My Healthcare Journey Part Two, or, You're Right, That Doesn't Seem Fair!

Last time we got together, I had just been told for the second time by our automated health-conscious overlords that my 7 year old is not eligible for health insurance.  I was slightly disturbed by this, as was my 7 year old.  (I really need to stop talking about these things with my wife when she is within earshot.) So, it's December 6th at this point, and I gave the Health Insurance Marketplace a call.  Before I relaunch into my tirade of continual disappointment with this system, I have to say, every single person I talked to at the Health Insurance Marketplace has been lovely.  I have also been in contact with representatives of The Internal Revenue Service this fall (that's a different blog post) and they could definitely take a few pointers from the Health Insurance Marketplace call center staff.  Everyone I have talked to there has been kind, empathetic and engaging.  In fact, only occasionally did I get a hint of the fact that they all get yelled at constantly and hate their jobs.

At first I spoke with a young man (I assume) with a nice thick southern accent.  I told him my problem and read him the Eligibility letter that I had received informing me that my 7 year old daughter was not eligible for health insurance while the rest of my small family was.  He asked if he could put me on hold while he looked into that.  I said yes.  He came back on the line a few minutes later having pulled up my file.  He then read me the Eligibility letter that I had already read to him.  I have to admit I enjoyed it more with the accent.  He then exclaimed, "That doesn't seem fair at all!"  It was at this point that he ran out of helpful ideas.  I asked him why the robo-insurance system might have made that determination.  He did not know.  I asked to talk to his supervisor.  He assured me that his supervisor would not know either.  I insisted.  He obliged me with a slight downturn in his mood.  I can only assume that a customer asking to be transferred to a supervisor reflects poorly on his performance record.  If you're reading this Health Insurance Marketplace Call Center frontline southern kid, I'm sorry.

I was transferred to his supervisor.  If I had to guess, I would say mid-twenties, young father, maybe a California vibe. (Actually, he told me the young father part)  He was very nice.  He too reread my Eligibility notice back to me.  I reminded him that I was actually the first person to read that notice, hence my call.  He also remarked that this set of circumstances was "unfair" and "weird."  He had a solution though!  He was going to reapply for me over the phone.  I thought, hey, maybe that's a great idea. Maybe.

We were about 15% of the way through the application when I realized that he was just filling in the fields on the website that I had already filled in.  At this point my hopes fell slightly, but I thought "at least we can rule out operator error on my part."  So we did it.

"Is your wife a woman?"

"Yes"

"Does your 7 year old have a job?"

"No."

I almost threw him when he asked the question about anyone in the household needing assistance dressing themselves, going to the bathroom or eating.  I told him that my 1 year old was still working through some of those things, but he decided that my situation probably didn't apply to the question the way our cybernetic medical benefactors intended.

We finally finished the application and he remarked "40 minutes for a family of four is a really good time!"  I sincerely hope he will get recognized for that achievement.  And then....drum roll please...

I'm eligible for insurance on the marketplace, my wife is eligible for insurance on the marketplace, my 1 year old is still eligible for medicaid and my 7 year old is NOT ELIGIBLE FOR ANYTHING!

My friendly application record breaking Health Insurance Marketplace supervisor said, "huh."  Then he said, "I'm really sorry man.  I've never seen anything like that."

I asked him what I should do now.  He said I should appeal the decision.  He said there was a form and I could download it and mail it in to the Department of Health and Human Services (what exactly does "Human Services" encompass anyway?)  So I did that.  I mailed it certified mail.

Tune in to part 3 of my tale to hear what happened next...