Insurance Agent Fraud – Story
My families health Insurance thru HEALTHCARE MARKETPLACE: BC/BS of NC has been Fraudulently CANCELLED by the Licensed Independent Agent that originally set it up in May of 2014.
Background information:
I contacted a recommended Authorized Licensed Agent in May of 2014 to see if my family would qualify for insurance thru the Healthcare Marketplace. We did and with his assistance we began our coverage with a subsidy in June of 2014. In October of 2014 I received a flyer from BC/BS with that same agent’s information stamped on it discussing renewal for 2015. I went online I determined that I could do our renewal myself and did for 2015. Everything was fine with our 2015 coverage and we were receiving a subsidy in the amount of 702.00. Our monthly premium was 78.00. Which was paid monthly on time and never late.
On March 13th 2015 I received a call from the agent asking me if I wanted to renew our coverage. I explained to him that I had completed the renewal online. He did not seem to like that answer at the time but I did not think anything else about it.
**Please keep in mind that was the first time I had spoken to the agent on the phone or in any other way since our original enrollment back in May/June 2014.**
Incident:
On March 30th, I went to my pharmacy to pick up my Blood pressure medicine and was told that my insurance had been cancelled. I had just paid the monthly premium online on the 21st of March. I went home and called BC/BS. They directed me to call the Healthcare Marketplace at 800.318.2596. I did and finally spoke with a supervisor named Selena. She went over everything and I mentioned the call from the agent on the 13th. After looking over all records, she explained that the system showed that I had called on March 11th 2015 at 9:32 am and cancelled my coverage. I did NOT call on March 11th and cancel my coverage. I pulled up my call log from my only phone and it had NO calls to Healthcare Marketplace for that day or even at all! She then stated that on that same day someone had tried to do a “Life Status Change” on our account. She determined (the agent) had probably gone into the system and canceled our policy ((since he is the ONLY person that would have policy number and all of our demographics)) it appeared he had then gone back in to attempt the “Life Status change” so that he could renew our policy but not before adding his VPN number to get credit. However, she said he must not have realized the open enrollment was over so he could therefore not renew the policy. She stated that is why is out of the blue he called us on the 13th ( just 2 days later) trying to get us to enroll thru him. If I had not tried to get my prescription filled I would not even know this had happened.
Result:
As a result of this, we are now without Health Insurance, even though the month of April is paid in full. They are renewing the policy effective May 1st 2015. . As of right now, our new subsidy is 452.00 making our new premium 402.00 per month verses our 78.00 prior to this nightmare. For the 2nd time our case is being sent to the Escalation/Resolution division to have our insurance reinstated and retroactive. Currently they are now saying that could take up to 30 days. During which time our subsidy has been cut in half due to doing a 2nd renewal Per (– Supervisor with Healthcare Marketplace) We have also been unable to go to the Doctor for needed care due to being uninsured. Throughout all of this they are not guaranteeing that our policy will be retroactive or that our subsidy will go back to 702.00. I just cannot believe that a Licensed agent would do something so unethical over greed and thus my family is having to pay such a price for it. We have had to pay out of pocket for medications that are costing hundreds. We do not have that kind of money and that is why we sought health care thru the marketplace to begin with.
PLEASE PLEASE HELP US., WE are absolutely overwhelmed at the violation that has taken place against us. This person pretended to be me and used my personal HIPPA protected information to cancel our insurance just so he could renew it and get credit. I have not called this person as badly as I have wanted to because I do not want to give him a chance to hide any evidence of his crime. I will guarantee if he did this to us, there are others!
Please help us. We did everything we were supposed to and yet we are now uninsured and looking at a new policy we cannot afford.
I , Catherine N, did NOT call HEALTHCARE MARKETPLACE or BC/BS of NC and request our Health Insurance be canceled. This person has committed a crime by pretending to be me and use my private information for personal gain.
Thank you for ANY help that you can provide my family
Cathy
Author: Thomas DeMichele
Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...
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Robin
We have a similar story and have gotten little resolved. Have you made progress? A criminal prosecution and/or your insurance fixed?
Terry
I was able to get the health insurance enrollment dates corrected. I got the agent off the dental policy. But getting her off the health policy is another issue. I have received two different types of answers. One, that she is still my agent and two, that she has been removed as an agent but is just still listed on the record and she will not receive commission. I actually am not sure whether the health insurance company is telling me the truth. I know they definitely did not want to remove her from the policy even when they were told what she did and even when the marketplace sent a new enrollment form with no agent listed. The way the marketplace corrected the issue was to update the application with the correct enrollment dates and a blank where the agent would have been listed. It was then my responsibility to contact the insurance companies and make sure they had the correct enrollment dates. This was very difficult. But because I did have health insurance, an appeal for special enrollment was denied. If I had had no access to health insurance, they would have gotten involved. I will follow up by asking for a tape of the call through the Freedom of Information Act (FOIA) of the CMS, with the State Board of insurance, with the Federal Trade Commission and the ethical appeal with the insurance company itself unless I am ever sure that this agent received no commission. I would rather not follow up like this as it puts me more at risk but who knows whether the insurance company is paying her for this or not. I do believe if one follows through there is a chance that activity like this by agent can result in that agent losing their license
Terry
Follow up: I now have proof that the agent called the health insurance marketplace saying she was me. I sent a request to the CMS FOIA Division to receive a transcript or audio of the call the agent made. According to the transcript, the agent’s phone number is the incoming number to the health insurance marketplace and she clearly verifies my identity using my information and, of course, asks to have the agents NPN number on the policy.
Terry
The same type of fraud was perpetrated on me in that an insurance agent changed my enrollment information in order to get her NPN number onto the policy. It took me 3 months of hard work to get her off and resolve enrollment. Now I have to decide whether to get the tape of her call and see what she said and maybe take it further. If you’re still listening, what was your end result?
ObamaCareFacts.comThe Author
Wow, that is one scary story! Thank you for bringing it to our attention, hopefully your story will provide direction for anyone else facing a similar situation. Please keep us updated.