The health insurance blues, Part II

In the first installment of this two-part series on our experience dealing with health insurance, I discussed my son’s coverage (or lack of) in an emergency situation following his birth. This second part will discuss obtaining normal coverage…or, more accurately, the near impossibility of getting normal coverage in a timely manner.

Emergency situations, by their nature, are going to be wrought with miscommunication and tons of red tape, so the difficulties we had in managing the coverage pitfalls after my son’s birth, though infuriating, were almost understandable. What isn’t understandable is the inability to get proper insurance for baby in the first year of his life at a time when obtaining health insurance is supposed to be easier than ever.

My son was born on November 15, 2016, but didn’t receive health coverage until December of 2017, only two weeks before qualifying for his 2018 insurance.

Here’s what happened.

When my wife and I attempted to enroll our family in 2017’s coverage through the Marketplace, my wife and I both qualified for coverage starting January 1 of 2017. However, my son’s application was passed off to the Illinois Department of Human Services (IDES) for review because my projected income for 2017 was supposedly low enough to warrant possible state aid.

This came as a shock. I’m not rich, but I’m not poor, either, and I was under the impression that state aid was for families near or below the poverty line. I’m nowhere near it, and I suspected that after the review process, this would be seen, and IDES would bounce my son’s application back to the Marketplace for coverage.

The review process is supposed to take up to forty-five days, during which, however, the applicant (in this case, my son), remains uninsured, with the idea being that were medical care required during this waiting period, the patient would be reimbursed by either the state or insurance company once the review process is complete and it’s decided who’s covering him.

That, of course, is in a perfect world, and seeing that medical bills can easily exceed mortgages, reimbursement isn’t a trustworthy word.

Forty-five days passed without a word from IDES and when I called to inquire about the status of his application, I was told there was a backup but was assured his application was in the review process and a decision should be made in a couple weeks.

A couple weeks passed and nothing. I called back, was informed about the backup again, and told, again, that verdict on his application would be decided in a few weeks.

This back and forth continued until June (over six months since his application was first filed), when I received a notice in the mail, stating that my son qualified for state aid. Honestly, this blew my mind, and I didn’t trust it. In my opinion, my annual income is way too high for anyone in a family of three to qualify for state aid. When I called to inquire about this and to ask some questions about how everything worked, two things happened.

First, I was informed that the qualifying parameters for children are very different than what they are for adults, so what might seem like a comfortable living to the parents may not be according to the state. The representative then told me that she’d seen families making $7K a month qualify (and she didn’t mean families making $7K a month with ten kids).

Now, before I move on to the second thing, I need to explain my employment with the Sun Day.

I’ll be clear and simple. I own White Silo Media, which is the parent company for the Sun Day. When I started the paper in 2010, I did so as a sole proprietor because I wasn’t sure if the Sun Day would succeed, so I didn’t want to take on the expense of an incorporation. Two years later, when it became clear to me the Sun Day was doing well, I incorporated White Silo Media as an S-Corp, or Small Corporation. My public position with the paper that you see in my byline is always Executive Editor, but my legal position with WSM is President. And although I’m the paper’s owner, I’m a W-2 employee of the paper with an annual salary. Anyone reading this who is/was a business owner probably understands this very common setup very well.

While inquiring into the management of my son’s state aid approval, the topic of my employment arose. Previously, when I filled out the initial application paperwork with the state, it was determined I was self-employed, but during this conversation, after explaining my employment, the IDES rep told me that I wouldn’t be considered self-employed but employed and my son’s approval was temporarily revoked for further review because there are different qualifying parameters if you’re employed or self-employed. Now, this doesn’t make much sense to me because in our country, and in most of the world, for that matter, you are either employed or unemployed. That’s it. And at the end of the year when you file your taxes, once all your earnings are ran through the lines of your return, you’re left with one number and that’s what you’re taxed on, no matter how you went about getting to that number. Take me, for instance. My primary annual earnings come as a W-2 employee of White Silo Media. But I also make some money from occasional freelance jobs, fiction sales, and a couple hundred bucks a month from a condo rental I own. All this income filters down into my

Adjusted Gross Income, and to me, at least, that should be the number the state works with when determining if you need medical state aid. It shouldn’t matter how you got there.

Apparently my terms of employment started a whole process of review with IDES in determining how to treat my son’s application due to the fact that I was employed by a company that I own. It came across like they’d never encountered such a thing before, when I’m sure they have thousands of applicants just like me come through every year.

This process took another month to finalize, and eventually, it was determined that I’m “Above Income” for state aid, which I said from the very beginning.

This brings us to July of 2017. It was during one of the many phone calls I had with IDES that I was informed my son’s application was rejected and would be passed back to the Marketplace. I was also informed I would receive an official letter in two weeks, a letter I would ABSOLUTELY need for the Marketplace in order to get them to open a special enrollment period for my son. I was specifically told by both IDES and Marketplace representatives that without this letter, a special enrollment period was unattainable.

According to the Marketplace, once an applicant has been denied for state aid, you have sixty days from the date of rejection to apply for a special enrollment. With the IDES notice coming in two weeks, I still had plenty of time to enroll my son. This would put us at mid-July.

But I didn’t receive the letter until late September, putting me past the sixty-day grace period.

During this time, I did call IDES numerous times and was consistently apologized to an promised the letter was being sent out “that day.”

When I finally had the letter, I tried enrolling my son through the Marketplace again but was declined for coverage because it was past the sixty days. After explaining that it took more than sixty days to receive the letter, I was then put into an appeal process with the Marketplace in hopes to get a special enrollment, which was finally granted in early November, qualifying my son for a whopping one month of insurance (December) in 2017 (with the option, of course, to pay retroactively for all the months he was uninsured), one year after he was born, technically about thirteen months.

Thirteen months. It took thirteen months for my son, a baby, to get insurance. Do I need to say more than that?

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