Thursday, April 03, 2008

All in a Day's (Week's? Month's?) Work: Part 1

This is the incredible story of persistence, perserverence and perspicacity on behalf of a client. Your intrepid correspondent endured countless weeks of nail-biting tension, seeking to resolve a seemingly insurmountable set of obstacles.
Either that, or it was a dark and stormy night.
While insurance certainly isn't rocket surgery, there's a reason why folks must endure many hours of training before becoming licensed, and fulfill continuing education requirements once they're officially "in the biz." And this case is illustrative of the role an agent can play in navigating potentially complicated waters. Obviously, I've changed the names of the insureds, but I'm also holding back the name of the insurer. That may change, but for now we'll just call them Thema.
In early February, I was referred to a family with a dilemna: they were on COBRA continuation which would run out at the end of the month, and the Mrs was pregnant, due mid-month. Further complicating matters was that this rendered the rest of the family uninsurable (until after the baby was born), as well. Don't ask me to explain that, by the way; it just is. So we had a definite and urgent need, and few options.
I sat down and wrote out all the the issues. After about an hour and a half (hey, I'm a little slow), I had my strategy: we would write a HIPAA plan (hang on, I'll explain shortly) for March 1, and simultaneously submit an application for a "regular" major med plan for an April 1 effective date. To my relief and pleasure, the clients are big fans of HSA's, so we chose a high deductible policy for the April 1st plan.
COBRA and HIPAA are two ubiquitous and generally misunderstood federal laws that greatly affect our health insurance choices. Under COBRA, one can keep one's existing group coverage for up to 18 months (and yes, there are exceptions) even if one is no longer part of that group. After 18 months, if one is "uninsurable," one can elect a special "HIPAA Plan:" essentially a mediocre and expensive major medical plan, whose primary benefit is to cover pre-existing conditons. In this case, the HIPAA plan was a life-saver: we could have it in place for March 1, giving us about a month and a half from the due date to the HSA's effective date.
So far, so good.
The rub is that I wanted to submit ALL the paperwork at the same time, using the same carrier. My primary reason for this was the KISS principle. I chose Thema because they had the lowest rate for the HIPAA plan (which is, by definition, standardized as to benefits) and because I like their HSA plan (which has first dollar coverage for most routine preventive benefits). And there's this: I also wanted to have all of this done prior to the baby's arrival. The good news was that the clients had a C-section scheduled, so the date was firm. So, we filled out both sets of paperwork, and sent them off to Thema (along with a cover letter I wrote to explain the extentuating circumstances). Now came the hard part: waiting and hoping.
The HIPAA plan was issued pretty quickly (as we knew it would be; generally speaking, it's something you simply sign up for, with no underwriting). The delays came when trying to get PHI (Private Health Information) from the client. PHI is a byproduct of HIPAA privacy concerns, and requires the carrier to go directly to the insured for answers (rather than through an agent). The problem was that the client was difficult to connect with (understandable, since she'd just had a baby). Complicating things further was the fact that the husband had a health history of his own, with quite a few med's.
As the clock ticked, and we got closer and closer to April 1, I became more and more concerned. It also occurred to me that, since we had submitted the applications before the due date, we'd have to add the new baby to the app while still in underwriting.
On the 25th, the client called to let me know that the Thema folks had called to discuss the PHI, and that she was going to call them back. I said "great, and you can tell them to add the new baby to the policy, as well." Progress!
Except not.
Stay tuned for Part 2.
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