Kaiser Cancelled Me But My Payments Are Up To Date
I have been certified to work with the health insurance exchanges for two years in both Maryland and the state of Virginia. I have signed people up with 4 of the major companies in our area over the course of the past 2 years. I’ve had good and bad experiences with resolving client issues. This article will highlight a problem that I have found with one of the major companies in my area.
The goal of this article is not to criticize the company but to inform the public of an ongoing problem that needs to be addressed. No business owner likes to admit when there are problems with their company but in my opinion when you are straight forward with your clients and give them clear truthful explanations as to why they are experiencing difficulty they will respect you more. If a problem has no solution the client has a right to know without getting the run around.
The following is based on my own experience. I will not say that this problem is unique to Kaiser but so far they are the only company where I have had this issue. So what is the problem? Consumers who have paid their premiums have had their policies cancelled despite being up to date with their payments.
How did I discover this problem? A client called me after making more than one premium payment. They were concerned because they had not received any plan materials. Since more than a month had gone by since they made their payment I decided to call and inquire what was going on. When I called I was told by Member Services that my client did not appear in the system. They checked with the billing department who said that the account had been cancelled one day before the effective date of March 1, 2015.
They said that my client probably cancelled their policy through the Marketplace without letting me know. They said that I should contact the Marketplace to have it reinstated. So I made the infamous call to the Marketplace not convinced that the problem originated with them. The Marketplace confirmed that the account was still active and had never been terminated. They, of course sent me back to the carrier.
This time I called the billing department directly. I explained to them the situation with my client. This is the first time I found out the true source of this billing issue. Kaiser uses a third party billing agent called Connexus. They are the ones that handle billing for all Marketplace Exchange business. They are responsible for processing the information when it comes from the Marketplace. It then goes to the Kaiser billing department and then it goes to Member Services. Once it reaches Member Services with all of the correct information then your account is considered fully activated and your membership cards and other material is sent to you. This is the best case scenario.
So what happens when Connexus makes a mistake and cancels your policy even though you are up to date with your payments? Do you get notified that you are cancelled? In most cases nothing happens. You will not get a notice letting you know that you have been cancelled. In all of the cases that I’ve dealt with so far the person called for another concern only to be surprised with the news that they had been cancelled. So if these clients had not had a reason to make an inquiry they could have possibly continued to pay their premiums for months thinking they were covered when in reality they were not.
So how can you know if you or a client of yours has been cancelled by the third party biller Connexus? First call Kaisers billing department to get the payment status of the account. In the Mid-Atlantic states the number for billing that I received from the Exchange is 1-866-475-3925. Wait and choose option 3 so you can speak to a live person. It has proved to be very effective. If you are a broker in the Mid-Atlantic States you may need to do three-way call since there are no agent broker services and in most cases the agent information will not show up on the clients account. You will need to get permission each time you call and inquire about the same account. They do not maintain the verbal permission within the notes for the account nor does the permission transcend across departments so if you are transferred to another department you may need to obtain permission depending on the customer service representative you speak to.
If the status of your account is active then you are good. I would recommend you check back periodically to be sure your account remains active through the end of the year. Insurance agents should recommend that all of their Kaiser clients do the same and to report any changes such as unexpected cancellations to you. I also recommend that everyone regardless of the company you choose keep a record of all of the payments you send to your insurance company along with the check number and the date you made the payment. If you pay by phone or online get a confirmation number and record the date and time that you made you payment. If you pay by mail especially if it is your very first payment that the company calls the “Binder payment” it’s a good idea to send it by certified or priority mail. Always mail your payment at least two weeks before the due date.
What if the status of your account is terminated? Get the date that your account was terminated. If you have it available give them the dates that your payments were made as well as the dates that the payments were deducted from your account. Give them your check numbers and any confirmation numbers you have available. If you have not done so call the Marketplace to confirm that your account is active.
Next let the representative know that you confirmed that your account is active at the Marketplace. Ask them if they can let you speak to someone at their third party Marketplace biller who can let you know why your account was cancelled even though your payments are up to date. They will tell you that they are not allowed to give out that number. If they insist there is no one that you can talk to ask them to inquire on your behalf. If they cooperate make sure they give you the six digit case number before you hang up. You will need this number to track your case. If they refuse to cooperate hang up and call back. Not all representatives will give you a hard time.
Many consumers who handle these tough issues on their own may feel that these issues are unique to them. As an agent we spot problems and gradually learn how to handle them after dealing with multiple clients who have dealt with the same issues.
Getting and keeping health insurance should not be this complicated. We the public whether we are insurance agents or consumers would really like to have a more consumer and agent friendly system. We would like a system that is more transparent. Would it not be easier to state upfront that you use a third party biller? Would it not make sense to inform the client when the third party biller makes a mistake that could affect their coverage? Shouldn’t the company who hires a third party biller hold them accountable for making mistakes? Just like in the real world should not the company be accountable for damages incurred by their clients when a sub-contractor hired by them ultimately does something that brings harm to the client?
If things were working out as promised by Kaiser in an agent webinar everything would be wonderful. I chose this company for many of my clients because many of them were new to the health insurance world. They did not have any doctor preferences and did not have access to nor know how to use the Internet to do a provider search. They do everything in house which eliminates the chance of out of network fees. Most clients like the idea that they included a dental bundle from Dominion Dental along with the adult major medical policy for routine dental care. In most cases they were one of the lowest price plans in the area which included doctor copays before the deductible. They liked the idea of a one stop shop.
I personally received some help from Kaiser this year with some minor issues but the major issues that concerns clients the most continue to linger. Unfortunately due to the major problems with billing and payments and simply getting to the end of the enrollment process many of my customers are ready to jump ship. They’ve had enough.
Of course all companies have had their issues. All we want is a little honesty about what’s going on. Honestly we are adults. We can take it.