Sorry, You're Screwed

Good news never comes with that many names on the top of the letter... new post on Health Insurance Issues With Dave

The letter came from The State of Ohio, The Ohio Department of Insurance, and Medical Mutual. Good news never comes with that many names on the top of the letter.

We are sorry to inform you that your Ohio High Risk Pool coverage will be canceled at the end of the day on November 30, 2012.

The letter was dated November 12, 2012. 

Some of the unhealthiest residents of the State of Ohio were being tossed off their insurance policy, the Ohio High Risk Pool. In less than three weeks they would no longer be insured. And nobody is standing in line to cover them. How could this happen? 

The Ohio High Risk Pool is part of the Patient Protection and Affordable Care Act(PPACA). A stop gap measure, the states were charged with the duty of offering coverage for the chronically uninsured suffering from significant preexisting conditions. The federal government also provided five billion dollars of which Ohio received $152,000,000 for the four year program.

To qualify for the Ohio High Risk Pool you must prove:

  1. Citizenship
  2. That you have not been credible insurance coverage for at least six months
  3. That you have been declined by two insurers within the last six months
  4. You may skip #3 if your medical records show that you have a major illness that would have gotten you declined 

You can not have had credible insurance coverage in the six months leading up to your application for coverage under the Ohio High Risk Pool. This is a federal requirement. Neither the State of Ohio nor Medical Mutual of Ohio, the insurer running our plan, has anything to do with this rule. Some people who are not easily insured have purchased supplements, a better than nothing option. If something happened while they were attempting to find real insurance or qualify for an affordable program, these responsible people were trying to do what they could. 

My friend Dave is a conscientious insurance agent. He took a letter from American Medical and Life Insurance Company (AMLI) to the Ohio High Risk Pool. The letter, dated February 11, 2011 was sent to clients to advise them that their policy was no longer HIPAA credible coverage. Dave verified that since the AMLI CoreValue policy was no longer credible coverage, his clients, including family members, could retain this minimum semblance of coverage until they had six months of no real insurance and could enter the Ohio High Risk Pool. NO PROBLEM. 

It is those people, those responsible people who attempted to have some coverage, no matter what, who are being kicked to the curb. The letter from the State specifically notes:

Our records indicate you were enrolled in an AMLI policy in the six months prior to enrolling in the Ohio High Risk Pool Program. Therefore, CMS directed us to cancel your coverage because you are not eligible for this program.

The PPACA is a poorly written law. We know that. Worse, the rules and regulations are being written on the fly. What complies one day is non-compliant the next. We went through this with the grandfathering rules. The costs, both human and financial, can’t possibly be calculated. 

The Ohioans being kicked out of the High Risk Pool did nothing wrong. They followed the rules of that moment. We are talking about individuals who are gravely ill. What do they do now?

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Linda Ellis January 11, 2013 at 09:18 PM
Linda Ellis January 11, 2013 at 09:20 PM
Hi David, I just saw this news story today. So, was this decision reversed again??? See link below. http://www.politico.com/story/2013/01/feds-ohio-in-dispute-over-high-risk-pool-eligibility-86036.html http://www.politico.com/story/2013/01/feds-ohio-in-dispute-over-high-risk-pool-eligibility-86036_Page2.html
Dave Cunix January 21, 2013 at 11:08 PM
This article from AP details Medical Mutual's lawsuit to clarify which government body has the final regulatory say. Special kudos to MMO and Mary Taylor for going the extra step for these Ohio residents. http://www.ajc.com/news/ap/financial-services/ohio-health-insurance-company-sues-state-feds/nTz4F/
Linda Ellis January 21, 2013 at 11:27 PM
Yes, this is good news. Let's hope it sets an example should this situation arise in the future. Fortunately, there is less than a year to go at this point with the high risk pools created under the ACA. They will sunset on January 1, 2014 and the exchanges will replace them where situations like this will no longer arise.
Linda Ellis January 21, 2013 at 11:30 PM
Thanks for the good news Dave. I can't imagine how relieved those folks are to have their health insurance re-instated for them. It was such a long hard fought battle to pass the ACA, and the law has withstood many challenges since that time for this type of problem to happen. Hopefully, there won't be any more like it this year.


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