Man says Affordable Care Act dental plan not clear

GREENWOOD, Ind. (WISH) –  A Greenwood man says he has dental work that needs to be done.  Zachery Lacefield signed up for the Affordable Care Act earlier this year.  His coverage went into effect March 1, 2014.  Now that it’s time to use the insurance for some major dental repairs the marketplace call center is telling him one thing and his insurance company, Anthem Blue Cross and Blue Shield, is saying another.

“As of right now at least one of my teeth could possibly break,” said Lacefield.

Lacefield says someone at the ACA marketplace told him effective March 1 he would have full coverage and be able to use it how he pleases.

“Now that I’ve actually run into a problem and I need to use the healthcare they’re telling me that I’m denied.  I can’t actually use any of it,” said Lacefield.

He’s recorded several conversations throughout his battle.  First he recorded a call to Anthem after he was denied coverage.

“As of September 1 we will cover your fillings.   Root canals have a twelve month wait,” said the Anthem call representative.

But, when he calls the marketplace, he’s given a different story.

“There’s no waiting period?” Lacefield asked.

“Right.  The start date is effective March 1 and you will be effective all the way until December 31st,” said the Marketplace representative.

“But, my plan itself, there is no waiting period?” Lacefield asked another Marketplace rep.

“That’s correct.  You can go to the doctor today,” she said.

Not one Marketplace representative that he talked to could confirm that he had a waiting period tied to his coverage plan.

“So, I can use it anytime.  I don’t have to wait six months to a year or anything like that?  I can use it immediately,” Lacefield asked another Marketplace rep.

“Right. You’re covered,” said the rep.

Tasha Bradley with Health and Human Services explains it’s easy to see on the website where plans detail the waiting period.  On the website when a viewer first looks at it, there’s no mention of coverage waiting periods in the quick rundown.  Someone must click on plan details and then it’s clearly stated at the top of the coverage plan.

Lacefield says since the site was down the day he registered, he had no idea.  Now, he’s having a hard time finding out who’s behind, what he calls, a major miscommunication.

“One of the biggest problems I’ve run into is everyone is blaming what’s going on, on someone else,” said Lacefield.

The work Lacefield needs will cost him thousands of dollars out of pocket on top of the insurance premium he’s already paying.  Now, he says, he’s stuck.  He says he just wants to make sure others know what they’re really getting when they sign up.

“If you filled out for insurance and you haven’t used it, oh please call and check.  You might be very surprised that you’re not covered when you were told that you were,” said Lacefield.

Anthem Blue Cross and Blue Shield sent us this statement:

“There is no waiting period for dental exams, X-rays or cleanings.  Major dental services such as restorations or oral surgery are subject to a 12 month waiting period, which is standard for all insurers who sell individual dental plans.”

Spokesman, Tony Felts, says the waiting period is to keep premiums affordable so someone doesn’t sign up, get an expensive procedure then cancel coverage.

Bradley says she will go over details with employees at the call center to make sure information that’s going out isn’t confusing.

blog comments powered by Disqus