With persistence and a team of helpers, insured finally

Lou Franzini of Exton , a former banker, was told his policy had been canceled.
Lou Franzini of Exton , a former banker, was told his policy had been canceled.
Posted: April 20, 2014

Lou Franzini was about to give up.

For two months, he had been trying to get re-enrolled in the health plan he chose on the Affordable Care Act's marketplace. The former banker, 63, had been paying for the plan since December, but then it was arbitrarily canceled.

And his calls to the marketplace always elicited a similar response: Nope, can't be done.

Even the support of U.S. Rep. Jim Gerlach, (R., Pa.) and Independence Blue Cross couldn't sway the decision.

"I'd call the marketplace and the rep would say, 'No, we have to talk to Independence,' " Franzini, of Exton, said. "And then I'd talk to another rep and they would say, 'No, it's too late. You can't do it until the next enrollment period in November.' "

What exasperated Franzini even more was that the marketplace created the problem by entering two plans under his name. It then canceled the one he chose - the insurer's bronze Preferred Provider Organization (PPO) - and replaced it with the carrier's lesser bronze reserve policy. "They had it that I was enrolled on Jan. 1 and that the plan was canceled on Jan. 1," Franzini said. "Well, I know where I was on Jan. 1, and I wasn't on the phone with the marketplace canceling plans."

Franzini started trying to enroll on Oct. 1. When he still couldn't complete his application by early November, he contacted Scott Savett, a legislative assistant in Gerlach's office.

"If it wasn't for Scott, I don't know what I would have done," Franzini said. "He was my go-to guy."

With Savett's help, Franzini enrolled and immediately paid his premium; the money was withdrawn from his checking account. In January, he received and paid the next invoice.

About mid-February, Franzini received a letter from Independence welcoming him to a new plan. The invoice was for a lesser amount than he had been paying. He called the insurer and was told the plan information was from the marketplace.

He called its 800 number, asking to be switched back, but the rep declined, saying Franzini had canceled the plan. Why, he responded, would he cancel a plan when he already had made two payments?

"In actuality, they canceled the plan," he said.

On Feb. 18, Franzini and Savett reached the Department of Health and Human Services. The upshot? The marketplace would open a "health insurance casework ticket" to review the case.

Franzini didn't get a premium invoice for March or April, but he still made two payments. By then, he had three Independence identification cards. He tried the one for the original plan at a doctor's office and another at a pharmacy. Both were rejected.

"I don't have insurance," Franzini recalls thinking. Worried, he made another push to resolve the issue. Franzini and Savett contacted HHS only to learn that the casework ticket from February was still untouched.

On April 11, Darlyn De La Cruz, an Independence specialist, joined Franzini on a conference call with the marketplace. During the three-hour call, De La Cruz told the marketplace rep that Franzini had made four payments on the bronze PPO plan and none on the bronze reserve plan.

"Darlyn said all you have to do is give us the approval and we will put him back in the plan," Franzini said. "But they wouldn't do it, because the enrollment period has expired and there is already an open enrollment ticket. The rep said the solution was to send my case to the advance resolution group."

Franzini was ready to quit.

On Monday, things suddenly started popping. About 2 p.m., Savett called to say the Centers for Medicare and Medicaid Services wanted proof of payment on the original plan. An hour later, an Independence rep called with news that the case had been favorably resolved.

At 3:30, the call came.

A government rep "apologized for the time spent on this matter and gave me assurances that I am now enrolled in the correct plan."

Franzini is grateful to whomever "pushed the buttons."

"I'm just grateful that I have insurance," he said.


This story was done in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

RTCaca@verizon.net

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