When Lindsay Franks got a letter in January demanding documents to prove her 4-year-old son is a citizen, she thought it was a scam.
That mistake almost cost Pierce Franks his health coverage, a chilling prospect for parents of a child with cerebral palsy and hydrocephalus. After Franks realized her error and sent the papers, she couldn’t get anyone in the federal call center to say whether the documents would be processed before his policy ended.
“Obviously this would be concerning to any mother,” she said as she struggled for answers. “But to a mother of a child with multiple medical needs, this is beyond frightening and overwhelming.”
Pierce’s disabilities make him eligible for Medicaid, but the family also has insurance to pay for expenses that the government program doesn’t cover, such as his neurosurgeon at Duke. Last year insurance paid about $140,000 for Pierce, his mom said.
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After moving from Charlotte to Fort Mill, the family went to a Blue Cross and Blue Shield of South Carolina agent to sign up for 2015 family coverage on the Affordable Care Act exchange.
On Jan. 13, they got a letter from the Health Insurance Marketplace asking for documents to verify the citizenship of Pierce and his father, Nikolas Franks.
Lindsay Franks thought it was bogus. The letter didn’t look official, with a return address on Industrial Boulevard in London, Ky. It asked for personal documents on father and son but not her. She, her husband and Pierce were all born in the United States, she said, and she’d never heard of the government doing citizenship checks on young children. And because she’d gone through Blue Cross to get the policy, she thought any correspondence would come from the company.
Her wariness was understandable. When the Affordable Care Act debuted, the Federal Trade Commission warned that “scammers are on the prowl, calling, emailing, sending letters and texts, trying to get your money – and your personal and financial information.”
But this letter was for real.
The federal marketplace checks all applications, including those of children, against available documents, said Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation. But most American-born children get Social Security numbers shortly after birth and never get a follow-up query, she said. And if there’s a discrepancy, it’s usually flagged when the insurance application is filed.
Lindsay Franks set the letter aside. On April 10, she got a follow-up saying Pierce would lose his policy on May 1. This letter was even more confusing, with a paragraph that read like someone had failed to fill in blanks: “For information about , contact the at Toll Free 1-888-318-8890 ...” Blue Cross didn’t know anything about it, she said, but she called the federal marketplace and verified that her son was being cut off.
She scrambled to find the right documents. The government requires a birth certificate plus another document from a list that includes such options as a driver’s license, school ID, military card or voter registration card. For children, suggestions include “a clinic, doctor, hospital or school record, including preschool or day care records.”
“These documents must have a photograph or other information such as name, age, sex, race, height, weight, eye color or address,” the government letter adds.
Lindsay Franks couldn’t find anything with her son’s eye color, but she quickly sent a birth certificate, medical records and paperwork from the Fort Mill school system. She got a receipt from her certified letter and started calling to make sure it had been received and would be processed before May 1.
As I’ve reported before, trying to get problems resolved can put customers through the wringer, and Franks was no exception. She spent an hour on the phone, talking to two employees and a supervisor. None, she said, could tell her when the documents would be processed. One blamed her for ignoring the first letter. Another said, “I’m in Kansas and your documents are in Kentucky.”
“There’s no one to sort it out,” Franks said in late April. “You’re really in the middle and at their mercy.”
After the Observer contacted the U.S. Department of Health and Human Services about her case and Franks kept calling, she says she finally got someone who could help. She was told Pierce’s Social Security number was left off the application, and his coverage was restored.
But she still got mixed signals about whether he’d be covered in May. When the parents refilled a prescription for the boy on May 1, they were told he had no coverage, so they paid $200 out of pocket.
On Wednesday, Franks said the mess finally seemed to be ironed out. Blue Cross confirmed that Pierce’s coverage had been restored as of May 1, and the pharmacy reimbursed the family.
“I’m just glad it’s fixed,” she said.
Tolbert and others who study the federal marketplace say it works well for a majority of users. But with almost 9 million people enrolled through the HealthCare.gov, even a tiny error rate equates to a lot of people. And it sure sounds like the customer service system still needs repairs.