First let me thank you once more for the help you gave me last month in getting coverage with Coventry.
Once I got covered I began to go to a provider that was told they were set up with Coventry for the ACA. I went for two visits. I was surprised, no shocked, to find a bill in the mail that I owed $150. After another two hours with various customer service people (being passed around like a skunk at a picnic), I was told that my provider was not “in network.” My provider had assured me that they were prior to my ever first going up there. They (the provider) was also quite surprised they were not “in network.”
I also had a lot of medical insurance jargon thrown at me. I had to stop people several time to explain I was not familiar with the insurance terms as I am an insurance outsider. How many of your customers would be familiar with the insiders terms and acronyms?
The outcome was that it was my fault because I had trusted the provider (who was misinformed) and I had not looked it up on a list of providers. This is the first time I had ever heard of a list of providers and the website it was on. They sure made me feel like an idiot not knowing information I never had a clue existed.
If there was real competition in this field I would be looking very hard right now. As it is I have no recourse. I have but 6 months to go to Medicare. Hopefully I can survive until then. I live in fear that if I do have an illness or injury I will fail some proscribed method that Coventry has set forth. Not having all the rules readily at hand all the time, I will no doubt assume that something logical would be the answer and it may not.
I have called my congressman’s office. I am fairly sure that this is not what they expected insurance companies to be doing with the ACA.
My provider was also shocked since they were told they were “in network.” The “in network” designation was supposed to mean that patients that were covered by Coventry could go to them for the stated “in network” costs. After a week of calls they found out that they were “in network” but not for my “plan.” There was a list of providers subsequently sent me that showed me that the “in network” providers for my plan mostly practice in Cedar Rapids, just 50 short miles away.
When I talked with the secretary at my provider’s office she told me that the Coventry person she talked with said the phones have been ringing off the wall with angry customers and bewildered providers. This sure seems like a bait and switch to me, but it would be hard to prove. From what I heard on the Stephanie Miller show from Jackie Sheckner, an expert who has been involved with the ACA from the beginning, every insurance company is doing this.
Once more insurance companies are thumbing their noses at us. While I back the ACA, there are some major problems with it. These problems will not be addressed let alone solved if Republicans are in charge of either house of Congress. We need Democrats to fix the ACA so it works. Better yet we need Democrats to do the right thing and make single payer health care the law of the land