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Announcer

And now America's Healthcare Advocate, Cary Hall.

00;00;05;27 - 00;00;22;00

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show. Broadcasting coast to coast across the USA. Here on the HIA Radio Network, my producer, Mr. Darren Willhite. I'm your host, Cary Hall. This is your show, America. Thank you for joining us and making us one of the most listened to talk shows in the United States.

00;00;22;08 - 00;00;52;08

Cary Hall

221 affiliates strong. Thanks to all of you in the listening audience and on 14 podcast platform, the 62,172 plays, which is really quite remarkable when you think about it. And we've got about 256,000 YouTube views and downloads of our show on YouTube. And all of that is being put together by Mr. Dave Thiessen, who is my producer that does all of this, the man behind the camera and the man who puts all of this up on the 14 podcast platforms and YouTube.

00;00;52;14 - 00;01;15;23

Cary Hall

And those platforms are Amazon, Audacy, Overcast, Pandora RSS Podcast Feeds, Stitcher, Spotify, Apple Podcasts, Google, Pocket Casts, Rumble, Spreaker, SoundCloud and TuneIn. So we're on 14 of those. You can find us up there under America's Healthcare Advocate. A lot of you evidently are doing it. I'm getting a lot of feedback and that's why we put them up there.

00;01;15;23 - 00;01;42;11

Cary Hall

So we appreciate all of you either listening on the AM/FM dial or if you're on one of those podcast platforms. We appreciate you're listening to us on the podcast and YouTube. If you're chronologically challenged and you're looking for Medicare, you can call the lovely Joyce Thompson or you can call Carolee Steel at RPS Benefits by Design, toll free anywhere in the country, 877 385 2224.

00;01;42;16 - 00;02;08;22

Cary Hall

They will show you all your Medicare options from all the carriers across the country and find one that fits your budget and your needs. If you're an employer and you are looking for health insurance reasonably priced, that will work for you and your employees. Give Maria Ahlers a call. She's also RPS Benefits by Design. That's 877 385 2224. They have plans that a lot of people don't know about and certainly aren't being seen out on the marketplace.

00;02;08;22 - 00;02;26;14

Cary Hall

So give them a call if you're not happy with what you've got or are you just want to see what the options are. All right. This is a show that came to me through one of the television stations here in Kansas City, KCTV5, a lady by the name of Angie Ricono, who I have worked with for years, who does a lot of reporting over there.

00;02;26;14 - 00;02;46;29

Cary Hall

She's a reporter at KCTV five, brought me this story of a lady by the name of Claire Benson, who's joining me in studio. Hi, Claire. Hey, Cary. And it is a classic example. What happens when you rely on a government entity to assist you with health insurance or other matters. And this is really quite a story. So I've asked Claire to come in studio with me today.

00;02;46;29 - 00;03;05;28

Cary Hall

We did a piece here in Kansas City on it. It was on television here, and I've got a lot of response to that. But what happened with Claire was she went on the website, HealthCare.gov, and I'm going to stop right there and I'm going to ask her to start telling her story about what happened on healthcare.gov. So what happened when you first signed up, Claire?

00;03;06;00 - 00;03;33;02

Claire Benson

Nothing, really. It was fairly straightforward. We got a health insurance policy that was a high deductible plan because we don't really rely on our insurance very much. We're both fairly healthy, just more of a backstop, you know, in case something serious happened. And we had that insurance for months. We got it in June and everything was going smoothly until September when I reported to the marketplace that I had become pregnant.

00;03;33;05 - 00;03;38;10

Cary Hall

Okay. So let's kind of go back. So you had an HSA plan, high deductible plan. That's basically what it was.

00;03;38;13 - 00;03;38;24

Claire Benson

Yeah.

00;03;38;29 - 00;03;44;22

Cary Hall

Okay, good. And you went on the website, signed up for it. And did you get a subsidy?

00;03;44;24 - 00;04;09;03

Claire Benson

Yes. Yeah. So that's how we were paying for it. We had a subsidy for part of the cost through the state. And so, I mean, it was really easy to sign up. We, you know, we went on Marketplace and I think it probably took about 10 minutes and the subsidy thing seemed fairly automatic. We just entered some, you know, personal information in our application and then hey presto, we had an insurance policy that was.

00;04;09;08 - 00;04;11;08

Cary Hall

And the carrier was UnitedHealthcare.

00;04;11;09 - 00;04;11;23

Claire Benson

Yep, that's.

00;04;11;23 - 00;04;17;10

Cary Hall

Right. Okay. But there's no interaction between you and United. It was all handled by healthcare.gov.

00;04;17;11 - 00;04;17;25

Claire Benson

Right.

00;04;17;27 - 00;04;42;04

Cary Hall

Okay, so then that's where this saga begins. Okay. Was the good people at healthcare.gov and how that how that comes to play Now, you know, you've heard me say this for years. The problem with government run health insurance is to delivered with the compassion of the IRS and the efficiency of the post office. And I'm going to prove that as we continue to talk to Claire here about what happened to her after she had signed up.

00;04;42;04 - 00;04;56;25

Cary Hall

So signing up wasn't necessarily a problem. How did you when you looked at the policies, did you see more than one did? Did you have a navigator or somebody who you talked to that explained to you, here's United, here's Blue Cross, here's Aetna, here’s Cigna.

00;04;56;28 - 00;05;06;22

Claire Benson

No, we didn't have a navigator. I did it all by myself on the computer. Yep. And so, you know, we entered our information. It showed us what options were available for.

00;05;06;25 - 00;05;08;04

Cary Hall

Populated all the plans.

00;05;08;04 - 00;05;15;03

Claire Benson

Yep. And then I, if I recall correctly, I just went through each like, plan summary.

00;05;15;03 - 00;05;16;00

Cary Hall

Right.

00;05;16;02 - 00;05;22;19

Claire Benson

Compared the, you know, the premiums and the benefits and chose the one that seemed like the, the best fit for us.

00;05;22;21 - 00;05;24;02

Cary Hall

And then they issued the policy.

00;05;24;06 - 00;05;26;26

Claire Benson

Yeah. And then we had health insurance the next day I think.

00;05;26;29 - 00;05;31;15

Cary Hall

my goodness. So that was fast that, that that's extremely efficient. I'm glad that part was.

00;05;31;15 - 00;05;32;23

Claire Benson

Yeah.

00;05;32;25 - 00;05;46;16

Cary Hall

Yeah. That part was. Then we'll get into the rest of it, which would not be that part obviously. So, so. So now you become pregnant. Okay, then you become pregnant in when you realize you're pregnant. It's about July. August, somewhere in there.

00;05;46;20 - 00;05;54;04

Claire Benson

Yeah, it was. Yeah. The beginning of July, I think. Okay. So it was only a few weeks after we'd gotten the insurance, but it was after we.

00;05;54;06 - 00;05;54;11

Cary Hall

Had.

00;05;54;11 - 00;05;55;03

Claire Benson

Gotten the insurance.

00;05;55;07 - 00;06;03;25

Cary Hall

So then it. How did they notify you that you needed to fill out another app? We get into this whole app discussion.

00;06;03;25 - 00;06;20;20

Claire Benson

Yeah. So it's somewhat convoluted, but I had been getting emails from healthcare.gov saying that I needed to log into our account and upload personal information just to verify my identity.

00;06;20;22 - 00;06;33;16

Cary Hall

And this is after you sign up. If you've gotten a card now says UnitedHealthcare on it, yeah, you have a policy in place, but now you're still getting emails from the government website saying We have to verify your identity.

00;06;33;16 - 00;06;56;02

Claire Benson

Yeah, and it boiled down to something simple. It turned out that because my married name doesn't match my maiden name, which is on my Social Security card, they just needed either a picture of my Social Security card and a picture of my ID, or they needed me to go back into my application and just check a box That said, my name has changed.

00;06;56;02 - 00;07;01;10

Cary Hall

And your name was Claire Delaval is your maiden name, and your married name was Clare Benson.

00;07;01;10 - 00;07;29;02

Claire Benson

Right. So I called the marketplace because I couldn't figure out how to log into my account. Okay. It turned out that I had used whatever account I had had created our marketplace application through wasn't synched up with our healthcare.gov account. Anyway, I called Marketplace Customer Service to help me log in. That went smoothly enough. I got logged into my account and then the woman stayed on the phone with me.

00;07;29;05 - 00;07;40;01

Claire Benson

She said all I needed to do was click through our marketplace application, find the page with the box to check about my name change. So we did that. I, I clicked through the pages of the application.

00;07;40;03 - 00;07;41;06

Cary Hall

She was on the phone with you.

00;07;41;06 - 00;07;49;04

Claire Benson

She stayed on the phone with me right. So I get to the part that has, you know, a box to check that says, you know, my name is different from my Social Security card

00;07;49;05 - 00;07;50;04

Cary Hall

And that was going to be it.

00;07;50;09 - 00;07;52;11

Claire Benson

That was support. Yeah, that was the reason I called you.

00;07;52;12 - 00;07;52;25

Cary Hall

You're done.

00;07;52;28 - 00;07;53;21

Claire Benson

Yeah, exactly.

00;07;53;21 - 00;07;55;10

Cary Hall

So why didn't you just click off and.

00;07;55;12 - 00;08;11;26

Claire Benson

And so now as as I'm going through, I see a page that has a question asking if anyone in the household is pregnant. And I, I realize, you know, that this was part of the application I'd forgotten about. I had since become pregnant, but you weren't.

00;08;12;01 - 00;08;31;26

Cary Hall

Here's the clarification. I want to make sure everybody has to. Since she was not pregnant right. When she applied for this insurance and it was issued, she became pregnant six, eight weeks, whatever it was after the fact that she had received a health insurance policy, had the card in her pocket. It was now covered by United Health Care, going through the health care dot gov website.

00;08;31;29 - 00;08;58;13

Claire Benson

Yes. Now, the thing is, when you fill out this application and really any time you interact with your health care dot gov account, you see these messages saying if any of your circumstances change, you have ten days to update your your marketplace application. I think it's ten days, otherwise you could lose coverage. So if you move, if you, you know, get married, if you become pregnant, if your income changes, you have to update your application.

00;08;58;20 - 00;09;01;07

Claire Benson

Otherwise you could lose your rights to the application.

00;09;01;08 - 00;09;04;22

Cary Hall

Yes, please. Yes. They're telling you now have to go back and update the application.

00;09;04;23 - 00;09;23;01

Claire Benson

Right. And so that was what popped into my head when I when I saw the question, is anyone pregnant? And so, you know, since I already had this helpful customer service representative on the phone, I asked her, do I need to update this now? Do I need to check this box to reflect that I'm pregnant?

00;09;23;01 - 00;09;45;00

Cary Hall

And we're going to come back after the break and she's going to tell you what she did and then we're going to tell you what happened after that, how the good people at healthcare.gov turned this whole situation upside down. It turns out to be very, very interesting. We'll be right back after the break. You're listening to America's Healthcare Advocates Show broadcasting coast to coast across the USA here on the HIA Radio Network.

00;09;45;03 - 00;10;02;29

Cary Hall

If you want to find out more about us, go to the website. America's Healthcare Advocate dot com. If you've got a question or a problem, you don't have to go to the television station. You can actually just email me from the website. I'll be happy to help you. Stay tuned. We'll be right back after the break. We've got more.

00;10;03;01 - 00;10;36;07

Steve Kuker

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00;10;36;09 - 00;11;04;11

Steve Kuker

If you're looking for someone who can provide you experienced and objective guidance when searching for a senior care community, reach out today and discover the services of Senior Care Consulting at 913 945 2800. Know your options and choose with care at seniorcareconsulting.com.

00;11;04;14 - 00;11;32;28

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across USA here on the HIA Radio Network. If you need help with health insurance, whether it's Medicare, ACA or individual policies or group, the good folks at RPS Benefits by Design. 877 385 2224 anywhere in the country they are happy to help you. In studio with me, Claire Benson, who is here talking to us about her saga in signing up for ACA, Obamacare.

00;11;32;28 - 00;11;54;20

Cary Hall

Using the healthcare.gov website and the navigator who assisted her after she was required to fill out some more information. It's a fascinating story of just how the government does things. And as I always say, anytime you interact with the federal government, you can always expect it to be interesting, to say the least. My producer today Mr. Darren Wilhite, behind the camera.

00;11;54;25 - 00;12;15;20

Cary Hall

Mr. Dave Thiessen And I'm your host, Cary Hall. So let's go back. We dropped off with now you're you're on the line with the health care navigator by the way. Navigators are not brokers and they're not agents, okay? They are people that sit in a cubicle at some government facility or offsite facility. They answer the phones. They sign people of these policies, but they are not seasoned agents.

00;12;15;23 - 00;12;28;29

Cary Hall

Okay? And they are not licensed brokers. They're navigators. It's a it's a different deal. And you're going to find that out shortly here in about a couple of minutes. So now she says to you, you see this question on there about pregnancy, right?

00;12;28;29 - 00;12;48;17

Claire Benson

So the person I'm on the phone with, I think her title was customer service representative. But she's a you know, she works for the marketplace, HealthCare.gov, Right. When you call their main number, you know, she's one of the the first people who answers. And so as we're going through to fix this, you know, name change, which is what.

00;12;48;17 - 00;13;00;11

Cary Hall

This was about. Yes. Reset is all she was trying to do was go from her maiden name to her married name. And that was all she was supposed to do. Now it morphs into this whole issue on pregnancy.

00;13;00;11 - 00;13;08;25

Claire Benson

And and only because I saw the question and I asked her, you know, do I need to update this, reflect that I'm pregnant? Do I need to report that I'm pregnant.

00;13;08;25 - 00;13;21;20

Cary Hall

Because of... After the fact that she already had the policy in place and the card from UnitedHealthcare in her pocket showing that she had coverage and she was not pregnant when she got the policy. This is the key to this whole thing. Keep going.

00;13;21;20 - 00;13;42;20

Claire Benson

So then she says, Yes, you do. You should. Any time anything changes, you should update your application to reflect it. And once you change it, to show that you're pregnant, it may mean you have cheaper coverage options. And that was was really all the forewarning she gave me. My coverage could become more affordable if I update, but.

00;13;42;20 - 00;13;49;06

Cary Hall

It wasn't going to be. And this is the key. It wasn't going to be the health care health insurance policy from UnitedHealthcare.

00;13;49;06 - 00;13;49;19

Claire Benson

Right.

00;13;49;19 - 00;13;52;00

Cary Hall

They were going to flip you over to Medicaid.

00;13;52;02 - 00;14;05;02

Claire Benson

Correct. So Medicaid there was there was no she didn't give me any information about this beforehand. It turns out there is a little information about this on their website, but I hadn't seen it before this phone call. I hadn't called for this.

00;14;05;02 - 00;14;05;22

Cary Hall

Purpose or.

00;14;05;22 - 00;14;06;09

Claire Benson

Done my research.

00;14;06;09 - 00;14;07;10

Cary Hall

Was what you were doing.

00;14;07;12 - 00;14;08;06

Claire Benson

So.

00;14;08;08 - 00;14;09;08

Cary Hall

So you check the box.

00;14;09;15 - 00;14;32;20

Claire Benson

I said, okay, no problem. I check the box to show that I'm pregnant. And then I resubmitted this now updated application. She had me close out of the window so that she could pull up the updated version on her and she takes a look at it and she says, Okay, I have to inform you that now you have no health insurance, your coverage is terminated as of today.

00;14;32;27 - 00;14;47;26

Cary Hall

Stop right there. She instructs her to do this. Okay. Tells her yes, check the box. Tells her you're going to get better or cheaper health insurance by checking the box and then tells you, hi. Now that we're done, I have to inform you.

00;14;47;29 - 00;14;49;23

Claire Benson

That your coverage is terminated as of.

00;14;49;23 - 00;15;07;24

Cary Hall

Today. So now you have no health insurance? Correct? You're pregnant. You have no health insurance. You went from United Health Care Policy to calling this lovely people on healthcare.gov. Okay. And going through what was supposed to be a simple name change and now you've lost your health insurance.

00;15;07;24 - 00;15;15;05

Claire Benson

Right. And so I asked her, you know, what does this mean? What happens now? How can I have no coverage.

00;15;15;07 - 00;15;17;03

Cary Hall

When I just had coverage? 15 minutes.

00;15;17;03 - 00;15;35;14

Claire Benson

Exactly right. And she said, well, you have to wait to hear from Medicaid. She said, we will automatically send all your information to Medicaid. They will process it, you know, on their own timeline. You don't need to do anything. Just sit back and wait to hear from Medicaid. If Medicaid approves you, then if.

00;15;35;16 - 00;15;53;27

Cary Hall

Medicaid approved you. Right. So you had health insurance in place. Now they cancel it and then they tell you, wait till Medicaid steps in and they'll get to you on their timeline. God only knows what that's going to be. All right. And in the meantime, she has no coverage. So if something happens to her, if she has an accident, she's involved.

00;15;53;28 - 00;16;00;24

Cary Hall

Motor vehicle accident. There's a complication with the pregnancy. Anything that may happen, she has no health insurance, period.

00;16;00;26 - 00;16;19;26

Claire Benson

Yes. So she said, you know, you'll either be accepted or denied by Medicaid. If you're denied, you'll take that denial letter back to the marketplace and they'll put you back on insurance. Otherwise, you'll you'll be on Medicaid. And I asked her what happens in the meantime? You know, who knows how long it'll take for this decision to be made?

00;16;19;29 - 00;16;25;15

Claire Benson

Am I am I just out here completely uncovered and vulnerable while I'm pregnant?

00;16;25;19 - 00;16;26;29

Cary Hall

And the answer to that was.

00;16;26;29 - 00;16;45;26

Claire Benson

Yes, you have absolutely no coverage. There's nothing, you know, to back you up. She did say if you're found eligible for Medicaid, Medicaid will retroactively pay any bills you incur in this period. If you if you end up going back to insurance, insurance will retroactively pay any bills you incur in this period, which sounded like a complete fantasy to me.

00;16;45;26 - 00;16;47;18

Claire Benson

You know, maybe maybe that's a rule.

00;16;47;18 - 00;17;04;27

Cary Hall

How are you going to walk into a doctor's office or an E.R.? And they say, where's your health, Well, I had health insurance. But see, I went on the healthcare.gov and got to a navigator and they canceled the policy. But I'm in line to get a medicaid policy. And you can go ahead and treat me as a patient, because if you if you treat me, they're going to retroactively pay you from one of these two.

00;17;04;27 - 00;17;07;11

Cary Hall

If you're supposed to explain that to your medical provider.

00;17;07;11 - 00;17;38;05

Claire Benson

Not just not just explain and expect someone else to understand it, but believe it. I just didn't believe it. You know, it sounded a little farfetched to me. So I went from the end of September when this happened on September 29th until the middle of November with absolutely no coverage. And the only reason I was able to continue seeing my physician, who is my my primary care provider and my O.B. was because she participates in the direct primary care model.

00;17;38;05 - 00;17;48;13

Claire Benson

So my doctor, thank goodness, operates completely out of the insurance system. And my loss of coverage did not interrupt my ability.

00;17;48;13 - 00;17;50;20

Cary Hall

To obtain private coverage outside of this.

00;17;50;23 - 00;18;11;19

Claire Benson

Because I pay my my doctors practice directly and. Yeah, exactly. Yeah. Yeah. So it it later turned out that you know what the customer service representative explained to me was partially the way it works, but was executed completely incorrectly.

00;18;11;25 - 00;18;32;27

Cary Hall

So. So let me just go back to what would have happened if she would have had a broker agent in this situation and the broker, she would have called her broker and said, I just got this notification saying that I need to check, I need to verify my ID. The broker agent would have gone into the portal at UnitedHealthcare and they would have upgraded and none of this would have happened.

00;18;33;04 - 00;18;56;27

Cary Hall

None of it. Okay. Instead of calling the people on healthcare.gov and the quote unquote, navigator, okay, none of this would have happened. There would have been none of this confusion. And because she had a health insurance policy in place, she got pregnant after she had the policy in place. That's the part the distinction didn't get made. And the healthcare.gov people should have recognized that and left well enough alone.

00;18;57;02 - 00;19;26;22

Cary Hall

But they didn't. Okay. They wanted to push her off into Medicaid and they canceled her policy effective that day that she was on the phone with him. This is the kind of thing that happens when we have government run health care. And this is a classic example of what it's like when you have the government running a health insurance system and this marketplace thing that competes in 38 states with independent brokers and agents, this is the kind of thing that occurs when people go to them and have always said it's not a good decision.

00;19;26;22 - 00;19;42;25

Cary Hall

People do it because they don't know any better. But this is what happens and this is why we're doing this show today. So we come back after the break. We'll continue and tell you what happened. At the end of the day, you're listing to America's Healthcare Advocate broadcasting here on the HIA Radio Network Coast to coast across the USA.

00;19;42;25 - 00;19;46;27

Cary Hall

We've got more. Stay tuned.

00;19;46;29 - 00;20;04;26

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate Show, broadcasting coast to coast across USA. Here on the HIA Radio Network, the show's posted on 14 podcast channels and on YouTube. If you have a question or comment, America's Healthcare Advocate dot com is the website. Send me an email if I can help you.

00;20;05;01 - 00;20;19;09

Cary Hall

Like I helped Claire. We are happy to do that. All right, back to Claire Benson. So now you've gotten to all this monkey business with them and what's the timeline for this from when you started to where we're at at this point in the story?

00;20;19;16 - 00;20;37;03

Claire Benson

So I made the phone call September 29th, and that was the day my coverage was canceled. Yeah. And then I did not have the option to regain my coverage, my insurance coverage until the middle of November, maybe the second week of November.

00;20;37;05 - 00;20;41;18

Cary Hall

All right. So now you reach out to Angie Ricono.

00;20;41;20 - 00;20;46;26

Claire Benson

Yeah. So in the meantime, I mean, there was a day I was on hold with you.

00;20;46;27 - 00;20;47;22

Cary Hall

Kept calling them?

00;20;47;28 - 00;20;59;11

Claire Benson

Yes, I was. I was calling everyone I could think of at this particular moment. I was on hold with Medicaid for an hour, at least an hour, maybe an hour and a half. And I was just getting an.

00;20;59;11 - 00;21;00;15

Cary Hall

Hour and a half more.

00;21;00;15 - 00;21;11;23

Claire Benson

And more frustrated. And so I sat there, you know, with the phone on hold. I had not spoken to a single person yet, and I just started emailing all the investigative journalists I could track down. In Kansas City.

00;21;11;23 - 00;21;13;10

Cary Hall

Angie And Angie Ricono.

00;21;13;10 - 00;21;14;00

Claire Benson

Angie wrote back.

00;21;14;00 - 00;21;17;16

Cary Hall

And I've worked with her a long time and she's really good at this kind of thing.

00;21;17;21 - 00;21;39;03

Claire Benson

Yeah. So she was what's crazy is I didn't start getting any meaningful help with this problem until I reached out to journalists, and a couple of them, including Angie, had these great resources, people like you, you know, agencies they had heard of or worked with in the past. And, you know, they sent me some actually useful information or contacts.

00;21;39;03 - 00;21;40;13

Claire Benson

And so I was in touch with

00;21;40;15 - 00;21;47;19

Cary Hall

the journalists. Did not not the government, not the navigators, not not the people at the at healthcare.gov. Okay.

00;21;47;21 - 00;21;58;08

Claire Benson

Yeah. So that's when I started reaching out to other people, got in touch with you, got your perspective on on the situation, which really helped me understand, you know, first.

00;21;58;08 - 00;22;17;08

Cary Hall

Of all, they had no right to cancel your policy. And at the end of the day, when all is said and done, there is a happy ending to this story. I told you upfront, there's absolutely no they have absolutely no right to cancel your policy. If you were pregnant before you signed up and you falsify the application, that is a different matter.

00;22;17;11 - 00;22;42;07

Cary Hall

But you were pregnant and you and I had this conversation after the fact. You had the card in your hand. You had not received the diagnosis of pregnancy or had any pregnancy tests that showed pregnancy until after the fact, a month, month and a half, whatever it was. So under no circumstances should you have been canceled and the healthcare.gov person knowing that because they saw the date of the policy and the date she was talking, you would have said, no, you don't need to check the box.

00;22;42;11 - 00;23;08;15

Cary Hall

You do not need to update the application regarding this issue because, okay, you weren't pregnant when you signed up for the policy. And if she had worked with her broker, then that never would have happened. If the broker knew what they were doing, which 90% of them hopefully do, they would never would have been an issue. You would have had UnitedHealthcare first of all, you would had direct contact with UnitedHealthcare through your broker and the broker broker portal at UnitedHealthcare.

00;23;08;15 - 00;23;18;06

Cary Hall

So there would have been no issues here. You would have gone to your doctor, gotten whatever care you needed and it would have been take care of it. Let's just keep so let's keep going through this. Now, this goes on for what, a month and a half?

00;23;18;07 - 00;23;47;22

Claire Benson

Yeah, it goes on on for a while. So I would have been insulated from this whole thing from the beginning had I had a broker. Yes, but I didn't. And I didn't know the crucial piece of information that people really do need to know. Legally, the marketplace is allowed to cancel your coverage. If you report a pregnancy, you are giving the marketplace permission to send an application on your behalf to Medicaid.

00;23;47;24 - 00;24;12;16

Claire Benson

And only if Medicaid finds you eligible, the marketplace will then cancel your policy. And that is written very clearly on their website. I didn't have that information at the time, but that is the way it technically works. What happened to me is not the way it works. So my coverage was terminated the moment I reported my pregnancy. Not once Medicaid had had made a decision.

00;24;12;16 - 00;24;24;27

Claire Benson

And what happened was Medicaid found me ineligible when I technically was eligible because the the application that the marketplace sent Medicaid was incorrect. The market

00;24;24;27 - 00;24;25;27

Cary Hall

if you believe that.

00;24;26;00 - 00;24;48;24

Claire Benson

The marketplace told Medicaid that we were a household of two. But in the state of Missouri, once you're pregnant, that unborn child counts as another person in the household. So we were agreed. Yes. So being a household of three made me eligible for Medicaid. So, you know, I should have received it at first and I was denied by Medicaid.

00;24;48;27 - 00;25;18;15

Claire Benson

The marketplace also messed up my contact information in that application. And so I was found ineligible by Medicaid, did not receive any communication from them about it, and just waited to hear and was completely uncovered, you know, by anyone until the middle of November. Finally, the marketplace admitted to me on the phone that this was their mistake, that they had to rectify it, but that I would have to wait a couple of weeks for them to conduct their own little investigation,

00;25;18;16 - 00;25;39;13

Cary Hall

and do an investigation. Yeah. I mean, seriously, they have to investigate the fact that they already investigated and they're the ones that caused this entire situation. But she has to be investigated. Now, this is this is the idiocy of dealing with these government agencies and their layer bureaucracy where they can't figure out, hey, you made a simple mistake.

00;25;39;17 - 00;26;01;10

Cary Hall

You should have never told Claire to check the box that she was pregnant. She wasn't interested in Medicaid. She had a health insurance policy with UnitedHealthcare Once again, as I said, if it had gone to a broker, that never would have happened because she would have been she would have had the UnitedHealthcare policy, the broker would have entered the portal if she needed some help with anything.

00;26;01;14 - 00;26;19;22

Cary Hall

And would have solved the problem. But you don't you don't have to report the pregnancy after the fact because it's covered every time you get pregnant. If you're if you have a policy, you don't have to go to the carrier and go, Hey, I'm pregnant now. No, that doesn't happen. The policy automatically covers your pregnancy. And she was covered under that policy and there should have never been a problem.

00;26;19;24 - 00;26;28;07

Cary Hall

The epiphany is that they actually admitted they were wrong. Yes, but then wait a minute, we're wrong. But we have to investigate for two more weeks, Right? Why?

00;26;28;07 - 00;26;47;22

Claire Benson

We're wrong. Right? So it took them, you know, a matter of minutes to cancel my coverage, you know, to wrongfully terminate my coverage against their own policies. And then it took them a couple of weeks to they had to then send the marketplace, had to send permission to my insurance company to retroactively reinstate me.

00;26;47;29 - 00;26;58;04

Cary Hall

Okay. So now UnitedHealthcare says will read to actively reinstate you. And here's the fun part. They're going to reinstate her. Isn't that great? Now tell them what happened when they told you to get a reinstated.

00;26;58;04 - 00;27;03;10

Claire Benson

Yeah. So the insurance company calls me and says, you know, hey, we're ready to retroactively reinstate.

00;27;03;10 - 00;27;04;19

Cary Hall

UnitedHealthcare calls you.

00;27;04;20 - 00;27;23;29

Claire Benson

Yeah, we can reinstate you back to September 29th. You'll have no gap in coverage. The only thing we need is for you to pay your premiums that you have not paid since then. You have to pay all these premiums for, you know, the weeks and weeks that you were not actually receiving coverage from us in order to be retroactively reinstated.

00;27;23;29 - 00;27;42;23

Cary Hall

Does this make any sense to you at all that did you do you see how totally ridiculous this is? This whole situation is absolutely ridiculous. And the hell that she had to go. She's pregnant at all, right. And if something happens, she has no coverage in place. Yeah, she said, what do you know? You walk into a doctor and say, well, if you you can cover me.

00;27;42;23 - 00;27;57;19

Cary Hall

But you I don't know if you're going to get paid by Medicaid, you're going to get paid by the health insurance company, but they're going to go back and forth until they figure it out. And there's a government investigation. Now, to add insult to injury, United Health Care, who hasn't been involved in this at all? This is all been handled by the good people of healthcare.gov.

00;27;57;22 - 00;28;19;06

Cary Hall

They go, hey, medic, the health care dot gov just gave us the permission to reinstate your policy. And the only thing you have to do is pay for coverage that you didn't have for the past 2 to 3 months. I mean, at this point, yeah, I mean, I think I might have started looking for mental health benefits at point.

00;28;19;12 - 00;28;36;01

Cary Hall

I mean, seriously. Yeah. To say it, talk about adding insult to injury. Okay now. yeah, we'll put it back in place. The government gave us permission. Now the people who caused this to put it back in place. But we need you to pay retroactively the previous right for health insurance. You didn't have it.

00;28;36;01 - 00;29;02;05

Claire Benson

Exactly. Yeah. And the. The person who called me from the insurance company said, you know, I see this all the time in these cases where we're retroactively reinstating marketplace, never warns the consumer or the customer that they will be financially responsible for these missing premiums. For the meantime, the marketplace doesn't cover that. You know, the marketplace doesn't pay the insurance company for, you know, the cost they.

00;29;02;06 - 00;29;02;28

Claire Benson

Yes, exactly.

00;29;02;28 - 00;29;23;12

Cary Hall

So they they don't they didn't tell her about Medicaid. They didn't tell her what the benefits was. They didn't tell her that what they did tell her was canceled. 10 minutes after she fills out re she does the application to quote unquote, update it. Then UnitedHealthcare says, no, we see this all the time. They caused the problem, but they don't bother to try to fix it.

00;29;23;12 - 00;29;49;20

Cary Hall

That's put back on you. You have to come up with the missing premiums and you have you're the one that has to turn around and get this back in place. I mean, you know, the level of absurdity is is it's it's just beyond belief. Right. Okay. And this is why I say to you, you people out there that want Medicare for All or want government run health care, this is just a microcosm of what it's like to deal with these people.

00;29;49;27 - 00;30;06;11

Cary Hall

And you think about this, okay, Because this is what it's like when you're trying to deal with these people. This is what it's like when you're dealing with some maddening government bureaucracy. They can't figure out if they're coming or going when it comes to a particular issue that pertains to you. And in this case, it could have been significantly serious.

00;30;06;11 - 00;30;21;16

Cary Hall

Thank God it wasn't. Okay. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network Coast to Coast across USA. We'll be right back.

00;30;21;19 - 00;30;33;29

Cary Hall

Welcome back. You're listening to America's Healthcare Advocates Show, broadcasting coast to coast across USA here on the HIA Radio Network. If you want help with something that can help you, go to the website americashealthcareadvocate.com.

00;30;33;29 - 00;30;53;20

Cary Hall

Send me an email. I'll be happy to help you. Hopefully you won't have a situation like Claire's, but if you do, I am happy to help you as I helped her. So once again, it's America's Healthcare Advocate dot com and send me an email. Okay. So now. So now. Now we're finally. So you so you know, I said to you, there's no way this should have been canceled.

00;30;53;20 - 00;31;03;10

Cary Hall

It's 100% wrong. They finally admit that they screwed this up. And now you're so when they did the investigation wind up being over at some point?

00;31;03;14 - 00;31;27;15

Claire Benson

Yes. So they had to complete their own little investigation and, you know, to to make sure that this was their mistake, even though they had already admitted to me that it was. And then they gave my insurance company permission to reinstate me, then my insurance company gave me the option to reinstate back to September 29th if I pay all those premiums, I declined that offer.

00;31;27;18 - 00;31;28;02

Cary Hall

Nothing.

00;31;28;03 - 00;31;46;21

Claire Benson

Right. Chose instead to be reinstated to the 1st of November. So, you know, I paid for for a little bit of time in November where I didn't have coverage, but that was really the only option. You know, you have to pick a first of the month and it's terrifying to have absolutely no coverage. While on top of that, you're pregnant, right?

00;31;46;21 - 00;32;03;04

Claire Benson

Right. My first pregnancy, you know, who knows what what could happen? You know, what risks I have that haven't cropped up yet. And so I chose to be reinstated back to November 1st so that, you know, I would have coverage immediately.

00;32;03;06 - 00;32;15;05

Cary Hall

So. So you got coverage reinstated with UnitedHealthcare, Right. Okay. And that so that finally happened? Yep. Okay. And coverage in place now, how did you morph from that into now you're on Medicaid.

00;32;15;08 - 00;32;54;15

Claire Benson

Yeah so that was that part was entirely my choice. So during this process, another person I reached out to was an attorney at Legal Aid. Now we because of our income bracket, we would not qualify for free help from legal aid, but they in some circumstances can use a waiver basically to do some pro-bono work with someone. Once they understood my story, an attorney at Legal Aid took on my case, and in a matter of days, you know, figured out everything that had happened on the Medicaid end why I was denied when really I was eligible.

00;32;54;17 - 00;33;08;08

Claire Benson

And, you know, she took it from there. It came back to me and said, you know, you are eligible for Medicaid if you would like it. Now, at this point, I opted to take Medicaid, and that's really a financial decision for our family.

00;33;08;08 - 00;33;09;19

Cary Hall

Sure, that makes sense.

00;33;09;21 - 00;33;24;21

Claire Benson

Yeah. And and so now at this point, I found out I was eligible for Medicaid. Got that letter from them, terminated my coverage from the insurance company, and my husband remains on that policy while I'm pregnant.

00;33;24;24 - 00;33;42;00

Cary Hall

And here's the other thing. If if she had gotten pregnant and she'd gone to the brokerage agency, the agency would have told her the same thing. Would you like us to see if you're qualified for Medicaid? If you are, then we'll help you go through that process. But you don't cancel the existing policy until you have the policy in place.

00;33;42;00 - 00;33;53;02

Cary Hall

And we certainly don't go up and update the application on healthcare.gov. And then have you canceled 10 minutes later, which is unfortunately what happened with the good people at healthcare.gov.

00;33;53;02 - 00;34;14;01

Claire Benson

The problem is that, you know, this is a good choice for people to have. For someone in my position, you know, where you you could afford to keep your insurance, you could qualify for Medicaid when you're pregnant. There are lots of things that make Medicaid a good form of coverage. But it's it should be a decision that's up to the person.

00;34;14;01 - 00;34;34;06

Claire Benson

And I was not informed that checking box amounted to making that decision. I was not informed of that. And then on top of that, the person at Marketplace just made their own, you know, clerical error and terminated my coverage because I reported I was pregnant.

00;34;34;06 - 00;34;35;06

Cary Hall

So she was honest.

00;34;35;06 - 00;34;38;06

Claire Benson

Instead of waiting for a decision to be made by Medicaid.

00;34;38;09 - 00;34;47;20

Cary Hall

And, you know, did you talk to that person? But you talked to you talked to supervisors. Yes. And you said during the break that you talked to supervisors of supervisors.

00;34;47;23 - 00;34;49;02

Claire Benson

Right.

00;34;49;04 - 00;34;55;10

Cary Hall

Do you have any idea how many people at this at the government level you talk to over this whole period of time.

00;34;55;13 - 00;35;13;09

Claire Benson

You know, I could tell you not off the top of my head, but I have a document in my phone right where I kept track of the name of every single person I spoke to at the marketplace and at the insurance company. You know, the the call reference numbers, the notes for that conversation.

00;35;13;12 - 00;35;15;17

Cary Hall

How much time do you think you put in today?

00;35;15;19 - 00;35;35;20

Claire Benson

my goodness. It consumed months of my life. Months. I mean, I'm a full time student and and I'm pregnant. And I mean, I have no real experience or professional knowledge of how any of this works. And still I have an advantage over lots of other people who could find themselves in this situation. You know, I speak fluent English.

00;35;35;24 - 00;35;56;28

Claire Benson

I actually had time to make these phone calls. You know, I don't work night shifts or something. I'm not a single mom with three kids. And still, it took me months and months to advocate for myself and get to the bottom of the situation. And every time I spent time on it, I came away thinking, you know, what about people who who don't have every advantage I have.

00;35;56;28 - 00;36;16;01

Cary Hall

All, you're advantage you're you're very well-spoken. You're clearly educated and you're clearly you clearly understand how to work through situations like this. And you're willing you have the tenacity to do it. Now, like you said, let's talk about a mother's got two children. She's pregnant again. Right? Okay. Or somebody that works night shifts or, you know, has to sleep during the day.

00;36;16;06 - 00;36;37;08

Cary Hall

I mean, this is my whole problem with this whole idea of government run health care. Okay? And when I hear this clamoring for this out there, this is exactly why this is just one element of why you know, this in my opinion. Okay? If we are ever foolish enough to do this in this country, you can dislike health insurance companies as much as you like.

00;36;37;15 - 00;36;52;19

Cary Hall

Okay. But here's what I will say to you. There is accountability there. If this had been a health insurance company that pulled this, number one, she could have gone to the broker. The broker agent could have gone to the portal and got it straight out. Number two, if that didn't happen and I have done this on multiple occasions.

00;36;52;19 - 00;37;12;09

Cary Hall

Okay, if the insurance company denied a claim or didn't follow through in the way they should have, I go right to the insurance commissioner's office and file a complaint. Okay, So you and I can give you a situation. United Health Care. Four years ago, a young lady had cancer in her mouth, lost all of her teeth, and they refused to cover replacement of the teeth.

00;37;12;11 - 00;37;38;23

Cary Hall

Okay. I wound up going to an attorney who I've worked with for years and pro bono. He took it. It was $45,000 worth of dental work. He sent one letter, one letter, and we got everything paid and done with. But I was able to go to the carrier and make them accountable for it. You can't do that in these government situations because you see the multiple layers of nonsense that she had to go through to get this policy reinstated by UnitedHealthcare.

00;37;38;26 - 00;37;59;19

Cary Hall

And back in play. And here's the other thing. There was no responsibility taken by healthcare.gov for what they did to her. None. Number one, they wouldn't admit it. Okay. Number two, when she finally does get permission to get the health insurance policy back in place, they tell her you got to pay the back premiums. Now, UnitedHealthcare doesn't have a choice in that matter.

00;37;59;24 - 00;38;19;25

Cary Hall

That's a decision that is part of how Obamacare-ACA is set up. And this is the kind of nightmare that people go through when they're dealing directly with one of these government agencies. Just understand one thing. People okay? There's no skin in the game for these people. These call centers, these navigators, sisters, whatever they're called. There's no skin in the game here.

00;38;20;01 - 00;38;38;26

Cary Hall

Contrast that with the broker, the agent broker just getting paid. And by the way, it costs no more to use a broker and agent than it does to go to healthcare.gov. That's a myth. Okay. The health insurance carriers paying broker, they don't charge more. It's the same price whether you do healthcare.gov or whether you go to a broker agent.

00;38;38;26 - 00;38;55;11

Cary Hall

But the difference is the broker agent has skin in the game. A, they've got their commission to gain, B, they've got their reputation in the community and see they've got the client who's not happy if they don't do what they're supposed to do. So at the end of the day, we have a happy ending, but it was hell to get there.

00;38;55;11 - 00;38;56;14

Claire Benson

Yes, it was awful.

00;38;56;14 - 00;39;11;11

Cary Hall

Well, thank you so much for doing this, because I just think it's important for people to understand how this all works. And that's why we did this show today. Thank you for listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. Good bye, America.

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