Sometimes the Best Things in Life aren’t Easy! Don’t Give up on the Health Exchanges!

When the Affordable Care Act was passed into law in 2010, there was a little known caveat called the Pre-Existing Condition Insurance Plan(PCIP) connected to the law.  It recognized that there were millions of people in the United States who through no fault of their own did not have access to health insurance due to a chronic illness.  ACA directed the federal government to set up an insurance plan, PCIP, with premiums, based only on age, so that this group of people could purchase insurance enabling them to get the healthcare they needed.

In 2011, the PCIP program was rolled out with very little fanfare or advertisement, but allowed people across the United States who had been denied insurance based on pre-existing illnesses to sign up and pay a monthly premium for insurance. I often tell people that this was the first roll-out of ACA and is very similar to the silver plan offered on the current federal and state exchanges. The primary difference was that there were no tax subsidies or any cost sharing of deductibles and co-pays involved.  Unfortunately, many people did not learn of the available insurance, so while almost a million people signed up for the plan, many others knew nothing about it and have been awaiting 2014 with great anticipation.  In fact, as I have talked about PCIP in the months leading up to the roll-out of the exchanges and since the opening of the federal and state exchanges, many people have accused me of lying about PCIP being the first insurance plan of ACA.

I first applied for PCIP in July, 2011.  I learned about the program, just by luck, when doing some research on the internet on the Affordable Care Act.  I could hardly contain my excitement about being able to purchase health insurance at a reasonable cost.  Based on my age, the premiums would either be $220.00 or $300.00 per month.  The lesser monthly premium meant the enrollee would pay a higher deductible and co-pay.  I chose the more expensive premium that also offered lower deductibles and co-pays. I immediately signed up via the internet and mailed in my “supporting documents.” These documents consisted of a copy of my social security card, my driver’s license and a letter from my doctor indicating I had chronic health issues.  I wish I could say that two weeks later I had health insurance, however like is often true of anything new, there were problems.

It took me four months to get signed up and the problems worked out.  While I got frustrated at times, I never gave up.  The PCIP administration was located in two different places Missouri and Louisiana.  The eligibility workers were in Missouri, but the financial administration was in Louisiana.  The two components did not communicate very well.  I would get letters from one indicating I had failed to provide something, and be told via telephone call that the information had been received. Sometimes I wanted to bang my head against a wall or pull every hair out of my head, but I persevered.  Perhaps the biggest problem came when making arrangements to pay my premium each month.  I elected to have it automatically withdrawn from my checking account each month.  For this, I had to send in a voided check and a check for my first month’s payment.  I did this, not once, but three times.  Each time no one could figure out where it was.  In fact, one time I sent it federal express and they still couldn’t figure out what happened to it.

Was I frustrated?  Absolutely.  Was I ready to give up?  No.  I needed this insurance and I was going to use every option I had to get this insurance.  Now, perhaps for most people that would have involved a few phone calls, however I have been a social worker for 25 years and those who know me “might” say I am very strong willed. I called both the Missouri and Louisiana offices and spoke to workers, supervisors and supervisor’s supervisors.  I documented every call I made and wasn’t afraid to let them know they were going to hear from me every day until I was approved for PCIP.  I remember clearly about three and a half months after applying, I was finally connected to the person who headed up the financial division of PCIP.  I told him the problems I had been having and how badly I needed this insurance.  That day I hit pay dirt.  He made it his mission to find out what happened and promised me I would have insurance within 30 days at the most.

He was true to his word.  He fixed  the problems in three days.  Suddenly I got a call. with an apology. that I was approved for health insurance.  They let me give them a “check” by phone and said my cards would arrive shortly in the mail.  I can not tell you the relief I felt.  You see, I was very ill.  I had spend several weeks during 2010 in the hospital and Nursing Home and it has depleted to a great extent my financial capabilities.  I also knew, that I had ongoing and consistent health problems that needed to be treated and if they were not taken care of would lead to my death.  For me, this insurance was simply a life or death matter.

So, in late 2011, I became a person who had health insurance for the first time in 7 years.  I would have gladly paid for it prior to then, but I couldn’t, due to my health not financial reasons, not one company wanted to offer me insurance.  The process of initially getting that insurance was horrific, however, once I was approved and had the cards in hand, I never had another problem with the insurance.  It paid well, it paid on time, and all my doctors were approved providers.  Even my medications were reasonable and at that time I took a lot of them.  Oh and by the way, just for the purpose of humor, that check I wrote and supposedly they never received was sent back to me about a year later…lol.

I am happy to report that since being approved for PCIP, my health has improved greatly.  If you want to read my story about my slide into chronic illness you can do so here:  https://progressiveandproud.wordpress.com/2013/09/30/obamacare-the-health-insurance-that-saved-my-life/.  Suffice it to say, sometimes the best things in life aren’t easy, but that doesn’t mean they are not worth it.  If you are one of those people having trouble getting signed up through your state or federal exchange for health insurance, don’t give up and don’t give in.  These problems will be solved.  There are many officials like the one who finally helped me out there, who believe in this program and will do whatever it takes to help people get signed up for the exchange.  Remember it took me a few months, but the pay-off has been incredible.  Because of PCIP today, I have more quality of life than I had in the previous ten years.  Stay strong and keep on trying.

About the Authors: By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW. Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations.  Please direct your questions and/or inquiries to askcobuzzi@gmail.com.

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