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Kaiser Cancelled Me But My Payments Are Up To Date

Health care coverage

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.

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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.



So, I'm not alone.
And I am STILL upset over it!
I am going through this right now. We went through all of the payments made since 2014 and can't see where we were behind. In fact from our calculations we have over paid. When I called they just say you are cancelled and the letter we got today says its backdated to before my son had his surgery. We are really freaking out.
Sorry you are going through this. My advice would be to gather proof of all of your payments from the day your insurance started. Contact the insurance company and have them give you the dates of all payments that you made. Compare it to what you have records of. If you find that a payment was taken out if your account on the dates that they say you missed a payment then you were still covered and any care your family received should have been covered. Unfortunately they do not mail out payment records to clients. If you set up an account online see if your payments appear there. This way you can skip the phone call. If you find that you did not miss any payments but still cannot resolve the issue you can contact your local department of insurance for help. If you can provide proof of payments that should resolve the case. My advice is to use an agent when purchasing insurance even if you prefer to enroll on your own. Many agents are using direct enrollment platforms which allow you to bypass the exchange during the application process. They can give you a link so you can submit it on your own without any agent involvement. You choose whether you want to engage with the agent or not. Many people do not run into problems but it's nice yo k is you will have help if you do. If you are subsidy eligible it's best to choose an agent that is certified to sell exchange plans. I hope this helps.
What happens if my payment is taken out every week from my work? And I know I still have a bill to pay them which is $60 from my last visit. I tried logging in and it says I'm not a member anymore.
Can Kaiser be taken to court if everybody gets together and file a complaint?
Monica it sounds like you have group health insurance. If you do contact the person on your job that’s in charge of employee benefits to see if they can help you can resolve the issue. If you have an individual policy that you purchased contact the agent who assisted you if you used one. If you applied on your own you are pretty much on your own to figure out how to resolve the issue.
Eric many times when a consumer handles an insurance problem on their own without the help of an experienced agent they do not always know the correct channel to go through in order to resolve their issues. Many times the insurance company customer services representatives also do not know the source of your problems. With the new laws it’s very important to identify if the problem is a Marketplace issue or an issue with your insurance company. If not you will be caught in the loop of being sent back and forward between your company and the Marketplace without getting any real answers. My advice is let someone with experience such as a licensed insurance agent certified to do ACA business in your area assist you (You pay for their services whenever you purchases a policy whether you choose to use them or not. You might as well get what you pay for). It’s best to work with one who has handled several problem cases or who has worked with the Affordable Care Act since the beginning. You can contact your local department of insurance if you have a complaint. That’s all of the advice I can give since I do not know the true nature of your problem.
This just happened to me in Oregon with Kaiser. I received a letter from Kaiser Yesterday Sept. 12, informing me my medical insurance through the marketplace had been cancelled 5 months earlier on April 30 per my request. This is although I made 2 payments in May and my insurance is paid through November. I have also been shut out of my medical record. Even though I still have dental insurance I am unable to check my dental appontment (or any other records) online. Kaiser says they received a message to cancel my insurance. The marketplace says they show me as covered. The information about a third party handling billing makes sense.
I have been dealing with this same type of issue for months now. I get tossed back and forth between the marketplace and Kaiser and no one will help me resolve the problem. I don't know where else to go. I was on a KP plan from January thru June and when I added my newborn we qualified for Medicaid and MCHP. When the medicaid coverage expired at the end of August they said it was due to the end of the pregnancy and I needed to select a plan to cover me thru the end of the year. I chose to go back on the same plan I had before and that's when everything went wrong. Marketplace claims the issue is resolved and I've been added to the KP Gold plan. Kaiser says they haven't gotten anything from them except and request from the Marketplace that we asked to cancel our coverage dating back to January. I've paid all the premiums up to date and have confirmation and bank statement showing the charges. And am now receiving bills for dr visits that should have been covered under the plan I had at the time.
I have had insurance with Kaiser for years and have always paid the premium between the 1st and 6th of the following month for the month before . I made a payment on 2/6 for my premium in January and I have 31days from 2/6 to make my premium for February so I didn't not pay that but was going to pay it next week but when I made the payment an agent told me to pay the 372 for the month of January and I will be good but I call to make an appt and was told I'm no longer a member !!! I call they said I didn't not make my payment and that the administration will not reactivate my account but I'm all caught up except February which i was told By mailed letter from Kaiser that I have 31 days from the date of the letter to make the premium and by law I'm supposed to have no less than 31 days to make the payment and if I'm cancelled the insurance company needs to do what's right for the customer but they are refusing to activate my account even when I said I'll pay for February and March . I have a medical condition from a botched surgery that requires me to get pain meds every month which I've already been on for 3 years but open enrollment is over and my doc is no longer my doc!!' I don't know what to do or where to go from here since I am not through the market place I've started this insurance on my own accord .