Dear Secretary Burwell:
After a disastrous experience with the HealthCare.gov Marketplace, I was advised by the Marketplace that you are the only person with whom I can register a complaint. My situation is as follows:
– I have had individual coverage through the Marketplace since 2014, but my HealthCare.gov user portal has never allowed me to complete an application, nor to see or select plans online. Having helped my boyfriend sign up for a 2016 individual Marketplace plan, I know what the process and interface should look like and my portal is definitely not the same. He’s a software engineer who works in the healthcare sector and he sat with me as I tried to use my portal; we both agreed that it’s caught in some sort of infinite loop and I will never be able to get covered through my online portal as it stands.
– Because I cannot use HealthCare.gov to enroll, I have to call the Marketplace call center.
– We moved from Illinois to Texas in December 2015. Our lease was finalized in mid-December (I obviously needed a home address in Texas in order to apply for 2016 coverage here), and I started calling the Marketplace as soon as I was able, on Dec. 16. Because of the extended deadline, I was still eligible for Jan. 1 coverage at the time.
– By the time our lease was in place, the Marketplace was being inundated with last-minute callers trying to get 2016 coverage. There is no separate phone number for special enrollment, so there was no way for me to circumvent that crowd. When I called on Dec. 16, I was told by a recording that, due to high call volume, the Marketplace had made note of my place in line, knew I called before the extended deadline, and I would call me back the next day to get me January coverage. For the next several days, I received a daily call conveying that same recorded message.
– After the extended deadline had passed without my having received a callback, I received a call on Dec. 20 with a voicemail telling me: “Due to high call volume around the December 15th deadline, we were unable to help you apply and enroll. Good news!: If you still need coverage, please call the Marketplace call center and we will help you enroll in coverage EFFECTIVE JANUARY FIRST.” (I still have the voicemail and it says that, verbatim.)
– Pursuant to the updated recorded message, I called the Marketplace on Dec. 20, 2015. I was finally able to select a plan and I was assured that I would have Jan. 1 coverage.
– Having forgotten to cancel my automatic enrollment in an Illinois plan (and being unable to do so online), I called the Marketplace again on Dec. 28. I confirmed repeatedly with the rep that my Texas coverage would start on Jan. 1.
– When the materials arrived from my selected insurer in January, I saw that I had been given a Feb. 1, 2016, effective date.
– I called the Marketplace on Jan. 11 to fix my effective date. I was assured that, although it may take up to 30 days for the insurance company to change my effective date, I would have retroactive coverage for January 2016. The rep told me to hold onto receipts for any healthcare expenses incurred in January so I could submit them for reimbursement and she told me that I could call back to check on the progress of this “escalation.”
– I called back on Jan. 25 to ask about the progress and a Marketplace rep assured me that everything was resolved and the necessary paperwork had been sent to my insurance company.
– I contacted my insurance company on Jan. 25 to ask why my effective date hadn’t been changed to Jan. 1. When they got back to me, they told me they never received any paperwork from the Marketplace indicating that change.
– On Jan. 27, a rep from the insurance company conference-called the Marketplace so we could all discuss the problem. At that time, I was told that–in spite of NUMEROUS assurances from Marketplace reps *and* automated messages from HealthCare.gov indicating otherwise–I could not have an effective date of Jan. 1, 2016, because I had selected a plan on Dec. 20. Again, it was impossible for me to have done so any earlier because my online portal is broken and the Marketplace hotline was unable to handle the high December call volume.
– A special enrollment period beginning in December does not guarantee a user January coverage, even though all individual plans terminate at the end of the calendar year.
– Because of these circumstances, I am forcibly uninsured for the month of January (my individual Illinois plan having ended on 12/31/15). It is currently Jan. 27, so I only need to make it a few more days without insurance, but if, heaven forbid, something were to happen that couldn’t wait until 2/1/2016, I would incur the entire expense of all care even though I have done everything in my power to secure 2016 coverage beginning in January.
I am someone who would have found myself in dire financial circumstances in 2014 without “Obamacare,” and I sincerely want to see it serve America as best it can. That said, my options as someone who has had repeated, bad experiences with HealthCare.gov and enrollment (a rep recorded the wrong plan for my 2014 selection and I was also uninsured during January 2014 while I remedied *that* Marketplace error) are to spend innumerable hours on the phone trying to fix it or to resign myself to bad outcomes like being uninsured this month. There are others who rely on the Marketplace for coverage who could never have devoted as much time to getting insured as I have. When things go wrong with the online portal, one escalates to the hotline; when they go wrong with the hotline, the case is escalated to a supervisor; when the supervisor is not trained or inclined to fix a situation like mine, that’s it. End of story.
There is no federal version of filing a complaint with the Department of Insurance, at least that I have been able to find, in order to resolve a problem with Marketplace. I am an above-average researcher and none of my Googling has led me to such a body, if one exists. From what Marketplace said today, filing an appeal with them wouldn’t help me, although I will still try. None of this is the fault of Texas or the insurance company, so the BBB and the DoI are of no use to me. I can only assume the supervisor who told me to contact you was doing so knowing that the likelihood of my receiving a response or a solution is next to zero.
I understand that your office can’t be responsible for customer service complaints along the lines of rude Marketplace reps, but where are consumers supposed to turn in situations like mine? The inability of individuals who move during December to get through to the Marketplace in time to get January 1 coverage is a clear design flaw. My inability to report a broken portal without spending countless hours on the phone is a clear design flaw. (It’s not user error that’s preventing me from signing up online and I’m willing to bet that the reps aren’t trained to resolve any other tech problems.)
Maybe my circumstances are a perfect storm and no other healthcare exchange user is in a similar situation, but I doubt it, especially having been in a similar situation myself already. Who are our advocates if our only chance of being heard is to email this scheduling address and cross our fingers? What if I were pregnant and due this month or on dialysis or chemo, unable to afford my care out of pocket, and unable to get the coverage I was promised for January? That shouldn’t be possible. Consumers need access to an oversight and enforcement body for when more time spent arguing with a call center or cursing at a website is guaranteed *not* to fix the problem.
I sincerely hope that this message reaches an appropriate recipient.