5 months, 21 logged phone hours, 6 so called "escalations" with HEALTHCARE.GOV.....outcome - Uninsured.
This is not another rant on Obamacare laws. It is a flawed system needing fixed. One of the many fixes, Service. A firsthand story below:
- Every Individual is guaranteed Health Insurance.....WONDERFUL!
- Tax Credit assistance in the Public Marketplace for individuals & families who need it....TREMENDOUS!
I rarely mess with the public marketplace. I if do, I am helping very close friends who may need assistance applying for a subsidy. Healthcare.gov with its tracking, verification, and service is too messy of a system to deal with and can be very risky at times. If you are perfectly healthy, you are better off with a 12 month Short term policy.
LET THE STORY BEGIN
A friend needed help and I wanted to assist! She was directed to a policy through the public exchange in December of 2014, by a Navigator; they apparently play "vital role" with Obamacare. *** (CMS.gov) NAVIGATOR - Navigators are funded through federal grant funds and must complete comprehensive federal Navigator training, criminal background checks, and state training.
NAVIGATORS - THE FIRST OF THE POOR SERVICE
This Navigator, with comprehensive training, directed my friend to a policy with Anthem through the public exchange, stating her preferred Primary Care Physician was In-Network. January comes along, her first appointment scheduled, she pays Out-of-Pocket, Doctor was not in network. Many things wrong with this - 1. ANTHEM is priced out of the individual market in 2015, expensive 2. they have a SKINNY Network (limited doctors & hospitals) 3. There are cheaper carriers with broader networks and similar coverage this Navigator over looked. Poorly trained, they do not know how to recommend and provide the right health policies to Individuals & Families. They are only good at navigating through the application.
WHERE THE MESS BEGINS, PHONE STAFF - POOR SERVICE CONTINUED
I clean up the mess of the Navigator in late January. Calling Healthcare.gov, I was instructed to submit a new application issuing the new policy my friend needed to include her doctor in-network. Still in the open enrollment period, by switching, we saved her an additional $140/month included her doctor in network, and she acquired stronger benefits.
After we completed her new application, we were instructed to cancel the old application over the phone with Healthcare.gov. We reported the proper numbers, confirmed cancellation over the phone, all was good!??????......The rep was not able to give us a tracking ID# for the phone call, .GOV apparently doesn't do this, it is based on trust I guess.....! The Healthcare.gov rep, little did we know after we got off the phone, proceeded to cancel an application, but canceled the wrong (new) application. This process takes Healthcare.gov 30+days to communicate to the insurance carrier. My friend received her invoice and ID card, 30 days later receives cancellation on the same policy. Anthem had also sent an invoice we thought in error, so we called them direct to tell them them policy had been replaced.
WHERE HEALTHCARE.GOV IS USELESS, ESCALATION MANAGERS? - AWFUL SERVICE LEVEL 3
5 months, 21 logged phone hours, 6 so called "escalations" later with HEALTHCARE.GOV. Rushing to get hold of Healthcare.gov, we had an emergency. A preventive cancer drug is needed every 30 days and my friend stood there uninsured. After a 45 minute hold we speak to a rep and are told to "escalate the issue with a manager." BUT AN ESCALATION COULD TAKE UP TO 60 DAYS! If its between life and death, they tell you to call 911 and continue care without insurance.
These policies run through healthcare.gov and .gov in turn communicates to the carriers. Most carriers will tell you there is nothing they can do on a subsidized policy without it coming direct from .gov staff. My friend, who needs urgent medication to prevent a relapse with cancer, might not be able to get it for 60 days because .gov staff will twiddle their thumbs taking their time to fix a mistake made they made?? FYI, this is apparently the highest level of escalation you can get through the system.
5 months, 21 logged phone hours, 6 so called "escalations" & the carrier finally felt so bad they kicked in their services and began to argue with .gov. Throughout this time the client paid hefty out of pocket costs to maintain her prescription.
As we approach the halfway mark of 2015, a policy has apparently been issued for a 7.1.2015 effective date.
If obama-CARE CARES, create a process that CARES.
If a mistake is made own up to it and have a system in place to take care of this matter SAME DAY. This is the insurance world, mistakes are very common, they are going to happen.
1. Have individuals hold 3 way calls with the carrier they choose and healthcare.gov. Utilize this as tracking so each party remains on the same page
2. Hire account managers for large participating cities so services requests requiring multiple calls are communicated through 1 person.
3. I had service reps tell me there was no tracking of calls, tracking of calls but no confirmation number could be passed, and also received activity ID #'s on certain calls. Your staff is not educated, know the rules and fix it.
4. PEOPLE CANT WAIT AROUND WITHOUT INSURANCE FOR 60+DAYS
#CAREobamaCARE
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