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Monday, June 2, 2014

A Health Care Reporter's Fight To Keep Health Coverage

Health care reporter Julie Rovner found out how hard it is maintain health coverage when changing jobs. (Twitter)

Health care reporter Julie Rovner found herself in the middle of a health care conundrum. (Twitter)

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.

Guest

Transcript

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.

HOBSON: Yeah.

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.

HOBSON: OK.

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...

HOBSON: Yeah.

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...

HOBSON: Yeah.

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?

HOBSON: Yeah.

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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  • Rick

    I just have to laugh at these types of stories. The people who were the biggest cheerleaders (NPR) of Obamacare complain about suffering through the the disaster of this bill in their own lives.

    • AmanaPlan

      Isn’t her current situation better than the pre-Obamacare situation, in terms of availability of insurance with pre-existing conditions?

    • mike

      Was it Obamacare that made the mistake, or was it the insurance company?

  • mike

    I had a similar experience. Many years ago, my COBRA coverage ran out and my application to get private insurance from the same carrier was turned down (I don’t know why). About a year later they called me and said they’d made a mistake and should have accepted me, because I had coverage with them. All I had to do was pay a years worth of premiums, retroactively.

  • jefe68

    This article points to many things, how complicated our health care system is, and also how dysfunctional. It seem to me that the problems laid out in this article are not about the ACA insomuch as it’s bout the insurance corporations getting their way and looking for loopholes to cut people off. The bottom line is, Obama gave away the store to the health care industrial complex, and that’s the real story here. Special interests.

  • DocB

    Can we PLEASE do away with private insurance companies and just go to Medicare for All?

    • Rick

      Are you serious? Did you pay any attention to how many veterans died while waiting to get care at the VA (government run) hospitals?
      And who would pay for it all?

      • Richard Hussong

        Do you imagine that we are not already paying for health care? I expect to continue paying for health care one way or another, no matter who runs it, but personally, I would gladly trade insurance companies for the government as managers of the overall health-care system. Also, the OP did not request “VA health care for all”, but “Medicare for All”. Those are very different animals.

      • mike

        “And who would pay for it all?”
        Isn’t that the problem at the VA: Congress hasn’t been funding it adequately. Most everyone I heard said VA care is good; there’s just not enough of it.

        I think the government would be more efficient at running health care than the insurance industry. Insurance companies add no value to health care. They are only adding to the paperwork and are just an overhead expense.

      • jefe68

        Insurance corporations have some of the highest paid CEO’s in the nation. They also do not have any incentive to make health care affordable or more assessable. All of us who have health insurance are contributing to the high salaries of the CEO’s and upper management.

        http://www.rooseveltinstitute.org/new-roosevelt/insurance-executives-big-part-our-health-care-problem

        • mike

          And do we have a choice about contributing? If we don’t pay premiums (protection racket– “if youse pays for our protection, your store’s windows won’t get broke”), we might not be able to see a doctor at all.

      • informedLI

        Medicare for all would change the business model we have today, as follows. All it would do is organize every single patient into a huge group purchasing organization that had the power to really negotiate pricing! The present system breaks everyone up into privately run smaller buying groups with less and less negotiating power. The VA is a different model altogether- you’re comparing apples to oranges.

  • Gamaliel Frederick

    If anything, that she is not qualified until the new law (affordable care act) comes into effect via the inevitable/ultimate renewal o the contract by her new employer demonstrate the need to revamp the health care system in the first place a d reveals the fallacy of the old system.

  • SGG

    Why doesn’t Rovner just go to her healthcare exchange and get a cheaper plan that adheres to the pre-existing condition rule. My plan went from $640 a month to $295 — same insurance carrier.

  • NSC

    I had similar problems as well albiet less serious. It eventually kinda worked out but i had to pay deductibles 2 times over, do some additional paperwork and it took nearly 4 months to sort out.

    In Sep ’13 I changed job and moved to a new house in same state. As a result I went from United Health to Cigna and changed some doctors.
    Problem 1: I had already met my family deductible (High deductible, thousands of dollars) for 2013 with UHC by that time. Now with Cigna, I had 3 months left. I can grudgingly accept that Cigna doesn’t care if I met my previous insurance’s deductible and UHC won’t pass any share of that to Cigna either (why?). I still fail to understand though, why Cigna would still expect me to meet entire year’s deductible (again, thousands of dollars) when I am only covered with them for 3 months in that year.

    Problem 2: 2-3 months after these changes, I started getting the dreaded pre-existing condition based denial letters from Cigna stating they can’t confirm I had “eligible” health care coverage when any given problem started and hence are denying it. Fortunately I have had continuous coverage so was hopeful but dreaded the paperwork involved while dealing with the two insurance behemoths. Sure enough, after enduring 40-60 minute wait times on multiple calls between Cigna and UHC, I got someone from UHC to agree to send letter of credible coverage to my house for entire family (why not to Cigna?). Had to again follow up with them a month and half later since letters never showed up. Eventually, I received and forwarded copies to Cigna. A lot of previously denied claims automatically got reviewed but then there were others for which I had to, yet again, get on phone with Cigna. Phew!
    Why couldn’t Cigna go to UHC to get credible coverage in the first place? Beyond me!

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