Mar. 25, 12:30pm: This post has been updated
Retired New Hampshire nurse Terry Wetherby doesn’t hide the fact that she smokes.
She checked the box on HealthCare.gov
saying she uses tobacco and fully expected to pay more for her insurance policy
under the Affordable Care Act. “It’s not a secret at all,” she said.
Wetherby
dutifully paid
the premium Anthem Blue Cross and Blue Shield charged
her for January and again for February — and believed she had coverage
effective on Jan. 1.
Then when Wetherby
went to pay her March premium, she was told she couldn’t. A check arrived in
the mail refunding her February premium with a two-word
explanation: “Contract cancelled.”
Turns out, Wetherby
was among about 100 smokers in New Hampshire caught up in a “technical glitch”
that caused them to lose their new health insurance policies because they had
been mistakenly charged non-smoking rates, according to the New Hampshire
Department of Insurance.
It is unclear if the error affected
smokers in other states served by Anthem.
Wetherby,
64, learned on Friday that her insurance was being reinstated, retroactive to
Jan. 1, and that the original rate she was quoted — about $26 a month after
a big government subsidy — would be honored throughout this year. She turns
65 in October and will then go on Medicare.
“When we were contacted by consumers
who were experiencing application processing problems, we reached out to the
carrier (Anthem), and worked with them to understand the factual situation,”
said insurance department spokeswoman Danielle Kronk Barrick. “Ultimately, Anthem agreed that it would honor the
originally quoted nonsmoker rates for the remainder of 2014, even though Anthem
believes the glitch was not of its making.”
Still, for the past month, Wetherby has been scrambling to find out what happened and
get it fixed. She contacted Anthem, her governor, her Congresswoman, her senator
and state insurance regulators. She set up a Twitter account to
try to get someone’s — anyone’s — attention.
“How can this be??” she wrote to me. “The ACA guarantees coverage.
I went to the ACA website and received a rate. Anthem has taken my premium for
2 months and undoubtedly they have taken the corresponding US government
subsidy dollars, yet they tell me I am not covered. I read where Obamacare is
covering millions but when I speak to the NH Insurance department I am told
many people have the same issue as I do.”
An official with the Centers for Medicare and Medicaid Services,
which oversees HealthCare.gov, said “this was an error committed by Anthem” and
that the insurer recently submitted revised data, which will soon be reflected
in the online health plan comparison tool.
“CMS works to ensure the accuracy and
completeness of the data issuers submit,” agency spokesman Aaron Albright said.
“Issuers are also responsible for sending accurate and complete rating
information to CMS.”
Maine’s insurance superintendent Eric Cioppa said that up to 200 smokers in his state were also affected by Anthem’s glitch. “We have been working with Anthem and they have agreed to not only reinstate the policies but offer and honor the rates that they [the smokers] have been quoted,” Cioppa said.
Cioppa said four consumers had complained to his department about the problem and that officials are now working with CMS to get approval for the fix.
Across the country, some of those
signing up for coverage are finding out that their policies are not what they
thought: Their physicians are not in their insurance network, their drugs aren’t
covered, or their copays are higher than expected. But Wetherby’s
case was different — she was left with no insurance at all.
While it is legal in many states to
charge smokers more for insurance, it generally is not okay to cancel them
based on an error made by the insurer.
Officials at Anthem, the lone
Obamacare offering in New Hampshire, did not return multiple emails and phone
calls seeking comment. In a letter
last week to the insurance department about Wetherby’s
case, an analyst wrote that “it was determined that when the policy was to be
loaded there was a difference between the calculated rate and the quoted rate,
so it was never effective.”
Wetherby is
exactly the type of person the ACA is intended to help. Retired in 2013, she
lives on Social Security benefits and had been paying $400 per month for
high-deductible coverage last year.
Once HealthCare.gov began working
again in November, she logged on and signed up for coverage. Because her income
is barely above the federal poverty limit, she qualifies for a huge federal
subsidy — $657 a month. She is also eligible for help paying her copays and
deductibles.
While Wetherby
said she is healthy, she said she was nervous about not having insurance. When
she canceled her old policy four days before the new one took effect, “I
wouldn’t leave the house. I was so afraid I was going to get hurt.”
Even after what’s happened, Wetherby said she remains a “boisterous” supporter of the
ACA.
“It’s been a long hard journey but I
still believe in it because I believe that everyone should have insurance,” she
said. “The president has just put so much effort into this and I feel we still
do have a lot of people in government who believe in this, and I myself believe
in it.”
Update: We’ve added information about additional Anthem customers in Maine who experienced similar problems to those in New Hampshire.
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