I had a pretty big fiasco last year with Kaiser Permanente and I wanted to write this publicly in case it helps anyone in the future. For the record, I don't expect to ever get my money back, but I now know how to keep this from happening again and I know more about the Affordable Care Act than I ever thought I'd need to.
I started the year off with Kaiser insurance with previous employer, but when I left that employer, I also left Kaiser. That was in March 2014. I got married in June and since I didn't have any health insurance, I paid out-of-pocket for my prescriptions during the summer months. Eventually I decided to get health insurance again. After reading about the ACA and qualifying events, I decided to wait until the end of the 60-day window after my wedding to sign up again for Kaiser health insurance, and I planned to have it begin on September 1. I submitted my forms and paid my first month of health insurance in late August.
I though all was good until I received a bill in the mail totalling almost $900.00, for "amount due for previous months". My first thought was, "what previous months? I just signed up!" This must be a simple billing mistake. I called member services, which were of no help to resolve the issue. The woman I talked to basically turned into a robot and kept repeating the same line to me. "Sorry, there's nothing we can do". I then called Kaiser sales, and they redirected me to member services. That was frustrating. After this I emailed KPMemberServices at kp dot org and didn't hear a response back about my problem. After this I spoke with the company who helped me find the best insurance plan for my needs, Berkeley Insurance and Financial Services, LLC. My rep there informed me that when signing up after a qualifying event, no matter when you sign up, coverage starts the month immediately following it. This means that, even though I waited to sign up for Kaiser insurance until 60 days after my wedding, they were still going to charge me for the months leading up to September 1.
This is where I got some questions from friends:
- Why didn't I sign up on my husband's company's health plan? Answer: Because they charged $400.00 extra per month for spouse health care, and it was cheaper for me to .
- Why did I wait? Answer: Because insurance is a gamble. I've never needed to use health insurance for more than just usual check-ups, so for me it wasn't necessary to have it. I decided to get health insurance because my prescription was running out in September.
- Didn't you read the ACA? Answer: Actually, yes! I did. I read the whole stinkin thing. No where in the bill does it state that the health insurance will start immediately after your qualifying event.
For me, this bill was incredibly upsetting. I was going through changes in my work place, so income was tight. My wedding was being paid off, and my honeymoon was just charged to my credit card. I DID NOT HAVE an extra $900.00 to spare. I specifically waited until the 60 days was almost up so I wouldn't have to pay for insurance during the summer that I didn't need, hadn't signed up for, and didn't want.
From there I took up my problem with the Member Case Resolution Center at Kaiser. I got an email EOD yesterday from Kaiser in response to my complaint. A nice lady said she's forwarding the information to her managers, so hopefully they'll be able to help out. This was in response to a $900 bill I got for 'previous months' of insurance, saying that I'm legally responsible to pay that bill, even though I didn't know I had insurance available to me BEFORE I signed up. This is part of the new reform bill that passed this year. I don't know why no one is aware of this clause but that's the case. The Department of Managed Health Care for California is saying they've been getting a lot of similar cases, and they are going to dispute the law.
At this point, the due date for the $900.00 bill was coming close and I was worried that they would come after me if I didn't pay it or they would cancel my insurance.
I got this email from Kaiser Member services:
After reviewing your enrollment information it appears that the enrollment effective date of 07/01/14 is correct. Since the implementation of Affordable Care Act (ACA) you are only able to enroll with a health care provider during open enrollment periods. Since you recently were married in June you met the qualification to enroll with us due to meeting the criteria of a "Special Enrollment Period." Since your marriage qualified you to enroll your effective date of coverage would unfortunately have to be 07/01/14. Normally the ACA open enrollment period is October 1, 2013 to March 31, 2014 for coverage to become effective as early as 01/01/14.
Since you expressed dissatisfaction of being billed for coverage you indicated you didn't need nor known you'd have I am escalating a case to our Member Case Resolution Center (MCRC) for a Case Manager to review. The complete process may take up to 30 days: however, the Case Manager may contact you much sooner if further information is needed or if the resolution comes prior to the 30 days. Please let us know if you have any further questions or concerns and I apologize for the confusion you've had with your enrollment.
Thank you for allowing us the opportunity to assist,
Senior Health Plan Representative
Member Services Social Media Unit
Follow us: @KPMemberService
I got a call from a Kaiser rep named Kimberly Donoville who was working my case. She put in my request to the insurance overlords and she said I could call billing and tell them I had disputed the bill, and an outcome wouldn't be available for 30 days so hopefully they will extend it til I get an answer. I called billing, and I told them that the bill was in dispute. I also called Danielle on 9/19/2014 at Member Services to file an extension for the $893.34 bill. She had 'never heard of MCRC telling a member to file an extension'. I spoke with Kimberly Donoville on Wednesday who said I should call to file the extension, since the case wouldn't be resolved for up to 30 days.
I decided to call Member Services again a few days later because I wanted more information about the bill. A helpful guy named Carlo was on the phone. He mentioned there isn't a way to extend the bill, but to try and pay enough to cover my insurance into October until the dispute is finalized. And if it's in my favor they'll refund me if I do end up paying the full amount. He also said this bill isn't sent to collections or hurts credit - since it's in dispute and IS a premium bill. They will cancel my insurance if I don't pay it by October 1, but I can reinstate my insurance up to four times a year if it's cancelled due to non-payment of premiums.
I received a letter from Kimberly Donaville on Sept 22, about the Member Case Resolution Center receiving my dispute and working on a resolution. I sent a reply to her on Sept 23 regarding my full charge towards prescription over the summertime, along with a copy of the pharmacy receipt and call log. I also took a video of the letter being sent via USPS and put in my outbox via smartphone just in case she said she never received the information.
Kimberly received my pharmacy receipt and letter explaining the issue. Without my consent - she forwarded this receipt to see if she can get it refunded. Obviously, I would prefer that they refund the Kaiser premium bill, not the pharmacy bill.
October 1 passed, and I thought the bill wouldn't be charged since it was in dispute. I looked at my banking account several days later and noticed that Kaiser Permanente had taken the $900 out of my account on October 2 without my consent - even though it was in dispute. I then called Sabrina from Member Services. The Kaiser bill overdrafted my checking account. Sabrina told me adjustments take 6-8 weeks to occur, and she transferred me to billing. Billing didn't pick up. I called Kimberly and left a VM about bill. I then spoke to Jamie at Member Services who transferred me to Shannon in Billing about refunding the bill. Shannon told me the bill will not be sent to collections. She has processed a refund which can take 30 days. She stated "We do not send premium bills to collections, but you'll be billed for the full amount for any services during that time".
30 days after this I never received notice that a refund would be given. I called Billing again to clarify where my money was, and they told me that the I was responsible for the bill and they would not be sending me a refund. During this 30 day period, they also charged me for another month of health insurance. At this point I told them that I would be cancelling my health insurance.
Because the entire process took from September - November before I received final notice, I decided that I would never return to Kaiser Permanente as a member. They are a for-profit business and only care about money. I also learned a lot from the process.
- The Affordable Care Act legally allows health insurance companies to charge you for previous months, even if you didn't know you had insurance.
- If you don't pay a premium, you enter a grace period and they don't send that premium to collections. Ever.
- Keep recordings of phone calls where you can legally do so, keep records of any paperwork, and file EVERYTHING.
- The Department of Managed Health Care may be able to change the law, since hundreds of individuals are running into the same problem. Unfortunately none of them have written about it on a public forum.
- If you set up your account to do ACH with Kaiser, they will still take your premium out even if that bill is in dispute.
I'll never get my $900 back, and I feel like I was scammed. It came at a very unfortunate time in my life financially, but I am bouncing back. I spent extra time and money sitting on the phone for hours, I got headaches from the stress, and I was extremely upset. I already know my story has made more than one person rethink signing up with Kaiser, and I hope it does more so of this in the future.
I know a lot of folks think that $900 isn't much in the scope of things, and I understand that the ACA does in fact help a lot of people. When you are in the situation I was in- my health insurance premium cost doubled when the ACA came into effect, and the quality of insurance stayed the same or decreased; I had just had a major change in my life, which incurred a pretty hefty bill; and I live in fucking expensive as hell California- it's like seeing the other side of the big picture. The bill that we all voted 'yes' for, has a nasty side to it and I'm not the only one that's seen the effects of that. I just hope that writing about it will help someone else in the long run.