Others with Fraud by marketplace insurance?? Grounds for legal action?
This is a long read, but I need HELP! If the marketplace has wronged you/your family, or if you have experience with the legalities of this issue, please read and comment with advice.
The Health Insurance Marketplace has caused me pain and suffering as well as interfered with my undergraduate education. I have reached out to a few law offices asking for assistance and advisement on restitution, but no one has been able to offer any advice on this issue. I had to reschedule medical procedures/diagnostics that I’d been waiting months to have, cancel physical therapy and chiropractic treatments, and cancel mental health treatments. The distress of loosing access to medical treatments and my daily medications caused me to fail one of my summer courses as well as poor performance in others. The following is my story:
This year I had to get insurance through the marketplace because I am a full-time student with only part-time jobs. When I first applied, I was enrolled fraudulently into an insurance plan. I called to cancel the plan, and I was able to get that taken care of in January. I chose my ideal plan and enrolled. In March, I was re-enrolled in the same plan from January by additional fraudulent activity. I called to cancel the fraudulent plan a second time, and I clearly stated which plan I wanted and which was fraud. In June, my primary insurance plan was incorrectly cancelled, despite my timely payment of the premium. I called and spoke with a supervisor that said she would have the issue handled through an escalation to a caseworker. I was told that urgent claims (bc I was having to go without proper medical care) take about 2 weeks but others can be 30-45 days. My case was supposed to be labeled urgent per the supervisor.
After the case was submitted, I called every 3-4 days for an update, but I was only told that a caseworker would call when they have reviewed my case. One and a half months had passed, when I called again to get an update on the status of my case; to my surprise, I was told the case had been settled and that the plans were both cancelled due to fraudulent activity and enrollment. I went through the process of creating an escalation for a second time with this employee, and he advised me that a caseworker would call when the case is processed for my retroactive reinstatement of coverage.
I was not contacted by the marketplace AT ALL to discuss this issue, but I received a new bill from my insurance company., which was my only notice that I had access to health insurance, again. I suffer from chronic illness, and I need my daily medications to function and stay healthy. Please, please, tell me who I can go to for help! I just want there to be some type of restitution for the losses and pain and suffering that these mistakes have caused.
Female, 27, North Carolina