Most Americans ought to be familiar with the recurring gag in the comic strip Peanuts in which every year Lucy offers to hold the football so that Charlie Brown can kick it. Each year, Charlie Brown complains that Lucy never acts in good faith and that she always pulls the ball away at the last minute, leaving poor Charlie Brown flat on his back after a flubbed kick attempt. Lucy invariably comes up with a compelling argument why Charlie Brown should trust her this time and Charlie Brown sees her logic and gives it a try. Predictably, he always winds up on his back.
As I have been struggling to activate my medical insurance purchased through the California PPACA (aka Obamacare) Exchange, this image of Charlie Brown lying on his back with Lucy gloating over having fooled him yet another year keeps coming to mind. Though a story ought to usually begin at the beginning, allow me to start with the most recent development. In yesterday’s mail (14 January 2014) I received a letter from my new insurance carrier. The letter is dated 24 December 2013. Here’s an excerpt:
The required payment to complete your enrollment has not been received for your coverage to begin on 1/1/2014. We need to receive and process your payment in the amount of $74.45 by 12/21/2013. Your request for coverage cannot proceed if we do not receive your complete payment by this date.
The first thing that I find interesting is that this, a month after I filled out the application, is the first communication that I’ve received, and it is the first time I’ve gotten anything with instructions on how to make a payment. My binder payment has been made, thanks to hours spent on the phone confirming that my application was made and obtaining instructions for payment. The first of these attempts was made back in December and resulted in a promise that the instructions would be sent to my email address «within an hour.» Those instructions never arrived.
While I understand the outrage conservatives have expressed over the recent legislation instructing insurers to honor claims even if PPACA customers haven’t made their binder payments, in this case I have to agree with the government. If the insurers can’t get a promised invoice sent, how can the insureds be expected to make the demanded payments on time? Letting the insurers off the hook for policies as yet uninvoiced gives them a perverse incentive never to get their invoices out.
The second thing that is interesting is that it was dated three days after the stated deadline for starting coverage. I hope that I don’t have to repeat myself about my suspicions that the insurer may be delaying their communications purposefully so as to postpone any liability for actual healthcare costs.
I still have not received a member ID so even though I trust that Blue Shield will be retroactively responsible for holding up their end of whatever expenses I may incur, in effect there is no coverage in place. I’ve spent hours at Walgreens getting prescriptions filled because despite the assurances of the customer support people at Blue Shield that my policy is in their system, they tell a different story when Walgreens calls to confirm.
Last week I called and spoke to a customer service representative who gave me a subscriber ID number. Though I had to wait on hold for quite some time, I was pleased to at least get through to someone who was capable of taking care of my request in what seemed to be an expedient manner. The representative told me that I need only use that number and that I could access my health plan’s website and could give the number to the pharmacy. Fantastic! Who needs a physical card to arrive in the mail?
I was foolish enough to thank the representative and get off the phone before plugging the number into the website to create my account. Unfortunately, the website reported the number as invalid. Likewise, at the pharmacy, the staff looked at the number and said that it didn’t look like any member policy number they had ever seen.
I’ve been trying to get through to the insurer for days now, and the message at the other end of the phone troublingly says that due to unexpected call volume that there are no representatives available to help, and then hangs up on me.
Here is what I think is a very reasonable question: considering that enrollment in plans through the healthcare exchanges is pretty much exactly what was predicted by (California’s exchanges have now enrolled almost 1.3 million1) why is everyone involved—from pharmacies to insurance companies to the staff of the exchanges themselves—experiencing «higher than anticipated» volume of requests for help. Did no one in government or private industry anticipate the need for some additional staffing? Or did they just fail to anticipate the amount of confusion that would have to be resolved?
UPDATE As of about 5pm this evening, I did get through to my insurer and got a hold of my membership number. Unfortunately, despite putting in great effort to choose a plan that would cover my current doctor, now that I can use the plan’s online tools to search more specifically, it looks like my doctor may not be covered. I’ll have more information in another 24 hours, but right now it looks as though despite my best efforts and the best information provided to me by both the State of California and by Blue Shield of California, I may not actually be able to keep my doctor without starting over from the beginning and choosing a new plan.