Obamacare and Me: Adventures in The Toilet Zone

Episode Three:  I Sing the Body Frustrated

Opening narration:  Submitted for your approval:  Portrait of a man stuck between two worlds, trapped in a place that's neither here nor there, light nor dark, hot nor cold.   Imagine, if you will, a hard, round, wet domain, swirling with confusion.  A land nestled somewhere between existence and non-existence; between shadow and substance; and between promise and fulfillment.   A place where you play the cards you’re dealt, and every hand is a royal flush.  It’s place we call:  The Toilet Zone.

Mission:  To keep the doctor who recently saved my life.   To do that, I must dump my Healthcare.gov Exchange policy and switch to another, non-Exchange plan.  I chose to remain with the same company, however, which had treated me well (despite some very, very confused communications).  Subsequent events have indicted the wisdom of that decision, but now I'm stuck with it.

Mission status at the beginning of this episode:  I hold an approved application for the replacement policy, but my credit card has not been charged.   The approval email, received from the company on March 21, specifically stated that I should not cancel existing plans until I have received and reviewed the membership materials for the new one.   Previous efforts to get answers by phone were not successful, leaving me not knowing whether I now have two policies in effect, just one, or none, or whether I can now see my existing doctors, must obtain new doctors, or cannot see any doctors.   This is a concern because the time is approaching for exams following up my recent surgeries.

In our last episode:  On March 31, the last day of open enrollment, I invested four hours on the phone (95% of which was spent on hold) and spoke with 4 different employees before I finally gave up for the day.

Task at hand:  Try again to get answers.

Update

Let me say right off the top that I don't blame all of this on my insurance company, which I am not naming at this juncture for reasons that should be obvious.   This company stood by me in January, authorizing my operation under my old providers when it could have fought me on it.   Change brings confusion, and so it follows that massive change brings massive confusion.  Given the broad impact of the Affordable Care Act, it would be surprising only if chaos were not the order of the day right now, on all fronts.

That said, even by those standards, the latest rounds of mirth and merriment score well above average on the You’ve-Gotta-Be-Kidding-Me-O-Meter.

Events of April 3

Now that we were three days past the open enrollment deadline, I had hoped this day would be a little less busy for employees working the phones.  However, I found I could not start my calls where I'd left off.  The last woman who'd talked to me on Monday had not given me the number she was dialing before she transferred me into The Toilet Zone.  So I had to start again.   From the beginning.   

9:03 am.  In starting the day’s new round of phone tag, rather than resort to the number listed on the email, which I now knew to be wrong, I looked up the customer service number indicated on my old membership card, and called that.  The phone picked up quickly.  After hearing my problem, right away the employee wanted to transfer me to someone else.  I stopped her, and explained the joys of my day on Monday.  She listened politely, and then checked her computer more closely.  But it turned out that she could not see any of my payment information because she worked in the company's Exchange area.  To get me help, she would have to transfer me off to a non-Exchange department or section within the company.  Reluctantly, I let her do so.   I spent some time on hold.

9:50 am.   The lady who finally picked up the phone next was extraordinarily helpful.  And bless her heart, she really dug into the issue for me.  She had to call around to several different people in order to gather information, but she did not transfer me or maroon me again in The Toilet Zone.  Finally, she found what she said was the answer:  my credit card had not been charged for the new policy because the company was waiting for me to cancel the old one.

Yes, you read it right.  After telling me, in writing, not to cancel the old policy, the company had then shelved my application until such time as I did so.

At this point, I think even the late Rod Serling would had rejected this story synopsis as being too bizarre for belief.  But at any rate, the woman on the phone (who was, let the record reflect, a consummate professional and a great advocate for me on this day) told me that the word from the enrollment department was that I needed to contact the government-run Exchange by phone and cancel my existing Exchange policy.  She said that, according to the enrollment people, this would result in a cancellation number.  She was very specific in saying I should write down that number.  Once I cancelled, she said, the government would notify the company, at which point the replacement policy would become active and I would get my new membership materials.  She said she expected this to take about a week to play out.  

I thanked her, and then politely gave her some summary comments about my recent customer experiences—both good and bad—which she promised to relay up the chain of command.

12:55 pm.  After taking a break for lunch, I hit the phones again and called the government number she'd given me.  After about 35 minutes on hold, a gentleman politely guided me through the cancellation process (as it turns out, I could have done this on line).  By the end of the call, I'd succeeded in terminating my Exchange plan, as of the earliest available effective date, April18.  However, I did not get the requested cancellation number.  When I asked for it, the man patiently explained that the termination procedure generates no such number.   

I swear to you, shortly after hearing this, I found that I had assumed the exact hands-to-face pose as the tortured figure in Edvard Munch's famous painting, "The Scream. " But at this point, there was nothing to do but wait.  However, on the strength of the assurances I’d just received, I went ahead and booked my next round of medical exams.

Events of April 20

I open a letter from my insurance company and find a notice that my upcoming round of medical appointments with my existing doctors has been approved.   Praise the Lord.  However, I have received no membership materials for the new plan, which should have arrived (based on the latest promises) one week ago.  Nor do I see any acknowledgment that the old Exchange plan has been cancelled.  But I do find a letter from my previous Exchange dental provider, acknowledging the cancellation of that plan.

Events of April 22

I check online, and learn that the credit card I’d provided with my application in February still has not been charged.   Now scenarios begin running through my mind wherein claims for the treatments I’d booked come back stamped CLAIM DENIED in big red letters on the grounds that the premium has not been paid.  Time for more calls.

9:45 am.  After only a short amount of time on hold, I reach a polite young lady.  I explain my story to her, and tell her that I need to find out why my credit card still hasn’t been charged, and that I need to verify that new policy is active and not in arrears.  She looks up my account and sees two applications.  But, as had happened with other employees in other phone round-robins, she is not able to assist me, and says she will need to transfer me to someone who can.  She tells me she will talk to that person first and explain my needs, so that I won’t have to repeat my entire story.

9:53 am.  The transfer is complete, and a new person comes on the line.   She does not know my name.  I repeat the entire sordid story from scratch.  This employee looks up my account, tells me she only sees one application, the one for the old Marketplace policy that I’ve already canceled, and says it’s inactive.  I point out that this is exactly what I’d just told her.   She then tells me that I don’t appear to be enrolled in anything.  By this point in my months-long quest, I have started to become immune to physical shocks to the system, so my head fails to explode.  Careful to maintain a calm, patient tone of voice, I explain that over the past several weeks I have spent hours on hold, and have spoken with probably a dozen of her fellow employees, and yet still have not be able to get any answers.  Only at this point do I learn that she is not on the payroll of my new insurance company.  The previous employee had transferred me right out of the company and had  connected me with the Government Marketplace Exchange.  There was not a thing the government worker could do for me.  There had never been any chance that she could do anything for me.

10:09 am.  I call my insurance company yet again.  This time, the moment I’m connected, I do something I should have done well before now:  I insist on speaking with a supervisor.  The man on the phone resists this notion and offers to assist me himself.  I explain that about a dozen of his fellow employees have crashed and burned while trying to do so, and say that it’s time I try my luck with a supervisor.  He asks if I would be willing to speak with a team leader instead of a supervisor.  I counter that I would really like a supervisor.  He agrees to look for one.  After several minutes on and off hold, he connects me with someone.  She turns out to be a team leader, not a supervisor.  The woman, whom we’ll call Freda,  apologizes and explains that no supervisor is currently available.  I tell her my story, yet again, in all its radiant glory.   Freda checks my file, and alleges that the reason  my credit card was not charged is that someone needs to read me a disclaimer.  I point out that no one had to read me any such disclaimer prior to my card being charged for the original plan in December.  She looks again and now finds a different problem:  no invoice has been generated for the new plan.   But Freda confirms that its effective date is April 1.   I point out that, since the card hasn’t been charged, payment has to be past due for the April premium, and is coming up on being due for May.  Freda puts me on hold to confer with a billing representative (I thought that’s what Freda was?).   After a few moments, she comes back on the line and says that the billing department will have to work on my case in order to determine the amount I should be charged.  They’ll get back to her, she says, at which point she’ll get back to me.  Freda promises me she’ll call me back by noon, whether she has an answer or not.  I repeat this promise back to her:  you will call me back by noon, no matter what, right?  She again promises me faithfully that she will do so.  She also gives me a direct line to her supervisor, just in case.  The call ends.

12:00 pm.  Freda has not called by the promised time.  I decide to give her an extra half hour.

12:30 pm.  I call the supervisor’s line.  I get voice mail.  I leave a detailed message.

1:00 pm.  I call the supervisor’s line.  I get voice mail.  I leave a detailed message.

1:02 pm.  Freda returns the call.  She explains that both she and the supervisor are working on my case but still don’t have an answer.  She promises to call me the moment she has an answer, but in no case later than 5:00 pm.   I ask if that is normal end of her shift.  She says it is but that she may stay late today.  I say I’ll call her by 4:30 pm if I haven’t heard from her sooner.  She assures me I don’t need to do that, because she will call by 5:00 pm without fail, but says I’m of course welcome to call.

Can you guess how the rest of the afternoon played out?  I’ll bet you can.  Here it is anyway.

4:30 pm.  I call as promised.  I get voice mail.  I leave a detailed message.

5:00 pm.  Freda was supposed to have called by now.  She hasn’t, nor has my 4:30 pm call been returned.   I decide to give her another half hour.

5:30 pm.  I call again.  I get voice mail.  I leave a detailed message.

6:00 pm.  I call again.  I get voice mail.  I leave a detailed message.

6:30 pm.  I call again.  I get voice mail.  I leave a detailed message.

Closing narration.   Forrest Carr’s journey for the day is over.  It will begin anew tomorrow.   When he resumes his toil at the break of day, he’ll do so with replenished vigor, a renewed spirit, and a heart filled with hope--hope that this hour, of this day, of this week, of this month, will be different from all the rest.   But what he doesn’t know now, won’t know tomorrow morning, and will never know on the many mornings to follow, is that the fresh hope that fills his heart daily is in fact the very heart of the joke.  It’s a loving cup of bitter potion, a noxious brew, a foul draft of venomous cruelty that is his price to pay for trespass... into the Toilet Zone.

Will Forrest get his insurance?  Will he be able to receive his next treatments?  And what have we learned from all this?  Find out in our next episode of The Toilet Zone.

###

You can find the entire series of blog posts on my medical journey on this page:  My Medical Travails:  Adventures in the Toilet Zone.  And of course, I invite you to check out my author's page, where you can learn about my novels, see critic and reader reviews, download sample chapters, and find purchase links:  www.forrestcarr.com.

© 2014 by Forrest Carr.  All rights reserved.