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Escaping Health Connector Hell: How to Fix Your Broken Enrollments

This post originally appeared on Yelp. If you like my reviews, follow me for more snarky points of view.

Well guys, I never wanted to be back in this situation reporting on how terrible the Massachusetts Health Connector can be, but here I am nonetheless! Your response to my ordeal, as well as noise from this post on Universal Hub, has prompted me to write a follow up post detailing how to fight the good fight when your enrollments get screwed up by the Health Connector’s incompetent billing center.

TLDR on the last post: last year, I spent about three months without access to coverage because the Massachusetts Health Connector couldn’t process a simple “retro request” properly. A retro request is when you move your effective date to a date other than when you started the plan, for example, when you leave your job but your enrollment won’t start until the next month, and you need coverage now. 

What I learned during this three month battle is quite simple: the Massachusetts Health Connector’s main line (1-877-623-6765) is operationally incapable of helping you, and that only an inaccessible department called “billing” calls the shots when it comes to modifying your enrollments. Not too surprising, right? I mean, most bloated corporate monstrosities have inaccessible billing departments: I spent a good two weeks dealing with some messed up billing with Bright House, a cable company in Florida, and wasn’t allowed to speak to their money people either. But in that dismal situation, at least there was real communication between the CSRs on the front lines and the accountant robots in the back room. In the Health Connector, not so! Neither the main call center nor your insurer (in my case, this was Neighborhood Health Plan) can pick up a phone and talk to the person screwing up your plan. Be prepared for the fate of your health insurance to be handled by carrier pigeons flying over volcanoes!

Anyway, if you get caught in the unfortunate situation where the Massachusetts Health Connector is threatening to terminate your insurance for nonpayment (when you’ve already paid all your premiums on time), and/or they’ve “restricted” your account without telling you (meaning, you have to pay full cost for your prescriptions) this is what you do to get it fixed in days rather than weeks.

Be Meticulous

First of all, in ALL cases, take down the first name and identifying # of anyone you speak with, whether on your insurer’s side or the Massachusetts Health Connector’s side, and note the time and day you called. If you’re unlucky like me, you may have to call the Connector 32 times, so after that many calls things can get confusing. Most insurers have ID numbers attached to their CSRs, and the Connector does too, though their CSRs will sometimes lie to you and claim they do not. I wish I could recommend recording your phone calls, but since we can’t be certain where the Connector’s or your insurer’s call centers are located, you might run up against two-party consent privacy laws with respect to the recordings.

Make an Ally of Your Insurer

Don’t bother calling the Massachusetts Health Connector directly just yet. Call your insurer and gather all the information they’re aware of. Ask for a supervisor immediately, and demand that the supervisor stay on your case specifically. Explain that the Connector is being intransigent and that you need someone on the insurer’s side to help you get on the case. Confirm that your account has been restricted and verify the dates of enrollment they have on file.

100% of the time, I’ve found that the Massachusetts Connector and the insurer will have a different idea of this, because the Connector is always reporting days or weeks old information to your insurer. This will give you the info you need to keep your story straight in the nightmare you’re about to embark on. While the insurer can’t modify your billing and doesn’t have access to any paper trail of payments you’ve made to the Connector, they can communicate with the Connector’s billing department by email.

Ask them to send a request to the Massachusetts Health Connector’s billing department to review your case, and provide the insurer with any relevant data proving that you’ve made your payments on time. One supervisor I spoke with at my insurer kept insisting that I needed to call the Connector and give them the confirmation number and amount of each on-time premium payment I made, but I was persistent enough to get her to do it for me on the insurer’s side. The Connector’s billing department can’t exactly ignore the insurer, so that’s why we go this route first.

Call the Dreaded Massachusetts Health Connector

Now that you have the insurer on the case, call the Massachusetts Health Connector, choose the Billing option on the robo-menu, and immediately ask for a supervisor. They may tell you there are no supervisors available, or that they can have someone get back to you in 3 days, which is ridiculous. They’re lying. The supervisors are just overworked and don’t want to talk to you. Tell the CSR that you’re willing to wait on the phone however long it takes to talk to someone. They’ll probably want you to explain what your problem is, but don’t bother, because they’re just trying to keep you away from a supervisor, and if you explain your convoluted case to them, it’s just going to get mangled in the game of telephone (if they even explain your problem to the supervisor before they transfer you). Put your phone on speaker and do some other work until they get you someone. Don’t relent.

Once you have a supervisor, explain that you’ve received this termination letter and that you’re disputing it. Explain that you’ve made all your premium payments and can prove it. Give them the dates of all your payments, the confirmations numbers from your bank, and the account IDs you billed them to. If you foolishly used their autopay, give them the dates the money was taken out of your bank (and then promptly turn autopay off! ONLY EVER SEND PAYMENTS MANUALLY TO THE HEALTH CONNECTOR. I use my bank’s autopay to schedule checks to be sent to them, so I can control when money comes out of my account). Ask them to explain why their system is telling them you’re past due and make sure that they write down your explanation for why this is wrong. In my case, on the second go-around this year, the problem was that the billing department was taking months to process a canceled application I submitted during a single day of enrollment in January. That is, whatever system is connected from the website to their billing department is so awful that if you jump into a plan and cancel it, then jump into another plan (all during the open enrollment period), the billing people process each of these events individually, increasing astronomically the possibility of screwing up your enrollment. This meant that they were shuffling me between plans from January to March, all the while demanding payment for the difference between these plans, even though I was never supposed to be enrolled in anything but the one I actually signed up for.

Do not let the Massachusetts Connector initiate any “retro requests,” because that will only make matters worse. The supervisor may insist this is the only way to solve the problem, because it’s the only way they know how to solve the problem. Or, they may also ask you to make the difference in payment, so they can reactivate your insurance now. Don’t do either of these things. If Amazon shipped you an empty box instead of whatever you paid for, would you send them more money before they sent you the actual product? I didn’t think so. Instead, ask them to send all of the information you’ve told them to the billing department for review. Ask the supervisor to re-read what they’re about to send back to you, so they don’t misinterpret anything you’re saying.

Call the Governor’s Constituent Services Office

Finally, this is the all-important step in the process. You are a citizen of the Commonwealth who’s forced to pay for coverage. You paid for coverage, and now because of the State’s technical incompetence, you’re being punished. Doubly punished if you ask me: not only are you being denied the coverage you paid for and that you’re required to pay for as a citizen of the Commonwealth, but you risk being penalized for not having full coverage by year’s end. So this is very much so an issue for the State’s constituent services department. Call the Office of the Governor and you’ll get one of their pleasant phone reps. Don’t use their form—call them. I tried using their form and nothing came of it. When you call, explain simply that you are being denied coverage despite that you’ve made all your premium payments on time, and that you need the restrictions lifted on your insurance immediately. Be polite, and don’t over-explain. The governor’s office will take information from you, and then forward your case down the line.

The end result of this—in the two times I tried it (which, admittedly, isn’t a large sample!)—is that you’ll get a phone call the next day from the Massachusetts Health Connector’s secret “Urgent Care Services” line. As far as I can surmise, the people at this number are a layer of the Connector management that can actually communicate with the billing department, as well as issue requests for technical assistance with the enrollments system. They will immediately lift whatever holds you have while they fix their systems. In the case I described above, it actually required them to make changes to the infrastructure of the system to void out the erroneous enrollment they placed me in. They fixed my problem in two days, in both cases. At the moment, the phone number for this line is 844.558.3454. If you try to call this number directly, however, it may backfire on you as they assign you a “case number” to proceed.

Takeaway

Getting out of Massachusetts Health Connector hell is not easy, but it’s not impossible. You have to talk to the right people, in the right order, as if you’re trapped in some kind of State-mandated insurance version of the horror movie The Cube. Be polite, but firm, like you’re talking to a bunch of airplane pilots who are flying on hallucinogenic drugs. And most importantly: try to keep your story straight. For me, that’s always the hardest part when I venture into the Kafkaesque torments of dealing with labyrinthine customer service.


Health Connector Hell

Massachusetts Health Connector Hell


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  1. Raechel 9 months ago

    Hi, going through my own hell here. Did you take or do you know of anyone who took any legal action against the Health Connector? What about recouping doctors’ or dentists’ fees that had to be paid out of pocket while the Health Connector still showed no enrollment (despite the fact that enrollment had taken place and all premiums were paid, all checks cancelled, etc.)? Thank you.

    • Daniel Quinn 9 months ago

      Hi Raechel,

      I’m unaware of anyone who’s tried to sue the Health Connector directly. In my case, they had tried to withdraw extra payments from me because of their screwed up billing process, and managed to royally botch the whole situation. I got around this by filing a merchant dispute through my bank and ultimately got a refund that way. In your case, you’re stuck in the middle of the insurance company and the Connector: the Connector is incompetent and will always have your billing wrong (and report the wrong status of your account to your insurer) while the insurer will do nothing until the Connector gets its act together. What I recommend you do is make sure that you have proof that you made payments to the Connector for your premium during the time you got care. That is, make sure you can demonstrate that you sent a check to them (and that they cashed it) for each month during the time you paid those out of pocket fees. This will prove later on that you should have had coverage when you paid those out of pocket fees.

      Next, don’t bother trying to dispute it directly with the Connector or your insurer. They won’t help you. Instead, contact constituent services at the Governor’s Office: http://www.mass.gov/governor/constituent-services/contact-governor-office/. I called them before and they were helpful. Tell them you have a dispute with the Connector and that they are refusing to insure you despite that you paid your premium on time, and that you’ve been forced to pay out of pocket for care. This will cause the Connector to get contacted by the Governor’s Office, and they’ll elevate your case to the “Urgent Care” hotline, which is hidden to the rest of us. The phone number is 844.558.3454 (unless they changed it again). Don’t call that line directly though: it may backfire on you. Just wait; as soon as you set up a case with the Governor’s Office, Urgent Care will call you.

      The Connector is capable of issuing refunds for premiums, but I don’t know about out of pocket $$ you paid because they didn’t activate your coverage when they were supposed to. Most likely, the insurer will need to refund you. Just make sure you’re working with the Urgent Care hotline and not the main callcenter (1-877-623-6765). The main callcenter is run by Dell employees and they are undertrained and misinformed 50% of the time.

  2. K 3 months, 3 weeks ago

    Call the governors office right away is the most effective route i have found. The connector would not allow me to wait on hold to speak to anyone and calling the urgent number only got me transferred to the connector that does nothing.

    THANK YOU!! For blogging and putting this major issue out there and giving us hope that one day this mess will be sorted out.

    • Daniel Quinn 3 months, 3 weeks ago

      Hi K, I’m glad this worked for you!

  3. Christina Babin 1 month ago

    Hi Daniel,
    First of all, thank you for this. I just hung up with the Governor’s Office. They are reaching out to their contact at the Health Connector. Yay, finally feeling some hope.
    I have been dealing with the same issues as you for months now. And promised April 1st my healthcare would be active again. Guess what, its not!!!! And hasn’t been since January 31st!! Such. A. Nightmare. Sadly, I’m happy to know I’m not the only one who has gone through this 🙂 but I’m sorry for everyone’s agony at the same time. The HC sucks. In every way. The hold music sucks too. Anyway, before I start a real rant…THANK YOU for the ideas!
    Christina B.

    • Daniel Quinn 1 month ago

      Good work! The governor’s office is the first step to forcing the Health Connector to sort out the mess. They have access to people who aren’t part of the general call center.

    • Christina 1 week, 6 days ago

      For all of you currently going through this pain, I’m happy to report that I finally have health coverage again! Calling the Governor’s office did the trick. They appointed me a secret agent in the upper level/secret office at the Health Connector, and my coverage was renewed in about 2 weeks. So glad I found Daniel’s article that directed us to do so. Thanks again! I went from Jan 31st – 2nd week of April with no coverage, and was paying monthly through it all. Now that my coverage is back, I am gearing up to start dealing with the next issue, which is getting reimbursed for the months I didn’t have coverage, as well as my overpayments (@$3,000) from last year (due to all the random threatening bills I received – each one a different amount). I’m a little nervous to begin this process as I’m afraid they’ll cut me off again! No one can truly understand this HC torture until they live it, but reading Daniel’s blogs about it pretty much summed it up exactly. I wouldn’t have had the energy to write it all down, but glad someone did. Hours on the phone, call after call, promises, lies, frustration, the insanity of it all. The insanity is almost laughable. Shaking my head.
      The more people who contact the Governor’s office, the better! Call!!! They can help!! Good Luck!

    • Daniel Quinn 1 week, 6 days ago

      I am so glad this worked out for you! Now that you have your insurance reactivated, don’t give up on getting refunded for all the time they refused to provide coverage. Continue to negotiate through the Governor’s office if the HC refuses to help you. Open a separate case if necessary. There is no excuse for them charging you premiums for months they refused service.

  4. Joe 4 weeks, 1 day ago

    I’ve been using the Health Connector off and on for health and/or dental coverage for about 18 months. I have found they usually do the opposite of what I ask. If I ask them to cancel coverage, they do not cancel it and I continue to receive bills. If I tell them not to cancel coverage, they immediately cancel it. Their answer to everything is “it will take 24 to 48 hours for our system to update.” Yet, days or weeks later, there is no update. After about 10 calls with them trying to solve my first (of several) problems, I finally contacted the Ombudsman and the issue was cleared up in about a week. It’s sad that no one else over there can help.

    • Daniel Quinn 4 weeks ago

      It’s worse than sad – it’s a disgrace. The Health Connector needs to get its act together because it’s doing a disservice to so many Massachusetts insured.

  5. Amy 2 weeks, 5 days ago

    Hello everyone. I am sad for everyone that is dealing with these issues, however I am so happy to have found you!!! I am going to start off by saying that as sad as this may sound, The Health Connector absolutely ruined my entire summer last year….I am not kidding! I will begin by saying that I stumbled upon this site, while searching for all of the articles that i am sending to Atty Generals Office to yet again explain what has happened to me, and by the looks of it thousands of others. It’s been almost a year now, however the residuals seem to never disappear! That being said I must finish my research to send to them as much evidence of incompetence as possible. I can imagine that it will not be a difficult task, however if anyone has anything that they wouldn’t mind sharing with me, I will send that in with my evidence. I let it go for a while, but I have been stewing about it, the reason I use Health Connector is because it is the law and because of my income. That being said, I don’t have a lot of money, I have just enough and sometimes not even enough for my monthly bills. So when money is taken without my consent….Bad things happen!
    Thank you for any links or anything you can send. I will be writing back with thanks and hopefully we can discuss and get all of this taken care of it. I am sick of them!!!!

    • Daniel Quinn 2 weeks, 4 days ago

      The Health Connector strikes again! I wish you the best of luck in your battle with The Beast.

  6. Rhonda Brockman 2 weeks ago

    Nightmare is only the beginning of what I’ve been going through with the Healthconnector. Everywhere from no insurance for two months, to 12 applications/case tickets taken out, to a whopping double payment out of the blue.

    • Daniel Quinn 2 weeks ago

      I’d love to hear your experience. Feel free to leave a rant here for all the world to see!

    • Rhonda Brockman 1 week ago

      Starting in November of 2015, the nightmare began. After receiving a notice from the Health Connector that I could call or apply online, I called and then attempted to apply online. My application was frozen, I then called the Connector and proceeded to go back and forth for days, racking up almost 15 hours on the phone, and going through several reps, all with different stories, I got….nowhere. Each rep would start a new application to fix the problem, which only made it worse. I finally had to go to the local office at 7:30 p.m. and get the problem fixed. Their claim, I had to show proof of identification. I spent one hour in this office, starting a brand new application with a new rep.

      We finally had health insurance, but now that my 18 year old son started his co-op job at a bank, he had to call and apply for his own health insurance because he was working. He would still be under me, but he had to apply. He was fine for a year, paying his premiums for dental, and health was covered because he was still in high school.

      Forward to Feb of 2016 his premium was increased and he was fine until February, 2017 following my nightmare tax return, and, after the advice of a rep, it was decided that he should come out from underneath me, and get his own health insurance. I cancelled his health insurance and they kicked out several notices of the cancellation. They continued to withdraw the premium which prompted him to call the health connector and ask why they were still withdrawing. They refused to talk to him because he was not the head of the household, and refused to allow him to apply for his own because he was still under my plan.

      I then called them back to cancel the plan (again). I was told that his premium would increase to an amount he can’t afford. I mean the kid is fresh out of high school by now and going through saving up for college for the Fall of 2017. I was told he was better off being under me, or basically he would be forced into this policy. Mind you he was not at my house for this phone call, and the rep informed me that Josh (my son) would have to be present to be signed up. Josh comes home calls the connector and proceeds to sign up for the plan he had before I cancelled him. He was told he would pay the same premium and that because they already deducted the money he was covered for April.

      Wrong. I received two notices from the Connector informing me that my son was not eligible for the high priced plan because he had been removed from the account. A second notice received on the same day stated that a total of two months for this high priced plan would be due by May 9 or he would be cancelled. A plan that he was not eligible for but being billed for on the same day. Right.

      I told my son to leave the notice and reassured him that it was a tech glitch and that the female he had spoken to told him that everything was all set.

      On April 26, they took the money out of his account, for a plan, he was not eligible for, and a plan that they put him on without his permission. The plan he signed up for was the standard 2 plan, they put him on a silver plan without his permission. He would not have agreed to a premium that high.

      I contacted Health Connector, and was basically told tough shit. They had sent me a bill for monthly premium and that I was lying, even with the evidence in front of my face, I was still lying. If anything they claimed, they would only be responsible for one payment, which they would not refund but credit him on his connector account. If he wanted his money he had to fight them for it. I said I wanted a supervisor, they said that one would call me the following day…..nothing. This caused me to research. I found your blog, and guess what? Another run around. I contacted the governor’s office, left a message with their nice rep, and waited. Nothing. I called the Urgent Care services and come to find out, they had received the request from the gov. and proceeded to put me off with a story of hope. Hope, that by two weeks, the problem would be solved, a refund would be received within two weeks and the problem would be solved. Here’s my number, we are an important department, this case will be fixed right, bla bla bla. I was told I was welcome to call and check on the status of the case at any time.

      I would have sat on those two weeks had it not been for the ridiculous notice I received today telling me that my son’s health insurance would begin on June 1. I contacted the rep by her phone number and once again the run around starts. They’re not sure how long it will take because the IT department is handling it, and they don’t know what the IT department does, so I can’t have an approximate time frame. I asked them to at least assure me that a refund was being issued….nope, can’t do that because the IT department hasn’t solved the problem through their many steps that it takes. They can’t tell me now if he’ll receive the refund by the two weeks that was first stated.

      I called the gov again, spoke to the same nice rep. I explained that my son had no health insurance and that I was being given the lying run around again. He stuck up for them.

      I told him, as a tax paying citizen I have the right to know the step by step process being made with the private information of my son and I. I have the right to know. The connector is a government entity. I have the right to know the steps. He wasn’t sure if I did.

      Sorry, but eff them all. My 19 year old is out the money he was saving up towards books for college. This huge, reckless, money grabbing department stole money out a 19 year old college bound kid’s checking account. I hope they’re happy with themselves. From the first rep to the last. None of them give a crap. Deflecting is their main purpose.

      How can you force a 19 year to pay for something he never uses? How? Take his money, give him the run around? How? What kind of real world lesson is that? My son can’t even be his own man, because what the hell does a 19 year old know about the ways of a huge far reaching government. I’ll tell you what he’s learning now. No matter what, they own us. And you have to be that disconnected to not give a crap. I’m sorry, I’m mad, and this is a rant. I’m crying cause no one cares. At all.

      Sorry for my anger.

    • Daniel Quinn 2 days, 22 hours ago

      That is quite the nightmare. I know not everyone has the time or wherewithal to keep playing the Connector’s game, but if I were you I would persist in calling the Governor’s office and filing certified letters attesting to your experience in as great detail as you can, until you get the answers and compensation you deserve.

  7. Marianne 2 weeks ago

    Thank you for posting. I had/have been going through Health Connector HELL since my company closed in September and I lost Private insurance. My situation is a little different as I have a child who is medically disabled and has Mass Health as a secondary. Mass Health had told me they were terminating him so I had him enrolled on the HC with the family. MH decided they would cover him and when I tried to un-enroll him from the HC they un-enrolled the entire family. Now mind you, I have another child who has severe Asthma and now no insurance. Oh, and then they sent me another bill. After several phone calls and a call back from a supervisor (who got short with me) they said they would fix it. Oh boy did they fix it. They went back to when my son was on it and re-enrolled the entire family. Now they messed up my sons MH again. Well needless to say my son ended up going through radiation and was in the hospital for Pneumonia. Because MH does not work with the HC we are now on the hook for thousands of dollars and have been told there is nothing that can be done. We have had to suck it up but want people to be aware of the damage the HC can cause mentally because they have no clue and financially because they have no clue.

    • Daniel Quinn 2 weeks ago

      Marianne, have you called the Governor’s office? If you have not, you should do that immediately and open a case. Many people here, including me, have had positive results speaking to them. There’s still a chance of forcing the Connector to make things right. Explain your case at length to the office, and also send a certified letter describing everything that happened. You may be surprised how fast things turn around.