Obamacare and Me: Emergence from the The Toilet Zone

How I won a four-month fight to keep my doctors.  But it’s probably too late for you to do the same.

Cue Etta:  “At last.  My health insurance has come along.  My fretting days are over.  And life is like a song.”  Finally, I have my new insurance card in hand.  My plan will allow me to remain insured at a rate comparable to what I was paying last year.  And I will be able to keep the doctor who saved my life. 

It’s a solution that has been four months in the making.  After my old policy (you know, the one I liked and wanted to keep) was canceled out from under me in the middle of a life-altering medical crisis, the following happened (material presented in quotes is paraphrased):

-- I received conflicting statements from Healthcare.gov.  (“Your enrollment is complete.” “Your enrollment is not complete.”)

-- I got conflicting advice from Healthcare.gov.  (“Wait to be contacted by your insurance company.”  “Don’t wait to be contacted by your insurance company.”)

-- I received misinformation about my primary care physician.  (“Your doctor is an approved provider.”  “Your doctor is not an approved provider.”)

-- The doctors’ offices themselves provided bad information about their plan status, telling me they were approved providers, when in fact the opposite was true.

-- After receiving approval for a replacement plan that would allow me to keep my doctors, the company gave me conflicting instructions on what to do next.  (“Don’t cancel your existing plan now.”  “Do cancel your existing plan now.”)

-- In the course of pursuing answers about all this, my insurer transferred me from person to person to person to person to person to person to person to person to person to person.  Is that enough persons for you?  Actually, I omitted several.  By my count, in trying to switch plans I talked with 19 different people.  19.  Think about that for a moment.  And that only counts calls or transfers that actually reached a real human being.  Throw in disconnects due to dead ends or endless holds, and the total comes to about 28.  In the course of doing that, I burned up hours and hours of cell phone minutes, most of which were spent listening to hold music and amusing fragments of health tips.

The ordeal finally ended when a employee told me she’d figured out what the problem was, would work on it, and would call be back by the end of the week.  It took her to the following week to call back, but when she did, she had a solution in hand. 

So what have we learned here today?

Toward the end of the movie The Good Girl, Jack the store manager asks that question.  I’ll give his answer in a moment.  Below are mine.  (Sadly, although I’m sure many Americans, perhaps millions of them, have found themselves in a situation similar to mine, much of what I’ve learned will be of no benefit to them, given that open enrollment has passed.  But there’s always next year. )

Problem:  Within my insurer (I don't know about other companies, but here is an invitation for some enterprising reporter to find out) apparently the Exchange plans are handled separately from the non-Exchange plans, using different teams of people.  This causes massive confusion and raises barriers to communication.

Solution:  Shouldn't any employee be able to access any information needed to solve any customer problem?  Make it so!  This factor alone accounted for at least 75% of the runaround I got.

Problem:  Before signing up with this company, I verified that my primary care physician was listed on its provider page.  I got the web address for that provider page from materials I downloaded from Healthcare.gov.  But as it turns out, the company’s list of Exchange policy providers is very different from its list of non-Exchange providers.  The lists do not overlap in every place.  I'm not sure they overlap in any place.

Solution:  The company should list its Exchange providers on a separate, clearly labeled web page.  Materials provided by the Healthcare.gov site should lead only to such a list, not to the irrelevant page to which the site directed me.

Problem:  The offices of both of my doctors told me they were authorized providers.  They weren’t.  

Solution:  Did the insurance company adequately warn its medical providers that patients would be asking them whether they are authorized to provide services under the company's Exchange plans?  Given that an insurance company rep admitted to me that its providers were very confused, the answer to that question seems obvious, and so is the corrective action that now needs to follow.

Problem:  The phone numbers that my insurance company listed on its acceptance email as the ones to call with any questions were incorrect.

Solution:  List the correct numbers.

Problem:  The emailed warning that instructed me not to cancel my existing policy before receiving my membership materials was exactly the opposite of what I needed to do.

Solution:  Give the correct instructions.

Problem:  When I called the company asking for help, I got a classic bureaucratic run-around, again and again and again.  It took weeks to finally get an answer.

Solution:  Train your employees and give them the tools they need to communicate with customers and with each other correctly and efficiently. 

Problem:  Customer service reps ignored promised call-back times.

Solution:  Train them to keep their promises.

Problem:  Not everyone realizes that Healthcare.gov may not be the only option for purchasing health insurance, or even the best option for many people.  In my case, based on what I was told later, no Exchange plan offered by any company would have allowed me to keep my doctors.  Yet other options were available outside the Exchange.

Solution: Yes, I should have taken steps to be a better-informed consumer.  However, I'm not sure the media have done a particularly good job of explaining that there are options outside the Exchange.  Nor has the government.  One news magazine report I relied on did show how brokers were available to help.  But in the example it gave, the broker did nothing more than sit down with the customer to view the Exchange website and interpret it for the client.  It would not hurt for the media to broaden the scope of their coverage.  Also, before I signed up, I don't recall seeing any items on the Healthcare.gov explainer 1-sheet mentioning other insurance options, suggesting the possibility of working with a broker, or warning about the possibility of having to change doctors if buying an Exchange plan.  None is there now.

And the biggest “misinformation” of all:  “You can keep your plan.  You can keep your doctor.”  The problem, of course, was that for millions of people, this statement was false.  Further, the facts are pretty clear that those who said it, and their supporters, knew at the time, or at very least should have known, that it was false.  The Affordable Care Act therefore was passed in a less than forthright way.  Not to put too fine a point on it:  Obamacare proponents led the American public down a primrose path.  This has led to hard feelings and has caused combatants on all sides to become even more entrenched and distrustful of one another.  (I've had some personal experience with this effect while discussing the topic with friends on my Facebook page).

Solution:  Despite what happened to me, now that I'm this far down the road I personally don't want to simply junk the Affordable Care Act.  Even so, the current distrustful political atmosphere is not okay.  Can it be set right?  To start, an apology would be good.  I mean a real, sincere one that accepts full, personal responsibility and takes steps to restore trust.  Now, only the president can know his own mind.  If he did deliberately fib, he should man up and say so.  I don't expect that to happen, whether or not he knew at the time that what he was saying was false.  But here is what I long to hear President Obama say now:  “In the debate over ACA, I said some things that turned out not to be true.  In an attempt to focus the debate, I oversimplified.  But I knew better.  It was poor judgment, and a bad call.  I am sincerely sorry.  What I should have said is this:  ‘We are taking steps to grandfather in as many policies as we can.  Even so, some of you will be inconvenienced.  You might have to change plans.  You might have to change doctors.  I regret that.  But I ask you to accept this sacrifice so that millions of your fellow Americans can have in the future what you have now and will continue to have in the future:  affordable health coverage.’”  I would have accepted that last year.  I might even accept it now.  But the current winners of the ACA debate don’t seem to much care what people like me think.  They should.  My politics are strictly middle of the road.  At the moment I’m reachable by either party.  And there’s a mid-term election coming up.

So what have we learned here today?   When that store manager in The Good Girl addressed employees about a sad incident involving a deranged coworker, he put the answer this way:  “Don’t be a thief.  And don’t be disturbed.”

Government and private insurers alike would do well to pay attention.  Tell us the straight-up truth.  Give us the correct facts.  Don’t steal our trust.  Don’t steal our time.  And don’t make us crazy.

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I’m not naming the company in this post because, among other things, I’d really like them to continue to pay my medical bills without hassle in the future, and there definitely will be more of them.  The next round of tests takes place next week.  But if you’d like more info, just drop me a line.  Contact me here.

If you like this style of writing, please check out my novel Messages, which gives the same treatment to TV news.

Other entries in this series:

Episode One
Obamacare and Me:   Head vs. Wall.  Wall wins.

Episode Two
Obamacare and Me:  Help Me.  Please.  Somebody.

Episode Three
Obamacare and Me:  Adventures in the Toilet Zone

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You can find the entire series of blog posts on my medical journey on this page:  My Medical Travails:  Adventures in the Toilet Zone.  And of course, I invite you to check out my author's page, where you can learn about my novels, see critic and reader reviews, download sample chapters, and find purchase links:  www.forrestcarr.com.

©2014 by Forrest Carr.  All rights reserved.