For many Americans, the Affordable Care Act (ACA) has finally brought them peace of mind, with it being mandated that healthcare costs would no longer eat into their budgets. While this does provide certain reassurances for many, it has caused some health insurance companies to raise their rates to compensate for those who have been affected by the new laws. The price hikes come at a time when so many low-income families are struggling after losing jobs and finding themselves unable to afford their premiums. In fact, one in four people is uninsured or underinsured when they buy new coverage, according to Gallup’s 2019 report on affordability. To put things into perspective, the same report found 17% of households were living below the poverty line. These statistics should not be taken lightly, especially as we continue to see mass shootings occurring across our nation. It can be easy to blame these mass shootings for high death rates. However, other factors can also play a role in why many aren’t insured.
The following are the top five most common reasons why some people are still uninsured:
- They don’t think their policy will cover everything
- They may not have received a letter from the U.S. Department of Health and Human Services
- They don’t understand what their plan covers
- They’re afraid of getting ripped off by their own insurer if they file an appeal
- They haven’t checked with their state office for changes made under the ACA
There’s only so much someone can do to change their provider, let alone how aggressively they could argue before the CMS. Of course, if you have any concerns about your care, reach out to your insurance company and find answers to all questions. Here are just a few steps you can take to get back on track:
1. Call Your Insurance Company Immediately
First thing first — let your doctor know you are worried about missing a payment check or wondering if you have enough coverage to cover all of your needs, because that is only half the battle. Next, call your current insurance carrier to ask if you qualify for financial help to pay your bills so that we can keep covering those costs. If they try and claim that you have missed a payment date even though you have paid, call again right away — you could face serious consequences if there isn’t enough coverage, so make sure you are on the list to receive assistance. You might also want to read up on your policy’s terms before calling to find out if there are any extra services, such as prescription co-payments or additional deductibles or co-payments.
2. Ask Them Who They Would Be Proudly Named By Their Loved One
Many consumers find it easier to speak with an individual rather than a representative from their insurance company. This can sometimes make matters worse — particularly if the representative doesn’t agree that the insurance coverages provided to you meet the guidelines outlined in the law. Even then, you can still expect an explanation of benefits and likely a reasonable amount of money off your premium, but you can make things more difficult by asking your representative if they would take pride in having their name in lights because they’ve helped others.
3. Appeal Before Getting Cut Off From Benefits And More
Any appeals process must start within 24 hours of filing under the preemption provisions of the ACA, which means it takes a little bit longer than usual. Once you do hear back from your insurance agent, contact them directly, and if you do receive a response, you can use it to inform your state of its actions and request that your initial appeal process be expedited. On average, these providers must deny an appeal within 60 days. Some providers may take longer — it’s important to do thorough research on each provider. Remember, you aren’t required to provide physical proof of a medical condition you are claiming to have without paying your deductible. There are several ways you can prove you are covered; however, a personal statement from a lawyer or another member of the household is usually best in the case of disputes over the uninsured status of loved ones.
4. Check With the State Office To Make Sure Changes Needed Under ACA Have Been Made
Most insurance plans include automatic enrollment tools that allow customers to choose whether they want healthcare benefits on their policy or not; many of these systems are set in place to automatically enroll you if you buy a “silver tier plan”. Unfortunately, the newer, higher “gold tier” plans don’t always include the same automatic options, which means there could be differences between how well these auto enrollment programs work. So it makes sense to check with your state office or employer for any necessary alterations to your current plan. This information will show whether you need to submit more paperwork, switch providers, or apply for Medicaid or Medi-Cal. If you have been added to Medicaid already, ensure you get approved before applying for Medicare.
In addition to these services, some insurance companies offer online enrollment technology through which you can complete forms that match with your existing records. Additionally, check with your HSA provider or FSA to confirm you have been enrolled in their system and that your cards will be loaded successfully once you finish filling out the application. Also, pay attention to what coverage and services you receive from your neighborhood hospital or doctor — if there aren’t any available through local hospitals and doctors, you might struggle to access them.
If you think your insurance company has a problem with the way it handles an appeal process, schedule an appointment to talk with your claims adjuster. If you live in an area where this service is offered, try making a follow-up appointment on your next visit. It may seem simple initially, but a significant number of insurance companies will only accept you if you have met up with them before for an interview. Furthermore, a good way to combat potential issues is to send your insurance agent to any local community college to review a sample form for understanding the specifics of your situation. Another great resource to review is MyHealthPlan’s free website or YouTube video: https://www.myhealthplan.gov/get-help-finding-a-plans-insurance-policy/
While we know better than everyone else that human error makes mistakes, the reality is there are millions of individuals in America who are trying to navigate life after President Trump’s administration. No matter what anyone says, we must never stop striving to improve and protect our society. We cannot wait until the issue is fully resolved to ensure that every person feels safe and secure in their life. Now is the time to get involved. You can learn more about affordable and responsible healthcare by visiting www.MyHealthPlan.gov or https://www.myhealthplan.gov/frequently-ask-questions.html.