David Gerfast and his family are fighting cancer with an old-fashioned ship captain's bell and high-tech proton beam radiation.
Julie Rovner recently left NPR for Kaiser Health News, but when making the switch, she found out just how hard it is to go from one job to the next while maintaining coverage.
On the same day, Rovner received two letters — one notifying her she had continuous coverage from NPR, which proved she had preexisting condition coverage; the other, a notice of a preexisting condition exclusion.
“It doesn’t make any sense,” Rovner told Here & Now’s Jeremy Hobson. “It’s, you know, ironic, because I was going from Cigna, to Cigna. It got even more ironic because I was able to sign onto the Cigna website with my old sign-on, my old password, and they were able to — they said ‘wait, processing,’ and it migrated directly to my new coverage.”
“Even the spokeswoman at Cigna said she learned something looking into this.”
Through this process, Rovner learned some things she didn’t know, even as a healthcare reporter.
“I actually had to backtrack and say, ‘Wait, a minute, how could they send this letter, because preexisting conditions are gone as of January 1?'” she said. “It turns out they’re not exactly gone as of January 1; they’re going away as of January 1. It turns out that if you go back to actually what the law says, it says they are going as of plan years that start January 1 and thereafter. So what it means for group health insurance plans is that, as these plans renew, then the preexisting condition exclusions have to go away.”
Rovner added that this only applies to people who have a break in coverage — and that everyone, even herself, is still figuring out all the changes stemming from the Affordable Care Act.
“I have to say, even the spokeswoman at Cigna said she learned something looking into this,” she said.
JEREMY HOBSON, HOST:
When NPR's longtime health reporter Julie Rovner changed jobs recently from NPR to Kaiser Health News, she found herself dealing with an issue that she'd been covering - switching health plans. Both NPR and Kaiser use Cigna. But even so, it turned out that making the switch was more complicated than she expected. Julie Rovner is with us to explain. Hi, Julie.
JULIE ROVNER: Hey, Jeremy.
HOBSON: So you posted on Facebook that you'd gotten two contradictory letters both from Cigna on the same day. Tell us what they said.
ROVNER: That's right. The first one of course was my notice of continuous coverage from NPR. And this is a notice that every insurer has to send out, assuming you've had coverage, that says this is your certificate that you've been covered, and you need to hang on to this.
ROVNER: Among other things, people will need it next year when they file their taxes to make sure they've had coverage. But for purposes up until now, it's to prove that you've had coverage so when you go new coverage, you won't get hit with a pre-existing condition exclusion. The other one, ironically, was a notice of a pre-existing condition exclusion.
HOBSON: Also from Cigna.
ROVNER: Also from Cigna that said, hey, we can't find any evidence that you've ever had health insurance coverage. So we're going to give you a one-year pre-existing condition exclusion.
HOBSON: Why did they send these? How does that make any sense?
ROVNER: Of course it doesn't make any sense. And, you know, it's ironic because when I was going from Cigna to Cigna - same health insurer - it got even more ironic because I was able to sign onto the Cigna website with my old sign on, my old password. And they were able to say, wait, processing. And they migrated directly to my new coverage.
So with my old NPR password they migrated to my new Kaiser coverage and said here, do you want a copy of your new temporary ID card? So Cigna's website knew that I'd had previously and now current coverage with Cigna. But they had sent, nevertheless, these two contradictory letters.
HOBSON: And what's the end result of that, by the way? If you were getting that and you had no idea what was going on, do you not have coverage then as a result?
ROVNER: Well, you do have coverage.
ROVNER: Now, the only thing that this said is that you would have a one-year waiting period to cover any pre-existing conditions for which you'd sought coverage in the previous six months. And this goes back to HIPPA, to a 1996 law, that basically got rid of pre-existing condition exclusions if you have had what's called a break in coverage of more than 63 days. Hence, the first letter this note is of continuous coverage.
So for most people who go from coverage to coverage, there had been no more pre-existing condition exclusions. And that's why the first letter came that you could show to your new insurer and say, hey, I've had coverage so you can't do this to me. That's what that first letter was for. So that has existed before the Affordable Care Act.
HOBSON: Now, you're a health care reporter getting these letters. You know all of this stuff. A lot of people probably get these letters and have no idea what to do.
ROVNER: That's right. And I think a lot of people who would have gotten this letter that said, hey, you have a pre-existing condition exclusion wouldn't have realized that if they were coming from previous coverage, that it doesn't apply to them. That's the first important thing. But the second important thing is that several people noted, when I put this on my Facebook page, said, hey, wait a minute. I thought pre-existing condition exclusions were made to go away...
ROVNER: ...By the Affordable Care Act.
HOBSON: And aren't they?
ROVNER: Well, yes and no. They are with very, very few exceptions. So I actually had to backtrack and say, wait a minute. How could they even send this letter because pre-existing condition exclusions are gone...
ROVNER: ...As of January 1. And it turns out that they're not exactly gone as of January 1. They are going away as of January 1. It turns out that if you go back to the - actually what the law says, it says they are going as of plan years that start January 1 and thereafter.
So what it means for group health insurance plans is that as these plans renew, then the pre-existing condition exclusions have to go away. So in the case of Keiser's plan, it's going to renew on September 1. So as of September 1, there'll be no more pre-existing condition exclusions. And again, to reiterate, these are only for people who've had a break in coverage.
But I asked one more question which is, what happens if someone has had a break in coverage, gets a pre-existing condition exclusion and then the plan renews and it goes away while they're in the middle of that? Do they have to wait out the whole year?
ROVNER: The answer is no, by the way. So when the plan renews and the exclusion goes away so does that pre-existing condition exclusion. I indeed talked to someone at Cigna who said that by the end of the year, obviously, all of their plans that have these, they'll all be gone. Now, that's true for all group health plans.
The only plans that can keep these are grandfathered individual plans. So people with their own individual coverage whose plans have not changed since the law passed in 2010, those are the only plans that can maintain exclusions on pre-existing conditions.
HOBSON: Just to be clear, what is the bottom line here for people with pre-existing conditions?
ROVNER: Bottom line for people with pre-existing conditions is that no health plan sold or renewed after January 1, 2014 can have any exclusions for pre-existing conditions except, as I just mentioned, those plans for individuals - people who buy their own cover that are grandfathered, that were - have not changed since the law was passed in 2010.
HOBSON: Now, these are to be expected, I guess we should say, growing pains as we adjust in this country to the Affordable Care Act and all that it means. It's a big bill. It has a lot of different parts of it. And I'm sure that there will be things that are confusing and stressful. But do you expect that's going to improve at some point, that it won't be like that?
ROVNER: Yeah, this is still part of a phase. And I have to say, even the spokeswoman at Cigna said she learned something looking into this. I certainly - you know, I had forgotten and it's - I knew obviously immediately when I got the letters, I knew they weren't right because I knew what the previous law had been. And then I forgot sort of with the overlay of the ACA, it's confusing.
And I've obviously been covering this from the beginning. So clearly people who don't know a lot of these things, you know, need to ask questions. But right now, as I mentioned, it is a rolling phase in of these things. Things are changing. But definitely if you get something that doesn't look right, you should ask questions.
HOBSON: What's your take away from this experience because when I saw your Facebook post, I thought to myself, wow, here's somebody who has been covering just the nuts and bolts and all of the little details of this health care law right now seeing firsthand some of what it's like to deal with insurance companies, which of course I'm sure you know, it can be very stressful for a lot of people. But this was a personal experience for you.
ROVNER: Oh, you know, I think everybody has their own personal experiences with, you know, dealing with health insurance companies. It can always be frustrating. I think, for me, just the most frustrating part was when I called and said to them, hey, I've got these two letters. They obviously are in disagreement with each other, and the customer service rep said, can you fax it to me? And I said really? Honestly? She said, yeah, we have two different systems and we can't access one from the other.
HOBSON: Julie Rovner, formally of NPR, now with Kaiser Health News. Thanks so much for joining.
ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.
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