Insurance Incompetence Ineptitude and So On

I like health insurance. I'm all for everyone having it. I hate the rantings about Obamacare that suggest everything was just fine until it came along. The private sector was doing just fine we are told. Well--- let me tell you---as a provider and a consumer the private sector has never gotten it right folks.

I'll take you with me on a little journey through our experiences with the insurance company my employer chose for us retirees  and our dependents since January  2014. The company isn't new to the insurance business. They just happened to land the contract for my former employer.

January : Imagine our shock when we arrived at the pharmacy to pick up Michael's meds, to be told he was no longer covered on our plan. Heart palpitations, hyperventilation. Gasp! What happened? I signed Michael and Barry and I up during Open Enrollment in November 2013. I am excruciatingly detailed, timely and accurate about doing so. I KNOW the importance of insurance.

I call the insurance company concierge line. Yes, a special line just for me and thousands of others! No sign of a Michael Connolly under my name/plan. So sorry. You'll just have to contact your employer's HR Department I was told. OK. Dial. Hold. Menu. Person!!! Of course Michael Connolly is on your plan. We'll get right on that. OK. Confirmation call: it's done. This four sentence recounting took about half a day to accomplish. No matter. Done. All set.

February : Yours truly has an ophthalmology appointment to rule out glaucoma. Insurance information given. Eye clinic bills insurance company and receives notice the "plan not in effect when service provided". Eye clinic tries multiple times to straighten situation out but has to call me to explain to the insurance company I am not on Medicare as they maintain. Make no mistake. I'm not that far away from being covered by Medicare but I know the year I was born and the fact I am not eligible and I KNOW I did not receive nearly constant reminders by multiple insurance companies to










 " sign up for Medicare" as my husband did last year. So....I called the insurer. Another two hours of hold, menu, hold. Person. Wait. Clarification. Account righted. Or so I thought.

May -July : Second ophthalmology appointment on May 9. July 31 I received letter from the eye clinic. " Dear Mrs. Connolly..... (Insurance co) still has not paid for the visits you had in Feb and May. They (ins co) explained you were automatically enrolled in Medicare...tried calling (ins co) three different times...tried whatever I could..... including hours on the phone with (ins co).... They said nothing else we can do and must be resolved on your end......." And on and on. They tried. I appreciate their efforts.  More on this one later. Just one more little glitch.

July: received letter from insurance company informing me my dependent Barry Connolly "reached the maximum age for coverage as a minor dependent under the terms of ... Current policy. ..... coverage will be cancelled on 01/01/14! Yes, that 's the date. Yes, letter dated 7/17/14! Yes DOB under Barry's name reads October 1948. The letter goes on to explain all Barry's options now that his insurance was cancelled 7 months ago.

Today: Barry begins the process by calling the number on his cancellation letter. After holding for about 10 minutes he speaks to someone. Explains he received letter. Explains HE IS covered by Medicare since last October. Receives another number to call. Calls number. Puts phone on speaker. Hold. 20, 30, 45 minutes. Person!! Tom: "Sorry , you're not in our system at all". You'll have to straighten that out with the HR department of your wife's employer". Barry: "Let me put my wife on. She has another problem. I take the phone. I relate my billing issue. ( see Feb - June above). Me : "I do not have Medicare. Do you see my birthdate?" Tom: "Yes. You are not eligible for Medicare. Let me look at another screen. Oh yes, they did say you had Medicare. I'll have to change that and send the change to that department" . Me to Tom: " I've been through this once before Tom. No offense intended but should I be talking to someone with more authority?" Tom assures me he's taking care of this as we speak. I hear the click , click , click.  Is that his computer keys? Or is he just pretending to fix my problem as in that commercial. I almost laugh. We spend another ten minutes Tom assuring me he'd make this happen. Me obtaining his phone number and extension. Tom remembers something : "oh if you call after next Friday I'll be on vacation for a month" . I encourage you to get to know one of our other representatives. Anything else can I do for you today? " Whaaaat?


Almost the end I promise. So by now I am starting to doubt myself just a teeny bit. I go to my former employers website and look up my family's health coverage. Under Michael: Medical-Yes. Dental-Yes. Medicare-No. Under Barry: Medical-Yes. Dental-Yes. Medicare-Yes.  I briefly describe our situation and look forward to them intervening with the insurance company.


Curiosity propelled me to look up the salary of my nonprofit insurance company's CEO. Last year: a cool 4.2 mil. BS! Pun intended.