Sunday, October 10, 2010

The Story, T2N∅, ^&*%$ Minutes!

So, the whole MinnesotaCare/MCHA fiasco was a result of several things: 1) misinformation from the MCHA customer service people, 2) lack of knowledge about MinnesotaCare and MCHA on the part of the insurance broker, and outdated and inefficient practices on the part of MinnesotaCare.

This all started last week when I was wondering where the hell the Notice of Termination was from MinnesotaCare, and began to check into the status of this form.

To back up: when you're changing to a new insurance policy (as self-insured, not an employer plan) you'll need the Certification of Credible Coverage (showing no more than a 61 day gap in coverage in the last 2 years) and you'll need the notice of termination of your old policy. The normal process in this situation says that you first cancel the old policy, wait for he Notice of Termination to arrive in the mail, and then send the Term notice on to the new provider, who then *retroactively* covers you back to the day your old policy ended.

NOTE: if you have a 61 day (or more) gap in the last two years they can exclude any pre-existing conditions. I don't have a gap, so I'm good as far as that goes.

I knew that this is just how its always done with any insurance changeover, but I was still nervous about having no insurance card in hand that was any good for a week or two.

So, I sent in the request to terminate MinnesotaCare in september and they informed me that they only process these at the end of the month. I sent in my MCHA application -- minus the Term Notice -- knowing that they'd send me a letter saying that they needed this. THe theory here was that the application would get in the works, and when they had the Term notice it would be processed faster.

So we're checking the mail everyday after the first of October and every day the notice from MinnesotaCare is not there. It gets to be the 7th (it should have been mailed on the 1st) and no notice, so I call MCHA to see if maybe they just sent it directly to MCHA? No, they said. WHat's more, when I laid out the situation to the phone rep at MCHA, she told me that, since *I* had "termed" MNcare, I would be excluded for 6 months for any pre-existing conditions (though she called it a "PreEx". Since everyone who calls into customer service is an insurance industry expert, there's no need to actually spell things out and explain what that means.) SHe was quite clear and quite adamant that quitting your insurance to get on MCHA is not what its for an constitutes an abuse of the system that is designed to be fore people who can't get insurance elsewhere.

When I explained that I was leaving MinnesotaCare because I had exhausted my $10,000 annual inpatient (surgical) benefit, she was adamant that it didn't matter: you couldn't leave an existing insurance to get on MCHA, you could only get on MCAH if your insurance cancelled *you* or if you didn't already have it. Part of the confusion appears to have been that I hadn't exhausted *all of my benefits. My chemo, as an example, was done on an outpatient basis and MinnesotaCare picked up the roughly $40,000 cost for that. If I had exhausted *all*benefits, the phone support person said, it would be different. But since I had exhausted only *some* of my benefits, I was ineligible for for MCHA and would have the 6 months PreEx clause, with *all* claims during that time being returned unpaid.

So, I called my insurance broker, who claimed she hadn't realized that I'd only exhausted *some* of my benefits. Even though we talked specifically about this. SHe called MCHA and -- alarmingly, got someone on the phone that confirmed that what they were saying was true: I *would* have the 6 months PreEx clause because I left an insurance program and hadn't exhausted *all* benefits. She mentions at this point that I could have just stayed on MinnesotaCare and MCHA would have covered the inpatient benefit difference. This was something she hadn't known before.

I'd like to point out that I was actually on vacation at this point, staying at a lovely cabin in Wisconsin and trying to have some peace and quiet time before the surgery.

So at this point I'm being told that I have no insurance and that I won't have any coverage (for chemo, prescriptions, surgery, mental health, etc. for 6 months. Add to this the fact that I have been told that if I don't seek aggressive treatment I have about 2 years to live. I'm sitting here thinking: this lady just murdered me. No exaggeration or over dramatization: with 6 months to let this aggressive cancer run rampant and completely unchecked, she just literally *murdered* me.

FYI, Karen Wandmacher is her name, at Gallagher Benefit Services in Bloomington, MN. Feel free to send her a postcard.

Somewhere in the back of my brian I think I remember that if you cancel an insurance policy (at least in Minnesota) you have 10 days to change your mind. Its now getting close to the close of business on the 7th, and tomorrow, Friday, is the 8th. Sunday would be the 10th, so Monday would be too late. If I was going to try to get *back* on MinnesotaCare, I need to do it on what is left of Thursday, Friday, or never. And this is *if* I remembered correctly about the 10 day window. Its about 2:30 pm on Thursday and I start trying to get ahold of MinnesotaCare.

If you've never tried to contact MinnesotaCare, count yourself lucky. Sometimes you'll get a message that says that all lines are busy and try your call again later. No queue, just call back: there are too many people in queue already. Most of the time, you'll get through, listen to hold messages and music, and wait for 10-30 minutes before reaching a representative. But on this particular day I think that the people must have been having a birthday party or some such, since the call would wait in queue, ring perhaps 30 times, and then just end, as if someone had picked up the call and slammed down the phone again. This happened for 2 hours straight, perhaps 10-15 attempts to get through, until they stop taking calls at 4:30.

NOTE: For the record, I am 100% behind nationalized healthcare. But I fervently hope that when we *do* get it, it is better funded and run by people who care about what they do more than the people who run MinnesotaCare. MinnesotaCare provides an essential service and I'm sure on a shoestring budget. I'm sure they're overworked and underpaid. But at that point in the day and in my life I didn't care about anything other than getting health insurance. Anything that stands in my way pisses me off.

At this point there isn't anything else I can do. Its the close of business on Thursday. JL comes up to the cabin as planned, and then I have to ruin her evening as well. I put the best face on it, but she knows this is serious shit and is livid at this women as well.

We debate heading back into the cities (2.5 hours away) but reason theres no real advantage to this. Might as well get some sleep and enjoy what we can of the cabin.

I know that Minnesotacare starts taking phone calls at 9am.

Friday eventually arrives. At 8 am I am up and talking to another medical insurance industry specialist (I think she may be a lawyer, but honestly I didn't even have time to ask) that my mom and her longtime friend ML have recommended to me. This person is amazing, knowledgeable, and helpful. I should have talked to her her long before. Thank you both for the recommendation.

At 9:05 am I am talking to a MinnesotaCare phone rep who confirms that I *can* get back on MinnesotaCare since it is within 10 days, but I will have to provide updated bank statements, car titles, employment information, pay stubs, lease agreements, etc. How this is different from simply reapplying, I'm not sure. But I would need to drive back to Minneapolis and spend all day waiting with a number in hand in order to reapply. And when talking to the rep, with the questions he's asking, and essentially starting the process all over again, I think its just going to take too long to get a decision out of them and I'm not sure they'd take me anyhow.

I call MCHA again, talk to a different rep who essentially confirms what the person the day before had said -- except mentions that MCHA does sometimes make exceptions for some extenuating circumstances. She doesn't have the authority to approve my claim of course, but just that possibility gives me some hope. We fret and stew and realize that it might be best to head back into town. If I need to reapply or go to some government office to get some other form, or knock some heads at Gallagher, I need to be in town. So we pack up and leave 2 days early.

On the way back, JL recommends that I call Karen at Gallagher again, maintaining that its Karen's screw up and her mess to fix. JL is a businesswoman and a boss, and she has many good ideas, especially in situations like this. I agree and -- though I avoid confrontation -- give Karen a call again. Karen volunteers to all MCHA again and get the scoop. To my surprise she calls back a few minutes later and says that its good news: she talked to a supervisor there and got assurances that -- no matter who terminated who or the reason for termination -- MCHA just needs the termination letter and then they'll process my application. Karen has the person's name, assurances, and has documented the call so we'll have a case if they deny my claim or do the PreEx. Why this would be different from what they told her the day before worries me, FYI.

Great news. Definitely. Still, it depends on verbal assurances and say-so, and nothing is in writing, so that makes me nervous. All they need is the Term Letter. And where *is* that term letter, anyhow?

I call MinnesotaCare again, asking them that same question. When was it mailed? And *where* was it mailed? The reason for the delay becomes clear. They sent it to my *old* address. Even though the request for cancellation that I faxed to them *also* had a request to change my address to the new one as well. That's okay, I say, I'm having my mail forwarded. It wont work that way, the guy says: there is a Do Not Forward notice written on the letters from them.

Can they fax it? No. Can they print it out and can I just pick it up? No. Can they email it? No. Printing is done somewhere else by magical elves, apparently, in a secure undisclosed location. They submit a request to print something and it prints the next day -- somewhere -- and is then mailed from there. I update my address and request a new one. It will print on Saturday and hopefully mail out on Monday, hopefully getting to me by Tuesday.

At this point I will need to rush this form to my nearest fax location and send to MCHA. Then I'll need Karen to call MCHA and light a fire under them, asking them to Expedite the process.

The scary thing is that I Mayo actually wants me to come in a day early now, on Thursday, for bloodwork and another CT scan. This means there is about a 20 work-hour window in between me faxing out the Term Notice until I ned to give my insurance number to Mayo. Eek.

If it were a simple process I would move the entire thing back a week. But Dr. Hunter schedules 6 weeks out at a minimum, and I don't think its a good idea to wait that long.

So there isn't much else I can do but have faith and hope that it will all go as they assure me it will, and that I'll have the insurance number before heading into Mayo.

So that's what my life is like, honestly. Its been like this off and on for the past 3 months since I got the diagnosis. Sleepless night dues to worry, hours spent on the phone, letters, forms, faxes, visits, tests. And, I should mentioned, the amazing support I have gotten and continue to get.

Oh and I did get a piece of good news, unconnected to the insurance drama: Dr. Grampa (my Oncologist) and Dr. Hunter (the Mayo Urological Surgeon) conferred an agreed that my tumor is now at T2n0 -- stage 2 tumor, no lymph node involvement, whereas it *had* been T2N1, stage 2, with one lymph node affected. So the chemo and everything else has had a positive effect and it is shrinking.

P.S. I have used about 430 minutes on my celphone in the past two days, eating up the remainder of my monthly minutes and all of my rollover minutes I had banked. This leaves me with just over 100 minutes to get me through until my minutes renew on October 24th. What this means is that I will no longer be accepting or making calls for anything other than business purposes during the week. Calls after 9pm are free for me as are weekends, so I'll talk to people then. I get virtually unlimited text messages, so those are preferable. Email is great, also. If you have AT&T, let me know, since I'll get free calls to you that don't count towards my minutes.

One advantage of the iPhone though: it doesn't cost me minutes to *listen* to your messages, since it actually downloads them to my phone. So I'll get your messages (and feel free to leave them, please) but I will respond via either email, text, or after 9pm or on the weekend.

Thanks so much to everyone, for everything!


emily said...

my dad, a former insurance broker now in grateful semi-retirement, sez gallagher is pretty big, and ms. wandmacher probably has "errors and omissions" insurance. so not only do you have a case with MCHA if things go south again, but you can probably get a claim against her if you have to pay retail.

but whose bright idea was it to have you stressed out about money/bureaucracy while fighting cancer? and whose bright idea was it to have someone like karen sitting behind a desk with your life in her hands? (it probably would only have been involuntary manslaughter, rather than murder 1... har.)

is this a great country or what? U!S!A!

Deborah in MN said...

I'm so glad to hear the tumor is getting smaller/less involved. And that the insurance is apparently straightened out. We'll keep praying it goes well. It was great to see you today and meet JL - a lovely lady.

Anonymous said...

It does start to look like good news. And you do not need to be churning over all this stuff while trying to get better physically.

On the other hand, as your dad, I have to say I admire the way you answer these potentially devasting setbacks by getting tough and smart. Many people would just curl up into a ball and wait for help. Not you.

Love, Dad

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