Appeals Hearing for Healthcare Marketplace: Good Luck Hunting
September 18, 2018 12:46 PM   Subscribe

I have a hearing (by phone) with a Healthcare Marketplace Appeals Federal Hearings Officer. This is the last stop on the appeals train when your coverage is terminated. Not seeking legal advice- just any other experiences, tips, or wisdom before making the call? [a bit more inside]

There are pallet-loads of details which aren't really relevant here. The gist of it is that there was one form that was not completed by the brand new insurance agent who sent my paperwork in, then there was a reversal of two digits on an account number, and my brief holiday of having health insurance was over before I got to really splurge on rather various -oscopies and -ectomies.

Now, having exhausted every level of the appeals process, this phone call is the last stop. From what I hear. I'm hoping for those who've had to make the same fated call what their experience was like... tips... do/not-do... not a post-mortem of what got this sad ball rolling (please). But I've certainly done my due diligence.
posted by moonbird to Law & Government (3 answers total)
 
It sounds like you may be seeking legal advice, and links to free and low-cost legal resources are available at the MeFi Wiki Get a lawyer page.

There may be also specific materials about how to prepare for this type of hearing available from legal aid organization websites. This 2016 document from the National Health Law Program (NHeLP) suggests that you can have a Navigator assist you during the appeals process, i.e. "A Navigator may be particularly helpful to appellants who don’t have legal assistance." [at 20]

More information about how to find a Navigator is available at HealthCare.gov.
posted by Little Dawn at 1:12 PM on September 18, 2018 [1 favorite]


Endorsing Little Dawn's advice, but, for yourself, you want to be maximally prepared. The better-prepared you are, the less work the officer has to do to figure out your case, the more likely he is to look kindly on your case. Have every relevant document in a folder labeled with name and date. Make an outline of each point you want to make and include a specific citation to each relevant document folder, so that you can say, "As you can see in my application dated [blah], the following error was made by the agent on line [blah]..." (If at any point the officer sounds like he doesn't have that document in front of him, you should ask respectfully if he does and say you think it's important that he see it. Make a note on your outline that he told you he didn't have it.) Work from the outline, but be sure to answer the officer's every question as fully as you can (it helps to try to think of what they might be in advance, so you are prepared). You may find it helpful to write the question down as he's asking it. You're allowed to take a little while to think of your answers, too. Go point by point and check off each point as you make it. Be courteous, but be persistent in making your points. Thank him at the end.
posted by praemunire at 1:27 PM on September 18, 2018 [2 favorites]


To clarify, not seeking legal advice- just looking for advice from those who have had this experience. What's the call like? What to expect? What was the tone? That sort of thing.

I've asked for legal options already, and thankfully have an attorney.
posted by moonbird at 1:29 PM on September 18, 2018


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