She Persevered! An Enrollment Story by Meryl Rice
On Feb. 1, l dealt with the case of a lady I’d been working with since mid-January. She was diagnosed with cancer, had no insurance. Her only income from social security and housekeeping for a relative. She applied for Tenncare last fall but was denied (wrong kind of cancer). She called the ACA Marketplace on the last day (12-15), secured her place in line without knowing it, but said she never got through to anybody.
In January, her doctor referred her to me. She said she hadn’t been thinking clearly since her treatments and had been forgetting a lot of things. She said Tenncare denied her. My system showed that she had a marketplace application pending— so we called the marketplace rather than my creating a new account or document. The assister asked the routine questions and then asked when she was denied Tenncare. She couldn’t remember, but she thought it was October. We arbitrarily picked the 16th. Her application was completed and she was deemed eligible for tax credits but she had to provide proof of denial before she could pick a plan. She was not where she could get the Tenncare denial letter so she said she would look for it when she was home.
The following day she called me. She only found the 2nd page of the letter and there was no date on it. No problem. We got online, created a Tenncare account, and found a copy of the letter. Alas, it was dated September 3–outside the 60 day window for a special enrollment period. A call to Tenncare to ask for a more recent denial, but the gentleman we spoke to said he’d have to do another app which would generate another denial—but it would take 7-10 days. We had no choice. However, I checked her Tenncare account 5 days later and the denial was already there. I downloaded it and called my consumer with the good news.
As I was talking to her, however, I noticed that the surname on the letter was not the same. I asked her about it. She told me that she got Tenncare 25+ years ago when she had small children. She had since divorced. I wrote an explanation on the letter and uploaded it to the marketplace. Several days later, the Marketplace sent a notice that the document was not accepted because the names were not the same. Good grief!!
So we call Tenncare again—please update the name. Ok they said, but it will take another 7-10 days. We agreed. We had no choice. However, I uploaded the letter that I had written the explanation on, again (to the marketplace).
Yesterday as I was on the computer, I clicked on her file and lo and behold, her letter had been Approved! I texted her immediately and told her to call to make the binder payment. The insurance had an effective date of 2-1 (we had been working on this for 2 weeks.) My phone rang almost immediately. I processed her payment and set her up for auto-pay. Her payment is $40 a month with a 0 deductible, $1400 max out of pocket.
Before we said goodbye, she said “I have one more question”. I waited. Silence on the other end. I said, “Yes? You had a question?” She started to cry. “I’m sorry—will this take care of everything I need? I’m so scared.” I told her the doctors she had been seeing and the hospital were in network, and she was good. She was still crying.. and she said, “I can’t thank you enough for all you have done to help me.” Now I’m crying telling this story.
Going the extra mile and being able to get someone the help they need is so rewarding. It’s why I continue to do this work.
