So from about July 2016- March 2017 I worked for the Affordable Care act marketplace. I know the process can be frustrating for a lot of people, and I know a lot of reps for the marketplace are frustrating to deal with, and believe me most of us were frustrated too because we were never allowed to deviate from scripts. If we didn’t have a script to read for info, we couldn’t say anything on the topic.
That said, a lot of the people that called in, no matter how simple the issue or how fast the wait times, came into the situation combative and ready to cause a fuss no matter what. The worst example I ever saw was the last call I ever took there. It was early March and call were finally down after open enrollment/the early days of the new insurance kicking in/the beginning of tax season as everyone started looking for their 1095-A forms.
So this man calls in, the wait times were at around 1 minute or so because it was mid day and volumes were low. I answer and he’s already very angry. He tells me he received a 1095-A form and wants to know why he got it when it was his wife who had this insurance last year. (Please note, he said wife) So I get his info, pull up the account l, verify his DoB and all that. I already have an idea of what has happened but I pull up the application and look through call logs under both his and his wife’s names. Neither has ever called before which means they either A) filled in all this on line themselves or B) had some insurance agent do it for them.
If you don’t know how a marketplace application and the tax credit works, or at least how it worked in 2017, i don’t know if it has changed since, you fill out an application that includes information on the entire household. This includes people who will not be on the insurance but who will be on the household’s tax return. This is because the tax credit that helps pay for any insurance is based on, well, your taxes. So, if you have a married couple, and only the wife needs insurance, but the couple is filing jointly, both peoples information/income will be included on the application. What most married couples do is list the husband as the main application filer no matter what, meaning his name will be on the top of any mailed out forms or info, and the envelopes will be addressed to him.
That’s exactly what happened here. This couple filed with the man I’m talking to as the main filer, but only the wife received insurance. I can see a copy of the form he’s holding which even says that only she received a tax credit and that it stopped in April of last year, which lines up with what he had told me as I was pulling up all of this. I cannot see why the insurance was canceled, since it was done online or by an agent there are no logs from other CSRs to say what the life change was. Marketplace insurance can change for a ton of reasons, like change of income, getting insurance from your job, changing states, having kids, getting Medicare or Medicaid, divorce etc. Since he told me this is his wife and he’s just asking about a tax form, and it doesn’t seem like the insurance or the credit continued longer than it should have I don’t think it matters.
So I explain to him that he was listed as the head of household on the application, that the application takes into account an entire tax paying household, and if he looks at such and such column on the form he will see that only his wife received the tax credit. His name is only listed there as part of the household, and this does not mean he was paid a credit or that he held any marketplace insurance yadda yadda give the form to your accountant (he had mentioned an accountant at some point) for your taxes all is as it should be. But instead of being relieved or comforted as expected, he just insists that he should never have gotten it. Why would he get something for her? Why would we EVER put his name on something for HER taxes? How dare we use his information for her taxes and he’s going to sue us for fucking up his taxes. And I keep trying to explain that that isn’t the case, but at this point he’s yelling and keeps cutting me off to say that we shouldn’t have sent it to him, this was for her taxes etc.
So he’s on this spiel about how we have ruined it and made him responsible for her insurance and now he’s going to have to pay the government because we signed him up for insurance that was only for her. I again point out that he was never on the insurance at all. Then, fully irritated at this point I try a different angle. I ask “Sir, are you planning to file a joint tax return with your wife?” (Because what I can see of the old application that’s what was stated on the application). Again remember he has only referred to her as his wife at this point. That is my only point of reference for this woman. He says, in the most condescending tone I have ever heard from a caller “Well we might have, if I hadn’t divorced her last April” (recall that April was when he insurance/tax credit was cancelled).
Well. That would have been helpful to know. I thought all this time the pair of them were still married because he kept saying his wife. Now. The form is actually still correct, but I’m not a tax person so I don’t really know how taxes work when you were married and one person was a dependent for a part of the year and then get divorced, so I don’t know exactly how the form would work. So I tell him, okay, I understand the concern, but once again, you were never under marketplace insurance, this was based on your wife being a dependent of your income, if your income hasn’t changed (id verified it hadn’t already) you shouldn’t be affected by this. You should bring the form to your accountant and he can tell you what you need or don’t need to do with it and if you don’t need it you can give it to your ex-wife.
I think this will be the end of it. It’s been made very clear at this point that all the info is correct. But oh no. He asks why it got sent to his house when she doesn’t live there anymore. Because that was the address she used when she signed up for the insurance. He tells me to change the address. I can’t do that for an application from a year that’s already over. Then he starts yelling at me for trying to “force him to talk to that bitch” I tell him that’s not the case. He can have us accountant send the form to her. I also point out she seems to have done all this online, she can just get the form online herself or call us if he doesn’t want to bother and if his accountant tells him the form won’t affect his taxes. But that isn’t good enough for him. He insists that I change the address and take his name off the form. I again tell him that is literally impossible to do for the reasons he wants me to do it (we can only request a change of name or address if they are wrong/misprinted, and his form is not wrong or misprinted) and we go back and forth for about another 25 minutes or so.
Eventually, he finally tells me I’m incompetent and asks for a supervisor, a transfer I was more than happy to make. All told I spent about 2 hours on that call, being shouted at because a man didn’t tell me his wife was his ex-wife and didn’t like the fact that he was listed as head of household for the time period where he was head of household and didn’t want to talk to his tax expert about his tax form because he didn’t like that his name was on it.