Health insurance woes (not mine), part 2

[Dreamstalker]

I posted in here awhile ago about my mom's attempts to get health insurance. In this great state there is a dedicated insurance plan ostensibly to cover those poor saps who can't afford private insurance (despite what Mitt The Twit claims, it doesn't quite function the way it needs to).

I recently got off MassHealth and am on an actual health plan now; it's still no cost to me (aside from manageable copays) with some decent benefits.

Well, mom got a letter from MassHealth yesterday. Apparently, she's not eligible for any of the free plans because according to them, her income is over 400% of the federal poverty limit...erm, NO.

I'm trying to ferret out how they came to that calculation, but I do know that MH does not account for ANY expenses (housing. food, etc). That's by their own admission, and is--frankly--a fucked-up way of doing it.

I want her to get her ducks in a row and contact the local news; they have a very good investigative reporter who loves uncovering this kind of stuff (usually, once the media gets their teeth in a state entity doing something not-kosher it gets fixed).

[Slayer]

Hopefully it's just an input error someone made along the way. Good luck for a speedy fix.

As for expenses, does your mom have special housing?

I think a lot of insurance companies ignore expenses and focus on salary. Well, from what I notice through work. Unless the individual requires assistance, of course. I see expenses and explanations on why more help is needed when people apply for copay. I'm in Canada though, so that might be a factor, too.

[Dreamstalker]

No particularly special housing; we live in a managed apartment complex. We've applied for housing assistance, but apart from a years-long waiting list we've been told that they can't help us because our apartment is 'above market value' for a two-bedroom in this town (and yet they won't say where in town these mythical 2BR for under $2K/month are).

We think the reason I was originally able to get approved for MassHealth so quickly (and stay in the system long enough to get bumped up to a normal insurance plan) is because my application was originally submitted through a state disability-assistance agency and those applicants are probably given priority and must be given at least basic coverage. Technically mom is 'disabled' (fibromyalgia, although it doesn't prevent her from working a lot of the time) so I don't know if she could claim that to at least get in the system.

[Slayer]

Ah, I understand. It's definitely worth a shot. Worse they can say is that she can't apply through there. They might even have some tips on what to do if she can't.

2k/mo whoa. You can tell I live just outside of the major city lol. If you had copies of appartment listings to prove that 2k is normal, say for a couple of weeks, would they need to finally factor that in? I'd hope so.

[Dreamstalker]

The company that manages our building does have a property where we could get a 2BR for $1800/month, but our great public transit system eliminated the one bus line that comes into this area from there so I would pretty much have no way to get to/from work.

Mom can appeal the Masshealth decision and plans to do so (I'll help with any and all proof that she needs to prepare); she might also contact a few of our local elected officials who love to hear about that system doing bad things.

[morgana]

2BR for under $2K/month.

I pay about a third of that, including water and basic cable, for a 2bd w fireplace, patio and washer/dryer in the unit. I ain't NEVER moving to Boston!

[Dreamstalker]

I have an update of sorts. Mom went to our clinic to see one of the staff who helps people out with insurance...yes, the center has a number of people whose sole job it is to help clients navigate the madness that is MassHealth.

Long convoluted story short, the state fucked up, big time (of course they're denying any responsibility). They claim that mom has a business "[mom]'s Cleaning Service" and has had it since 2001 O_o Mom has never cleaned houses in her life (well, not for other people). This information was apparently under her social security number.

At first there was a suspicion of identity theft; but that would have come up on tax returns, when mom applied for unemployment and also when she went through the bankruptcy (both in 2009). Which it never did. I suspect that someone at MH screwed up entering info; whether accidentally (not good for them) or intentionally (really not good for them) we have no idea. Now she has to get a notarized letter from her accountant saying she doesn't have a business.

I did find online listings for two people with the same first name that are self-employed as housecleaners in Boston, and the listed revenue roughly matches what MassHealth thinks mom's monthly income was...although the SSN matter still puzzles both of us (that to me points to a mistake; if that is what happened, mom thinks she knows the name of the employee that likely did it).

[Andara Bledin]

What it tells me is that someone got lazy, saw that the first part of the name matched, that some other information internal to them matched, and they just went with the first person that came up rather than actually making certain that all of the data was identical before running things through.

^-.-^

[Dreamstalker]

Probably. The screwup had to have happened fairly recently, between May of 2011 (that's the last time mom sent in pay stubs from her part-time job at the church) and now. We'll see what happens after she gets that letter; I for one am extremely curious what errors were made and how.

[Dreamstalker]

Another update, a good one this time.

Mom contacted one of our local senators, who then contacted MassHealth on her behalf, and that's when things got done.

Not two days later, she got a letter from them saying that she was eligible for Commonwealth Care--a notch or two up from MassHealth in that even Commonwealth Care's no-cost plans actually have useful coverage. As expected, MH didn't actually admit that they even fucked up in the first place...we were kinda hoping that they would, as then we could let the I-Team have some fun (they've been doing stories for years on the need for better oversight in the state system, and a mistake of this magnitude would prove their point).

She's now with the same insurance provider I am; her premium is about $90/month (even though our reportable income is roughly the same), but at least she has something. I'm still pushing her to contact Social Security just in case there was something fishy going on.

[Cia]

I just wonder about the agencies in Massachusetts - don't they ever talk to each other? The health insurance division sent me a letter requesting payrates and insurance info on an employee. A former employee. Sent back a note with the date he quit highlighted. A month later child support sent a letter requesting the same info. -bangs head- Then we get a form letter requesting us to update our contact info. Called about that one and the lady on the end of the line said they sent that letter out to every employer in the country - I'm thinking that's a lot of stamps. Explains why the state is called Taxachusetts.

[Dreamstalker]

Earlier last year, mom got harassed by the state claiming that she owed nearly $3K in 'use tax' for a business she owned (now I wonder if these two were connected). Nobody that she talked to had any paperwork on this alleged business (no business name, no dates, they couldn't even tell her what she was supposed to have 'imported'), she was supposed to pay up because somebody in the tax office said so. Finally I think her accountant (who thought it was bull from the outset) made them go away.

[fma_fanatic]

Just curious, and I'm sure it's been done, but has she pulled her credit reports? If she's being told she has a cleaning business when she doesn't, then what else might be hiding?