34F 42K household income in TX 78613. I’m hoping for advice for an upcoming hearing I have with the Marketplace Appeals department. I had a baby 12/11/2021. I was under the impression that he would be covered under my insurance for the 30 days following his birth. After 30 days, I applied for coverage through the marketplace & listed him as a dependent. It covered him retroactively from 01/01/2022. In mid-Feb, I began getting bills for the full amount of his stay after his birth. I made calls to the insurance company, the marketplace, the hospital billing department & back to the marketplace in order to figure out what happened. Eventually finding that when I called to list him as a dependent, it didn’t count as adding him as a newborn. By this time, (FEB 22nd) it has already been beyond the 60 day window where they can cover him retroactively. The next steps were to initiate an appeal to get him coverage. I was instructed to open an appeal which I did. I sent in his birth records & copies of my request for his birth certificate (it takes 4-6 weeks to receive the actual birth certificate). This was around mid-March. Then I received a denial based on it being an invalid appeal because they hadn’t denied me a special enrollment period. The appeals department assured me all I needed to do was request the special enrollment going back to the date of his birth & for the following 30 days, have it either approved & they’d cover it or have it denied & we could appeal it & get it covered. We’re now at April 1st & I’m told by the Marketplace that they were giving me a special enrollment period moving forward but not backward so it technically can’t be considered a denial of a special enrollment period so there’s nothing to appeal. :/ I had them stay on the line for a 3-way call back to the appeals department. They say this is considered a verbal denial & we can appeal it. At that point, I was extremely distressed & asked to speak to the customer service manager about what to expect. She assured me this happens semi-regularly & isn’t a big deal, they would submit the appeal & he’d likely be covered. I’d added him as a dependent born within the previous 30 days so it was an error that I technically didn’t specify him as a newborn. She assured me this was pretty standard & everything would be taken care of. I told her I really can’t afford these bills & she essentially said, don’t even worry about it, you’re doing the right thing & had seen this happen before leading me to believe they’d see what happened & approve the appeal. I called today & they said appeal denied. You can accept it or ask for a hearing. I asked for & set a hearing for as soon as I could (May 19th). I’m at a loss as to what to expect & what the likely outcome is. I’m not trying to get coverage I wouldn’t of been owed. I made a technical mistake & wasn’t made aware of it until after there was no option for me to correct it. Beyond that, they’re saying I didn’t report him as a newborn until April 1st even though I began making these calls mid Feb & had initially had the issue escalated to the next tier on FEB 22nd when I was first told to appeal. Even if that was beyond the 60 day report period, why wouldn’t that have counted as my initial reporting of him as a newborn? That’s the first day I was able to get through to someone who knew what had happened & told me to file the first appeal. At that point, I was trying to get retroactive coverage for my newborn but they said I didn’t report him as a newborn until my April 1st call? I feel like they’ve been all trying to push me from one person to the next to make sure it’s so far beyond the 60 day period that there’s no way the appeals worker will find in my favor. The hearing scheduler said “oh, no, the appeals case workers don’t think like that” but I have no faith left in this system & am at my wits end. Every day off I’ve had I spend hours getting through to people, end up crying & Eventually being assured it’s all going to be fine and work out only to get let down. I don’t understand how this system works & I can’t pay these medical bills. Please can someone give guidance or make it make sense, this is destroying the Little bit of sanity I have left at this point
submitted by /u/sustainabee
[link] [comments]34F 42K household income in TX 78613. I’m hoping for advice for an upcoming hearing I have with the Marketplace Appeals department. I had a baby 12/11/2021. I was under the impression that he would be covered under my insurance for the 30 days following his birth. After 30 days, I applied for coverage through the marketplace & listed him as a dependent. It covered him retroactively from 01/01/2022. In mid-Feb, I began getting bills for the full amount of his stay after his birth. I made calls to the insurance company, the marketplace, the hospital billing department & back to the marketplace in order to figure out what happened. Eventually finding that when I called to list him as a dependent, it didn’t count as adding him as a newborn. By this time, (FEB 22nd) it has already been beyond the 60 day window where they can cover him retroactively. The next steps were to initiate an appeal to get him coverage. I was instructed to open an appeal which I did. I sent in his birth records & copies of my request for his birth certificate (it takes 4-6 weeks to receive the actual birth certificate). This was around mid-March. Then I received a denial based on it being an invalid appeal because they hadn’t denied me a special enrollment period. The appeals department assured me all I needed to do was request the special enrollment going back to the date of his birth & for the following 30 days, have it either approved & they’d cover it or have it denied & we could appeal it & get it covered. We’re now at April 1st & I’m told by the Marketplace that they were giving me a special enrollment period moving forward but not backward so it technically can’t be considered a denial of a special enrollment period so there’s nothing to appeal. :/ I had them stay on the line for a 3-way call back to the appeals department. They say this is considered a verbal denial & we can appeal it. At that point, I was extremely distressed & asked to speak to the customer service manager about what to expect. She assured me this happens semi-regularly & isn’t a big deal, they would submit the appeal & he’d likely be covered. I’d added him as a dependent born within the previous 30 days so it was an error that I technically didn’t specify him as a newborn. She assured me this was pretty standard & everything would be taken care of. I told her I really can’t afford these bills & she essentially said, don’t even worry about it, you’re doing the right thing & had seen this happen before leading me to believe they’d see what happened & approve the appeal. I called today & they said appeal denied. You can accept it or ask for a hearing. I asked for & set a hearing for as soon as I could (May 19th). I’m at a loss as to what to expect & what the likely outcome is. I’m not trying to get coverage I wouldn’t of been owed. I made a technical mistake & wasn’t made aware of it until after there was no option for me to correct it. Beyond that, they’re saying I didn’t report him as a newborn until April 1st even though I began making these calls mid Feb & had initially had the issue escalated to the next tier on FEB 22nd when I was first told to appeal. Even if that was beyond the 60 day report period, why wouldn’t that have counted as my initial reporting of him as a newborn? That’s the first day I was able to get through to someone who knew what had happened & told me to file the first appeal. At that point, I was trying to get retroactive coverage for my newborn but they said I didn’t report him as a newborn until my April 1st call? I feel like they’ve been all trying to push me from one person to the next to make sure it’s so far beyond the 60 day period that there’s no way the appeals worker will find in my favor. The hearing scheduler said “oh, no, the appeals case workers don’t think like that” but I have no faith left in this system & am at my wits end. Every day off I’ve had I spend hours getting through to people, end up crying & Eventually being assured it’s all going to be fine and work out only to get let down. I don’t understand how this system works & I can’t pay these medical bills. Please can someone give guidance or make it make sense, this is destroying the Little bit of sanity I have left at this point submitted by /u/sustainabee [link] [comments]Read Morer/HealthInsurance