received a notice from the Department of Finance, after my complaint was successfully resolved by their intervention, that my low-cost health insurance did not allow me to use the Department of Finance’s website, that I’d have to lodge any future complaints with Andrew Cuomo’s incompetent political appointee at Medicaid (also in charge of all ACA programs in NYS). Medicaid’s website contains no on-line form, you have to wait for someone who can help you, possibly, to pick up the phone there, you indigent piece of shit.
Note: this letter from the Department of Finance did not stop them from filing my next online complaint against the insurance company, though that one led to nothing, as current New York State law required.
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