Covering the uncoverable
April 4, 2012 6:32 AM   Subscribe

Health insurance quagmire (NYC based) A year and a half ago for the first time in my life I got health insurance. It wasn't an easy process, as I am a small business owner, and it was difficult to find a policy that my employment status (I was categorized as self employed for this policy) made me eligible for. All was fine until last November, when I made a late payment. I thought I had put my payments on auto pay on my online banking, but apparently I messed up the process along the way and the payment didn't go out.

When I caught the error, I sent in the payment. I also sent in the next three months payments as they became due. In the beginning of March, I received a check from the insurance company refunding me the last few months premiums. I also started receiving phone calls from the hospital where I received care for my ongoing medical condition in December informing me that I had outstanding balances.
When I called the insurance company, they informed me that my insurance had been cancelled on November 30, and because it was beyond the reinstatement period of 63 days, I would not be eligible for the group policy for one year from the date of cancellation and would need to get an individual policy. They told me that they had sent out a letter informing me of the pending cancellation in mid-November (which I swear I had never received) and that despite them cashing my checks every month afterward, in order to have the policy re-instated I needed to call them and specifically request a reinstatement.
This letter was the only thing informing me within the 63 day period that my account was about to be terminated. Even when I called the customer service number, the automated voice on the other end listed the billings from the hospital as being paid. Later when I asked a human customer service rep about this, she said that they always have any bill submitted to them as paid on the automated system, whether paid or not. Ack.
Despite my pleading to have my insurance reinstated, no one in customer service was able or willing to do this. The issue I face now is that for an individual policy the premiums are $1972 a month (I'm single, non-smoking 40's female), and that doesn't cover my pre-existing condition for a year. I cannot afford this, especially if I have to pay for my treatments out of pocket on top of it. They are saying that I will be eligible for the group policy again on November 30 (my previous monthly premium for this was $625), but once again, my pre-existing condition won't be covered initially. The longer I wait to get a policy, the longer it will be before my condition is covered by whatever insurance I get.
My condition is such that I need treatment approximately every 6 months or so, and will need major surgery when the temporary treatments stop working. No one knows when this will happen.
I just paid the $4000 worth of bills for the treatment I had in December out of my pocket. I can afford to pay for the other temporary treatments, as they normally run only about $2000 each time, however, the potential surgery would likely bankrupt me.
Other options I've looked into which I'm not eligible for are Freelancers Union (I get a w-2 making me ineligible) and the Healthy NY program (I earn too much money).
I also recall reading that there is something about not having a pre-existing condition covered by insurance for longer than six months which makes it more difficult to get that condition covered, so I need to get this straightened out ASAP.
My questions are these:
Is there any recourse I can take against this insurance company (Oxford/ United)?
Is there someone out there who might potentially have some sway with the insurance company?
Are there such things as health insurance brokers who can potentially help me find another carrier? If so, where do I find them?
Is there some source of health insurance that I am forgetting about or am unaware of that I can potentially qualify for?
I tried to find out if this cancellation made me ineligible for a group policy within the Oxford group or with all insurance companies, but was unable to get a clear answer. Either way, my previous experience of being self-employed and having one option only to choose from doesn't make me think that there are a lot of options open to me.

Thank you in advance and this is anonymous because of embarrassment and paranoia of big insurance industry
posted by anonymous to Health & Fitness (3 answers total) 4 users marked this as a favorite
This doesn't help on your prior insurer, but it might help if in another month or two: would you be eligible for the New York State Bridge Plan for people with pre-existing conditions? It looks like you won't be eligible until May 30 (once you've been without insurance for six months). However, it is designed for people with pre-existing conditions, and the premiums and coverage might work for you.

Good luck -- I hope you get this sorted.
posted by pie ninja at 6:54 AM on April 4, 2012 [2 favorites]

Call the NYS Attorney General's Health Care Help LineThey might be able to help you. Alternatively, think about getting an attorney to write a letter or two. Sometimes that helps.

I'm really sorry that this is happening to you.
posted by the young rope-rider at 7:36 AM on April 4, 2012

I've known several people who've worked in politics over the years, and to my surprise help in matters like these are precisely what politicians (well, okay, their aides, really) do for a living. All day long. There is definitely an almost social worky aspect to being in politics. And this makes sense if you think about it: After all, politicians are supposed to be representing you, their constituent.

I would definitely try the Attorney General's Health Care Help Line, listed above, given their named mission. But if they can't help you, you should call your U.S. Senator's office, tell them you are a voter, and explain you have a problem and need help fast! It is amazing how often politicians can help constituents sort through bureaucracy in a single phone call.
posted by Violet Blue at 3:12 PM on April 4, 2012

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