2014 PPACA Health Insurance: Help, I Need to Change Plans, Doctors Aren’t Covered!

I signed up for a new health insurance policy using Healthcare.gov in October. I paid my first premium and was ready to go Jan. 1, 2014.

Then…upon leaving my doctor’s office the other day, I was told their services “were not covered by my plan”. I had to come out of pocket close to $300 to cover bills. I was under the impression these doctors accepted my health insurance plan, but due to the confusion and “moving parts” of the new changes, it turned out they were not.

How do I cancel, change, or get a new health insurance plan for 2014? (even if I’ve already paid the first premium?)

Open Enrollment is available to March 31, 2014. You still have time to switch!

Important: The following is my own personal experience. It might or might not work for you.

My situation:

  1. Un-subsidized. I’m not being folded into Medicare. I’m paying the full rate myself. I am self employed, not part of a company.
  2. I purchased a Florida Blue plan called “Blue Select”. The plan I actually needed was “Blue Options” (a larger network that had all my doctors).
  3. I paid my January premium already. The first month’s insurance fee was deducted from my bank account in October 2013.

If you have NOT paid your premium yet, go to Healthcare.gov and cancel your application. If the website fails, call and do it in person: Call 1-800-318-2596. You can ignore the rest of this blog and pick a new plan! 🙂

How did I change my plan in one afternoon?

Part 1 – Do the Mess Around

After getting the painful cash-only bill from my doctors, I spent the afternoon working the phones. I called Healthcare.gov (Call 1-800-318-2596) and was told “You’re locked in, we can’t help you”. On another call I was told “Talk to the insurance company, you’re already their customer because you paid the first premium”.

Similar calls to Florida Blue (Call 1-800-352-2583) produced unanswered 1 hour wait times listening to Chuck Mangione’s “Feels so Good”. When I did get through, the operator sent me to their cancellation department – that, lo and behold – was someone answering phones at Healthcare.gov 🙂 Don’t you love bureaucracy?

Tip: Don’t waste your time calling Healthcare.gov or your insurance company. They are not answering phones on purpose because thousands of confused customers are calling. That will save you 6 hours.

Part 2 – Anal Retentive Googling and Searching

On Friday I decided to fully research a new plan. That means going to your health insurance provider’s website and checking which doctors are covered under each respective plan.

For Florida Blue Customers: Go to Find a Doctor Advanced Search – Click Here. In the search options tab (Doctor or Facility Name) select the “All” radio box at the end. This will give you the broadest matching possible. Enter last names for the first few searches. Use one or two word hospital names for facilities searches.

Tip: Some mental health clinics are extensions of local hospitals. Therefore, their insurance billing process is under the legal name of the affiliate hospital, not necessarily the individual doctor or therapist. Make sure BOTH your facility and individual doctors are covered.

The same procedure above should apply to any other insurance company.

Find a plan. Double check your “network” is covered by your doctors and facilities, not just the insurance company itself. Large providers like Blue Cross/Blue Shield have multiple networks within their company. It’s not enough to move ahead knowing your doctor accepts Blue Cross/Blue Shield. Double check the specific insurance “network” within that company is covered.

Example: Florida Blue offers “Blue Select”, “Blue Options”, “All Copays”, etc. Some doctors might accept “Blue Options” but NOT the others. That means if you purchased a “Blue Select” plan, you will NOT be covered for office visits.

Finally, check to make sure your pharmacy benefits and durable medical equipment (if applicable to you) are covered.

I switched from one “platinum” network to another within Florida Blue, so there were no changes other than a $50 increase in monthly premiums (not a big deal because NOT switching plans would have cost more than $300/month in cash payments to out-of-network doctors).

Part 3 – Screw the Government, Do It Yourself In Person (Implied rhetorically 🙂 )

Find the nearest service center for your health insurance provider, making sure it has office hours for the general public. Set aside 3-4 hours of time and go. It didn’t take me this long, but wait times and service quality will vary from place to place.

Bring the following:

  1. Your current health insurance card.
  2. The full name, ID code, and network of the NEW plan you desire. Avoid shopping on the spot because that will waste time.
  3. Photo ID and full address.
  4. Social Security number.
  5. Healthcare.gov existing or approved application number.
  6. A personal check which provides bank account number and routing number.
  7. All your doctor’s names and facility names.
  8. Durable medical equipment needs, if applicable.
  9. The date you were billed for January 1, 2014 premium.
  10. Your old insurance card from 2013 whether or not it is the same company (this is helpful for the agent).
  11. Good manners and patience 🙂 This confusion is a clusterf**k that isn’t really anyone’s fault.

Tip: Tell the agent helping you that you want to switch plans. Emphasize they are NOT losing your business. You are simply joining a different network within the same company.

The agent will do his/her due diligence. This will include calls to Healthcare.gov to argue with the representatives. There will be calls to internal billing to make sure you paid for January. There will be calls to management to approve the change. You will probably be offered coffee, tea, or water while you wait. 🙂

Major Contradiction with Healthcare.gov: They will say you can’t switch because you already paid the first premium. They will say you are locked in for a year. Yet, there is still open enrollment until March 31, 2014. As a result, they will only change your application if there is a “special circumstance”.

This is categorically false. You are not locked into anything. It is your right to change plans, special circumstance or not. Remember, you are sitting in the insurance company’s office. They want your business. You make the new deal with them.

Part 4 – Git er done 🙂

Fill out all the info for the new plan. It will be fast since they already have most of it from your other application.

Arrange payment on the spot via your checking account or credit card. This saves them the hassle of calling or billing later on, which might interrupt coverage.

Extremely Important:

For Florida Blue (and most insurance companies) you will need to sign a cancellation letter. The letter will state you are cancelling the existing plan on February 1, 2014 and beginning a new plan on the SAME day.

Get a copy of the letter. Request the direct line to billing just in case you get double billed. If so, remind billing you have a new plan and they will eventually reconcile the difference.

Thank your insurance agent for their time and take their card for followup questions.

You’re ready to go! 🙂

Please email and share this with anyone it might help. The goal is to help people, that’s why I wrote it.

Footnote 1: Healthcare.gov is really a marketplace, not insurance. Marketplace = “place to shop and compare”. If you are subsidized, it will become a insurance provider via Medicare. For un-subsidized healthcare, you might be better served approaching your local insurance companies on your own or through your employer. You can not be denied for pre-existing conditions, so the rates will be the same on Healthcare.gov and your insurance company’s website.

Footnote 2: If you require a subsidy, I don’t know if this process will work. The subsidy involves the government. You might be better served calling the government first and/or going to a Medicare facility in person.

Footnote 3: Ignore your application with Healthcare.gov if you applied last fall. They will catch up with your change later. The important part is that the local insurance company is covering you, and that you will continue to have to access to your doctors, meds, and medical equipment. After all, the check goes to the insurer, NOT Healthcare.gov!