Sunday, December 08, 2013

Franz Kafka, Obamacare, and Me

He worked for two insurance companies.

I should preface this by saying that when I signed up for my 2014 health insurance last month on the New York exchange, four United Healthcare plans were available to me, in ascending order of price: Bronze, Silver, Gold and Platinum.

I couldn't help but notice that the Silver plan was substantially better than the Gold plan. The annual deductible was less--just $500 for two people, vs. $1200 for the Gold plan. Copayments were less, as was the maximum out-of-pocket ($4000 vs. $8000).  Yet the Gold plan cost $235 a month more.

It made no sense whatsoever. I also thought it odd that this peculiarity was nowhere noted in any of the news media accounts of the New York debut of Obamacare. But my feeling at the time was that this was the System, and it was not to be questioned. I signed up for the Silver plan.

On Friday the first monthly bill for 2014 arrived in the mail. It contained no details of my insurance coverage, just a bill. The bill matched the amount stated on the website when I signed up for the plan some weeks ago. It described the Silver plan for which I signed up as "Silver EPO Rx 10/35/70 87AV CS."

A perusal of the United Healthcare website for New York health exchange plans showed plan documents for 12 New York Silver plans. However, "Silver EPO Rx 10/35/70 87AV CS" was not there.

A Google search for "Silver EPO Rx 10/35/70 87AV CS" revealed that it did not exist.

The plan I signed up for did not exist

I telephoned the toll-free number provided on the website. I was connected to a customer service person after a short wait. I described the discrepancy to her. I pointed out to her that no health plan called  "Silver EPO Rx 10/35/70 87AV CS" was listed on the United Healthcare website.

The existence of this discrepancy  appeared to annoy this person. She behaved as if I was somehow withholding information readily available to me, or was too dimwitted to read plain English.

"Can you please tell me the plan that you signed up for?" she asked.

I pointed out to her, again, everything I had previously told her, including that the website called the plan merely "Silver EPO" but that I was billed for "Silver EPO Rx 10/35/70 87AV CS."

That was impossible, she said to me. The website surely must have a more complete description of the plan than "Silver EPO." No, I responded, it did not.

She did not believe me.  She told me that no plan called "Silver EPO Rx 10/35/70 87AV CS" existed for New York State, and that no Silver plan had such a low annual deductible.

No supervisor was available

"If that's true, then what plan did I sign up for? What am I being asked to pay for?" I asked.

"I don't have that information," she said.

Would it help if I called the phone number listed on the bill?

"That's just the billing number," she said.

Could I speak to a supervisor?

"They have all gone home," she said. She promised that one would call me Monday morning.

I telephoned the New York Health Exchange. After an hour of waiting, during which time I was told repeatedly by a mechanical voice, "Your call is important to us," I was disconnected.

My call was important to them

I called back United Healthcare. I was promptly connected to a customer service representative. Her manner and tone were so different from the previous one that it was if she was from a different planet.

After hearing about the discrepancy, she pointed out to me that the New York Silver plan that I signed up for did indeed exist, but was not "Silver EPO Rx 10/35/70 87AV CS" but was actually " Silver EPO Rx 9.20.40 87AV CSR."

Yes, she said, the information on the New York Exchange website is and was correct. The deductibles are correct, as are the copayments and annual spending limits.

She said she did not know why it had a different name than the one stated on my bill, but assured me that it was the same one.

My fate remains uncertain
I questioned her closely. Her answers were clear and reassuring. Yes, the Silver plan is cheaper than the Gold plan. Yes it is better.  She had no explanation.

"A number of people have asked about that," she said.

I wasn't sure what to make of these two conversations. Was the System toying with me? Was I being punished? But if so, for what? What did I do? What was my crime? How would this end?

I will find out on January 1.

Note: Comments are accepted for this blog and as of this writing there was one published comment. However, perhaps not surprisingly, when I click on the "comment" button below I get a "not found" message.

© 2013 Gary Weiss. All rights reserved.
My latest book is AYN RAND NATION: The Hidden Struggle for America's Soul, published by St. Martin's Press. Click here to order the book from, and here to order it from Barnes & Noble. Follow me on Twitter: @gary_weiss

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