Errors Can Turn ACA Benefits To Customer Torment
But by the time the
As days ticked by without the needed medication, Welborn couldn't get anyone at the insurance company or the federal exchange to resolve the problem.
"It's just the perfect storm of mistakes and nobody can fix them," she said. "I feel absolutely wiped out by this battle."
Welborn's quandary illustrates not only the benefit of the act but an ongoing challenge.
N.C. health insurance officials say complaints dropped in 2014, even as a problem-plagued federal website debuted and the ranks of the insured swelled. That's because people like Welborn, previously denied insurance for expensive medical conditions, had accounted for the bulk of calls before the act took effect. Starting last year they had a guarantee of coverage and, in many cases, federal aid to help pay for it.
The catch? When you pair private insurance companies seeing a surge of customers with a federal agency making millions of monthly payments, small mistakes can spiral into massive headaches. Some customers report spending hours on the phone trying to get the two bureaucracies to work together.
"The process stinks," said
"To your consumers who say it takes a lot of time, we'd say, 'Yeah. That's exactly what we've found,'" she said.
As some customer-service challenges related to the ACA are resolved, new ones emerge. Website failures that nearly torpedoed the system's start-up in fall 2013 were largely gone a year later when 2015 sign-ups began. But Smart NC saw a spike of calls in September and October, as customers got renewal rates -- sometimes with big hikes -- and had to decide whether to switch plans.
Now people with subsidized insurance are filing 2014 tax returns, which can bring surprises about how much they owe. Meanwhile, people who remain uninsured and are hit with a 2014 tax penalty might qualify for one more chance to enroll this spring.
A costly lifeline
Thirteen years ago, Welborn was diagnosed with chronic myeloid leukemia, a cancer of the blood. Her doctor put her on Gleevec, a pill that has greatly extended survival. But that victory comes at a cost: Welborn says the drug runs
Gleevec has become emblematic of one of the biggest challenges of controlling health care costs. High-priced specialty drugs accounted for about 1 percent of all prescriptions in 2013 but more than 25 percent of pharmacy spending. Costs keep rising, even as new drugs come online.
For years, Welborn, a writer who now works grading exams, got coverage on her husband's insurance. But she's divorced now, so she was thrilled when she went to the ACA exchange in 2014 and got a
"Some days," Stephens said, "I'm just as confused as the first day this came out."
Trouble begins
Last November, Welborn called the federal exchange to update her income for calculating her 2015 subsidy. Her monthly payment rose to
But Welborn was still so grateful she wrote the president a thank-you letter.
Her January bill from
Welborn began calling the exchange and
And she wasn't getting answers. The insurance company said the problem came from the federal exchange. The government staff kept saying things like, "The computer won't let me fix the problem."
Some help, new issues
Welborn's policy was restored after the Observer contacted
A federal spokeswoman said she couldn't discuss Welborn's situation but assured a reporter it was being straightened out. Shortly afterward,
Vulcan says
There was also a new twist:
In the first three months of this year, Welborn got three bills for amounts ranging from
Welborn says she's through wrangling. She will become eligible for
Early in her struggle, Welborn told her story in an online forum for people with her disease. A woman in
Welborn is using that to tide her over, and hopes to get another month's supply from the manufacturer's assistance program for the uninsured.
"Sometimes you've got to acknowledge defeat," she said. "Sometimes things are too big."
Helms: 704-358-5033;
Twitter: @anndosshelms. This article is done in collaboration with
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