All Things Insurance

Hello all,

I’m looking for some advice on how to resolve an ongoing dispute with our insurance company. Last year (2019), my wife and I started the year with a health plan and immediately met her individual deductible in January (due to her medication costs). Then, in July, the insurance company changed our account number, effectively restarting the deductible. This has caused hours of work for us (which is still continuing today) trying to get all the hospitals to bill the new account number (just for giggles, the insurance company switched us back to the old number at the beginning of 2020). We again met the deductible in July for the new account (a second time) for my wife due to her medication, but there is one hospital that is still billing us because they submitted the claim before the deductible was met (for the second time!).

I’ve called the hospital and they have filed the claim to the corrected account number. I called the insurance company and they claimed that the amount owed is correct because it did not exceed the deductible. However, the only reason it didn’t go over the deductible is because they restarted our account in the middle of the year with a new number and never transferred the (already met) deductible balance over.

We’ve been sent to collections once over another bill that I was able to get resolved, and we’re about to be sent to collections again on this latest bill.

I’m tired and frustrated for still having to deal with this. We filed a grievance with the insurance company which of course they “investigated” and then round filed. What am I supposed to do to get the insurance company to correct their screw up?

Edit:

My insurance is through the marketplace, not through an employer.

I’m positive that my policies run Jan – Dec. This is how it’s reported on statements, renewal notices, and actual renewal. Policy is through health insurance marketplace. I’ve been with this company before, and this is the first time it’s happened.

As to why the policy was changed mid year, I don’t know! All I can make out is that the marketplace reported a different account number than the insurance company had and made insurance change it mid year. Why this wasn’t done at the beginning of the year or as a transfer, I have no idea.

Best I can tell (the grievance case manager I’ve been speaking with couldn’t say definitively, but accepted my theory sounded plausible), my wife was enrolled in 2018, but I was not. We both enrolled in 2019, with myself as the primary, and they (insurance company) issued a new number for me being primary. However, since it was the same plan my wife was on the previous year (2018), the marketplace kept her account number from 2018. This resulted in a mismatch in records, and the marketplace forced insurance company to change their accounts to match. Ok, that’s understandable, but they failed to transfer over claims and records of deductible amount which has resulted in the problem.

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