No Title
SUMMARY:
A. I enrolled with the ACA program Oct. 26, 2023 by calling a phone number from an ad on Youtube. I enrolled under the express understanding that I was enrolling for the year 2024. I never expected to be enrolled anytime in 2023 or expect any benefits or expect to receive any bills. I fully expected that my membership and my benefits would begin in 2024. Further I had no understanding or knowledge of how the market place worked. All I knew is the person who enrolled me got me both qualified and approved with the market place AND slotted me into an Insurance Plan. I didn't understand the difference at the time. I though they were the same thing. We talked quite a bit about the insurance plan because I quadruple checked with him that I would be paying ZERO out of pocket for premium payments and he confirmed this to be the case. My paying zero out of pocket was the single determining factor for my answering the qualifying questions and enrolling. I believe at the time he also confirmed that his company (I didn't know the name at the time) would be auto-renewing my enrollment with the market place/insurance plan (remember, I believe these are one and the same thing). I fairly certain I agree, because I was in fact later both qualified with the market place and my insurance plan were both renewed on or around
Dec. 15, 2023 as best as I can determine from the evidence I've gathered in my emails which I never even saw until Dec. 26, 2023 which I will now explain as to why I never saw these emails. The reason is, I was never told to look for any emails. And why would I? As far as I'm concerned the entire process is over and down with. I was never asked to confirm my enrollment through email or check any emails for any information. It was only later on Dec. 26, 2023 did I start my own investigation as to why I was getting billed in December that I saw any emails. The four emails I got on Oct. 26, 2023 were essentially irrelevant anyway and none asked for a confirmation. All emails and links to them are listed below for reference. At this point the process on my end is over. At this point I believe I will be waiting for material telling me what to do for 2024.
B. I can't say for sure the exact dates that the bill from Ambetter arrived in the mail at my house (this is also the first time I learn what company I guess is running my insurance plan) or when my Ambetter insurance card arrived. But they both came in November. The bill is dated Nov. 7, 2023 and it confirmed that I did indeed owe ZERO out of pocket premium payments. It also showed that the government was paying 683.62. This fact is important because the next bill in December 2023 states that the government is paying 707.90. That change signaled to be in my brain, that something significantly changed without my knowledge or my permission. Now I had no clue what changed or why. Remember, I barely understand what is going on. I have no experience with this at all. What I know, is that medical insurance is always a nightmare to deal with and when I got the bill for December I regretted getting involved. Anyway, back to the Nov. 7, 2023 bill. When I looked at that zero out of pocket premium payment I was actually pleasantly surprised. I really didn't hold much hope for a smooth process. But there it was. I felt relieved. Like I was actually going to get some healthcare without the nightmare. As far as I understood the process at this point I had nothing more to do. I did question to myself why was I getting a bill in November for December since I was sure that my coverage didn't start until January 2024. Considering that the widely disseminated enrollment time was from Nov. 1 , 2023 to Dec. 15, 2023. How could I believe the enrollment time was for any period other than for 2024? Why would I question this and more, why would I question any of the process? I still don't know what is going on for sure. I don't even know what my next step is. I still have to figure that out. I vaguely remember talking to the man that enrolled me over the phone or somebody else that I had to log onto a website. But I cannot remember if they told me it was Ambetter at the time. But it really doesn't matter. I have the bill now and I know I have to at some point find a doctor and I'm smart enough to know I have to go to Ambetter's site to do this. But remember I believe I can't do this until January 2024 because I believe that is the time I'm enrolled for. So this November bill is some kind of anomaly that I can't explain. But it says ZERO out of pocket payment and that is all I care about.
C. Sometime later in November I received in the mail my Ambetter membership card. I only glanced at it and left it in the envelope and added it to the Ambetter bill on my dresser. I never looked at it again until I prepared the links on this website for Mr. Kellogg on Jan. 8, 2024. And that was when I confirmed what insurance plan I was actually in because it doesn't say on the bill. However the card did. That was when I figured out I was in the Standard Silver VALUE plan. That was the plan I enrolled in on Oct. 26, 2023. That was the plan that had a ZERO out of pocket premium payment. That was the plan I was auto-renewed in without having to answer anymore qualifying questions with the market place or have to manually select myself. My enrollment in the market place, my enrollment in the insurance plan and the auto-renewal of both were performed by Ambetter and or its partnered marketing company (TrueCoverage). My hands were completely clean of all of this. As as best as I can remember.
OPEN ENROLLMENT PERIOD for 2023 and 2024:
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2023
1. https://files.catbox.moe/3typr3.png
2. https://www.cms.gov/newsroom/fact-sheets/marketplace-2023-open-enrollment-period-report-final-national-snapshot
3. https://files.catbox.moe/arew5f.png
4. https://www.verywellhealth.com/aca-open-enrollment-2023-6825487
2024
5. https://files.catbox.moe/rkvlzo.png
6. https://www.cms.gov/newsroom/fact-sheets/marketplace-plan-year-2024-open-enrollment-fact-sheet
A. Network Type
B. Metal Level
C. Inclusion of Dental and Vision
D. Service Area
As far as I can tell, the two following plans that I will be talking about, are only cosmetically different and have no foundational difference other than the one that cost me money, is more restrictive. How does that make sense? To me, this seems contrived.
PLANS:
A person qualifies for a DOLLAR AMOUNT under the ACA.
They do not qualify for an insurance plan. Though the following plans have the appearance of different attributes, it is NOT the plan that matters, it is the dollar amount covering the plan that matters. Rather, both plans are 'engineered' to align with the dollar amount approved in the EXACT SAME way. One just charges the customer for no extra benefit and the other one doesn't.
The company sets you up to believe you have a ZERO PRICE PREMIUM PLAN then switches it to a PRICED PREMIUM PLAN. All the while telling you before hand that they will auto-renew you, while having you believe you are ALREADY enrolled for 2024 because you joined during the 2024 Enrollment Drive.....or so you were led to believe. The truth is, they somehow got me enrolled BEFORE the official 2024 Enrollment Drive, duped me, then planted a trail of mixed-message communications for plausible deniability. Then I called them (Dec. 26, 2023), and they tell me to pay and they lie about "law changes", then tell me to cancel. I refused to cancel and I said fix it. To this day I still have no idea for sure what plan I'm in.
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Standard Silver VALUE (plan) - Enrolled page
Provider Network: Value
Network: HMO
Premium: $5.90/month
7. https://files.catbox.moe/tm6zsg.png
(See Red Box - KEY)
Standard Silver (plan) - Actual page???
Provider Network (Metal): Bronze | Silver | Gold
Network: EPO
Premium: $0/month
8. https://files.catbox.moe/nu2osx.png
A DISTINCTION WITHOUT A DIFFERENCE:
The Customer is paying $5.90/month for the exact same plan but with RESTRICTIONS. All Covered Services and Out-Of-Pocket Expenses are the same.
My argument is that the Standard Silver VALUE (plan) should not even exist. But customers are being pushed into it without knowing it. Just like I was.
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Plans Shopping Page:
9. https://files.catbox.moe/x9ohbj.png
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Covered Services - Standard Silver - $0/month
10. https://files.catbox.moe/my41l4.png
Covered Services - Standard Silver VALUE - $5.90/month
11. https://files.catbox.moe/k0fld1.png
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No Restrictions - Standard Silver - $0/month
12. https://files.catbox.moe/e44lsd.png
Restrictions - Standard Silver VALUE - $5.90/month
13. https://files.catbox.moe/tqlh0o.png
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Side By Side FULL Comparison of Plans
No Restrictions - Standard Silver - $0/month
12a. https://files.catbox.moe/pojknr.png
12b. https://www.hostize.com/v/jp4HrGYCTA/standard-silver-plan-pdf
Restrictions - Standard Silver VALUE - $5.90/month
13a. https://files.catbox.moe/ddn45d.png
13b. https://www.hostize.com/v/ad6qZEpNeC/standard-silver-value-plan-pdf
SPECIAL NOTE:
Other than the Oct. 26, 2023 emails, I never saw a single email UNTIL Dec. 26, 2023 when I received my bill for December dated Dec. 6, 2023 on Dec. 26, 2023. It was then I began my own investigation. It was then I found emails telling me about renewing my enrollment which I didn't even know I had to do because I already thought I was enrolled for the 2024 Enrollment Drive. Even so, my account Enrollment Page (see Link #7) clearly states in the Red Box that if my enrollment information hasn't changed then I need DO NOTHING. Thus any responsibility on my part to watchdog AMBETTER goes out the window. There was ZERO need or responsibility on my part to RENEW or SHOP for a new plan when
1. I already thought I was enrolled in 2024 and
2. AMBETTER literally tells me I don't need to do anything if my information hasn't changed. MEANING......they already know there is NO CHANGE IN THE 2024 ACA LAW regarding QUALIFICATIONS. Thus when they told me over the phone - on Dec. 26, 2023 when I called customer service - that the reason my Plan went from a ZERO Out-of-Pocket Premium to a $5.90 Out-of-Pocket Premium was do to a change in the ACA Law, they were lying. They can't have it BOTH WAYS. They can't say "If you have no household changes" do nothing (see Link #7) and at the same time say "The law has changed making your household qualifications part of a reformulation of ACA benefits for 2024 thus YOU HAVE TO RE-APPLY". The point is moot in either case because as I stated, qualifying for the ACA benefit and making a plan selection are two very separate tasks. The first does not effect the second. But my point is, they are purposely being deceptive.
EMAILS:
14. https://files.catbox.moe/0q764e.jpg - Oct. 26, 2023
15. https://files.catbox.moe/bjyg2a.png - Oct. 26, 2023
16. https://files.catbox.moe/qefvnk.png - Oct. 26, 2023
17. https://files.catbox.moe/n84fsc.png - Oct, 26, 2023
18. https://files.catbox.moe/747j4j.png - Nov. 1, 2023
18a. https://files.catbox.moe/orjmr2.jpg -Nov. 1, 2023
I already have my enrollment card which I was led to believe WAS for the 2024 Enrollment Drive. But no....it was a sneaky enrollment in which I was led to believe my plan was a ZERO PREMIUM PLAN. This set my psychology up to trust that I was all set to go. Wrong. Also note, it says I'm in the Standard Silver VALUE (plan), which according to my Nov. 7, 2023 bills says I have ZERO Premium to pay.
19. https://files.catbox.moe/xochl5.png - Nov. 7, 2023
19a. https://files.catbox.moe/0swy4f.jpg - Nov. 7, 2023
The two above links say I'm enrolled and prove that I was paying zero dollars for my plan.
20. https://files.catbox.moe/hic5cb.png - Nov. 13, 2023
21. https://files.catbox.moe/y76lfn.png - Nov. 15, 2023
22. https://files.catbox.moe/cfi5n5.png
23. https://files.catbox.moe/b073vo.png
24. https://files.catbox.moe/9ysk54.png
25. https://files.catbox.moe/evtu2h.png
26. https://files.catbox.moe/qzba78.png
27. https://files.catbox.moe/ci4qhq.png - Dec. 4, 2023
The first time it is clarified that a warning is given about a higher premium but at the same time it is saying I will be enrolled in my current plan which I believe to have a ZERO premium.
28. https://files.catbox.moe/a040nv.png - Dec. 6, 2023
28a. https://files.catbox.moe/ymb572.jpg - Dec. 6, 2023
This bill is dated (Dec. 6) but I don't receive it until Dec. 26, 2023 because I made a note on the envelope. It arrives late but regardless It WAS ALREADY IN THE MAIL BEFORE the first email (Dec. 4) stating anything about an increase in PLAN PREMIUMS. Please tell me this this is not a contrived 'coincidence'. I'm warned of a price increase a day and a half before I get the price increase that was already in the mail. Are they even trying? Remember, I still have until DECEMBER 15th to enroll for 2024 but they have already AUTO-RENEWED ME and bumped me up to an out-of-pocket plan BEFORE even noticing me that this was about to happen. THIS IS A BAIT AND SWITCH.....PERIOD.
28b. https://files.catbox.moe/m8jn75.jpg - Dec. 15, 2023 - FRONT SIDE
28c. https://files.catbox.moe/913sz3.jpg - Dec. 15, 20233 - BACK SIDE
As can be seen from this letter (Dec. 15) dated AFTER the date for the December bill (Dec. 6), AMBETTER essentially fabricates a myth about higher premium rates and encourages me to re-enroll into the Standard Silver VALUE (plan) which they have already auto-renewed me and billed me for as stated prior (Dec. 6). It is as if they purposely locked me into a bait and switch pushing me past the deadline
(Dec. 15) thus making it impossible to use their online site to correct their malfeasance. A malfeasance I didn't even know was occurring because why would I be re-enrolling for the 2024 Enrollment Drive when that is exactly what I thought I was already enrolled in. This isn't a "comedy of errors". This is planned. And I know it was planned because of their defiance over the phone. Making me wait. Making me speak to somebody higher, then telling me "oh the law changed". Yeah it changed. It issued MORE money for the ACA do to INFLATION. But from what I can tell, that is all that changed. All the qualification questions and answers seemed upon examination to be the exact same as what transpired over the phone when I was enrolled by TrueCoverage on behalf of AMBETTER on Oct. 26, 2023 for what I led to believe WAS for the 2024 Enrollment Drive.
Further, looking at the BACK SIDE of the letter (an maybe I'm wrong here) but it seems to clearly state that my premium "change" (rather stayed the same) to ZERO. However the Maximum Out-Of-Pocket apparently DID CHANGE (Implying this is an actual list of active and current changes) from $1,700 on my Membership Card to $1,800
(See #18 Nov. 1).
So what am I supposed to believe? One thing changes but one thing doesn't but I get billed anyway?
29. https://files.catbox.moe/e5qi5y.png
30. https://files.catbox.moe/azf2wj.png
31. https://files.catbox.moe/1y4uot.png
32. https://files.catbox.moe/v5c615.png
33. https://files.catbox.moe/cbx9ta.png
34. https://files.catbox.moe/lbfara.png
35. https://files.catbox.moe/k5cl5u.png - Dec. 12, 2023
36. https://files.catbox.moe/87stbk.png
37. https://files.catbox.moe/cmikdg.png
38. https://files.catbox.moe/5vyiwc.png
39. https://files.catbox.moe/ln6qol.png
40. https://files.catbox.moe/r9a0bs.png
41. https://files.catbox.moe/99flb0.png
42. https://files.catbox.moe/ddjd5g.png
I get billed on Dec. 26, 2023 (Dated Dec. 6, 2023) and I call AMBETTTER customer service where they supposedly corrected the problem but this never seemed clear according to
(Links #7 and #8) and on Jan. 10, 2024 they suspended my account.
43. https://files.catbox.moe/cirrlw.png - Jan. 3, 2024
44. https://files.catbox.moe/p5n05p.jpg - Jan. 9, 2024 - FRONT SIDE
45. https://files.catbox.moe/97a9jp.jpg - Jan. 9, 2024 - BACK SIDE
Documents from the Marketplace saying I'm in the Standard Silver VALUE (plan)
46. https://files.catbox.moe/bsb7c3.png - Jan. 10, 2024
My account was suspended. I'm assuming because I did not pay the December bill, even though I have all the way until Jan. 15 or 16th 2024 to modify my plan selection according to all the Marketplace information I got. However it also says I've been auto-renewed because I didn't select a plan by Dec. 15, 2023 even though I was auto-renewed and billed BEFORE that date without notice as far as I can tell. (See Links #27 and #28)
ARTICLES:
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47. https://files.catbox.moe/g0oek7.png
47a. https://www.centene.com/products-and-services/state-and-national-solutions/marketplace.html
AMBETTER has 3.6 million members of which 84% are in Silver Plans. How many of those people just got their FREE Standard Silver VALUE plan (2023) switched to an Out-of-Pocket Premium Plan (2024) AFTER they have already selected a PCP in an HMO Network and actually gone for a medical visit? How many are now more or less TRAPPED by this deceptive maneuver by AMBETTER?
48. https://files.catbox.moe/dnpnoq.png
48a. https://smartfinancial.com/compare-health/blue-cross-blue-shield-vs-ambetter-insurance
This articles has some information (Green Highlights) about how if the Medical Loss Ratio is below 80% then the balance has to be refunded to the patients. Does this mean AMBETTER owes me
$683.62 for November 2023 and $702.90 for December 2023? And if so, what about January through December 2024 in which AMBETTER will be receiving ACA Premium Payments while denying me coverage because of their suspension of my account? Or will they stop receiving ACA Premium Payments and have to refund the government? Or am I simply not understanding the meaning of the article?
