Kafkaesque Bureaucratic Health Care Nightmare - HELP!

(Ed note: Sorry it's been a while. I've been quite busy with the new job. I need a place to publish and tweet to the anguish that this 'Kafkaesque Bureaucratic Health Care Nightmare' has become.)

Courtney M. Kelly

614 D St. NE Apt. B

Washington DC 20002

(917) 405-5829

courtneymkelly@yahoo.com

December 19, 2014

United Healthcare

PO Box 30555

Salt Lake City UT 84130-0555

To whom it may concern:

My name is Courtney Marie Kelly (DOB June 2, 1976).  My member ID is XXXXXXXXX. My Health Plan is (XXXXX) XXX-XXXXX-XX. My group number is XXXXXX.

I am writing to formally protest that my medical claims are being rejected for OI (other insurance).  I have had health insurance only from UnitedHealthcare from July 1 2014-present. I have attempted to clarify this with my previous health insurance provider, Kaiser Permanente on multiple occasions, as I will detail below.

I received health insurance from Kaiser Permanente (KP) purchased through DC Health Link, the Washington DC Health Insurance Marketplace. I was insured by KP from February 1, 2014 through June 30, 2014.

I started a new (full time) job on May 12, 2014 with GlobalGiving.org, and this employer provides health insurance (through United Healthcare). My insurance through United Healthcare became effective June 11, 2014.

I called Kaiser Permanente (KP) (877 608 0077) on June 24, 2014 to cancel my health coverage. I was informed by the KP representative (Adelpho) that KP could not cancel my health insurance because it was purchased through the exchange. On that same morning (6/24/14) I called the DC Health Link (855 532 5465 & spoke with agent Keisha at 9:24 AM, call record: S-165-414-478) and cancelled my health insurance, completing a disenroll order effective June 30, 2014. (I have paid all my monthly premiums to KP through June 2014.)

On August 13, 2014 I called KP again to confirm the disenroll order had been processed. I spoke with agents Arielle and Tiffany. I was told my coverage was still active in the system. I was repeatedly told there was no escalation point and no one I could speak with because I came through the exchange. I asked that they at least record my attempts to cancel in the call record and they refused saying that they could have nothing to do with an account that was purchased from the exchange. On that same day, I spoke with a DC Health Link agent again (Keisha, call record #S-167-749-611). She assured me the June 30th 2014 suspension had been processed and noted in my record that I contacted the carrier.

On September 4, 2014 I again called KP to confirm the disenroll order had been processed. Again, I was told I was still active in KPs system and no one could complete a disenroll action because I came through the exchange. I requested any kind of escalation or assistance and was told that none was available. Again, on that same day I called DC Health Link and spoke with Nyisha (call record: S-168-688-788). She confirmed the disenroll process was complete and had been “acknowledged by Kaiser Permanente on August 19, 2014”. At this point, I was satisfied the matter was finally resolved because DC Health Link had a record of Kaiser Permanente acknowledging the disenroll order.

In November and December I began to see my health care claims denied by my health insurance provider United Healthcare (UHC). These claims were denied for “OI, Other Insurance”. I called UHC several times in November and December to have these claims processed and explained that I had no other insurance and I had disenrolled from Kaiser Permanente in June of 2014. On December 15th 2014, Sharon G, the agent from United Healthcare explained to me via chat session that at this point to have these health care claims processed, I need a certificate of creditable coverage from Kaiser Permanente to show the start and end dates of my coverage.

On December 16th, 2014 I called the DC Health Link again (and spoke with Angela at 9:19 AM) who once again confirmed that my disenroll statement had been acknowledged on August 19, 2014 by Kaiser Permanente. Angela informed me that she would resubmit the termination request, confirming this was back-dated to June 30, 2014. I requested a physical letter or fax confirming this request and was told by Angela that this was not possible, that DC Health Link could not provide this per HIPPA requirements.

Also on the morning on December 16, 2014 I again called Kaiser Permanente (301 468 6000) and spoke with agent Seisey who again told me that I was active in the KP system and that there was nothing she could do to help me. She transferred me to Denise in ‘KCC internal department’ and both Denise and Seise said ‘As soon as I head DC Health Link I can’t do anything.”

So  I am trapped between these three health care systems. Please assist me. I am writing to request that all my medical care claims that have been denied for ‘OI’ be resubmitted. I have not paid any KP monthly premiums beyond June of 2014. From July 2014 to the present, UnitedHealthcare has been my only health insurance provider and it is unfair and unacceptable that I am being punished and charged for health care services that are covered under my current UHC plan because  Kaiser Permanente is too incompetent to process my dis-enrollment. As my health insurance provider, I trust you to treat me fairly and not punish or charge me for the unfair business practices of Kaiser Permanente.

Rest assured that I have sent a similar letter (and fax) seeking redress from  Kaiser Permanente, and to DC Health Link.  However, the resolution of this matter is entirely in your hands, as you are my only health insurance provider and should process my claims as such.

If you have any questions or concerns with this matter please call me at 917.405.5829 or email me directly at courtneymkelly@yahoo.com or postal mail it to me at:

Courtney M. Kelly

614 D St. NE Apt. B

Washington DC 20002

Thank you for your prompt attention to this matter. I will fax, mail and blog post this letter in an effort to resolve this matter.

Sincerely,

Courtney M. Kelly