January 4th, 2014

Customer “service” in the Obamacare era

Recently, in order to help a friend, I was trying to get health insurance information from Anthem. My questions were mainly about out-of-network benefits on individual policies—in particular whether the out-of-network deductibles and out-of-pocket caps were the same or different if the insurance was purchased from Anthem on the exchanges versus off the exchanges (the websites are quite mum about this).

Seems to be a pretty straightforward question, doesn’t it? Well, think again. There was a hierarchy of responses from the “customer service representatives” and “agents,” requiring many call-backs from me, with the whole operation taking the better part of several hours:

(1) the black hole of seemingly endless “holds,” punctuated by chirpy informational ads.

(2) after my being asked tons of questions and me giving them tons of information (much of it seemingly irrelevant), an abrupt and unexplained disconnect. Back to the drawing board.

(3) a disconnect after them taking even more information from me and the so-called agent telling me, “I don’t know the answer, but I’ll connect you to a supervisor.” Silence, and call ended.

(4) after taking tons of info and hearing my question, an agent says “I don’t know the answer, but you have to speak to claims. I’ll connect you.” Claims puts me on hold for an hour, after which I give up and end the call.

(5) after the usual lengthy question-and-answer period, the agent tells me, “I don’t know” and gets short-tempered, insisting that no one will be able to answer my question. I’m beginning to believe him.

(6) the next agent fails to even understand the question and gets similarly short-tempered.

(7) the next agent gives me an answer, but the answer is clearly wrong and not responsive to the question.

(8) and then, wonder of wonders, I get a great great guy who gives me answers and sounds knowledgeable. So maybe he’s even correct. So I ask him another question (one I hadn’t gotten around to with anyone before), and he responds, “That’s a great question!” sounding really excited to be able to talk insurance minutiae with me. Then he confides, “We [he and the other agents] were just asking that question of our supervisor in a group meeting yesterday, and even he couldn’t answer it. But it’s a great question!” (The question was about whether “usual and customary” rates for out-of-network reimbursement are based on last year’s more generous rates, or whether they are based on this year’s newer, lower, Medicaid-like rates that have been making doctors flee the networks.)

I cannot even imagine how most people are negotiating this maze. I think they are just blindly selecting a plan and hoping for the best. Of course, health insurance tends to be that way anyway: the fine print goes on for a hundred pages, the lingo is obscure, and most people don’t really know what they have till they make a claim and find out whether insurance will pay for it or not.

But Obamacare seems to be a thousand times worse. Even the agents haven’t a clue what they’re talking about for the most part, and things we used to take for granted (such as fairly comprehensive networks for prominent national insurance companies) have hidden and unexpected restrictions.

27 Responses to “Customer “service” in the Obamacare era”

  1. Jenk Says:

    I’m not sure if this is worse or better, but my end of this whole sorry business is Medicaid–I’m a PA welfare caseworker specialized in Medicaid. From what I’ve seen so far the successful Obamacare enrollments simply represent the expansion of Medicaid eligibility to allow more people to qualify for either state or federally funded benefits; those who can’t face a journey that would drive Xhenophon to tears.

    Determining Medicaid eligibility is pretty simple in PA, and I have little difficulty explaining it. God help me if I had to explain private medical insurance, especially now that the former rules have been torpedoed in the effort to completely restructure a business that was already arcane but at least had some actuarial logic.

    People who qualify for Medicaid don’t have to negotiate all of the obstacles those trying to buy private plans do, but what do they really get? A card saying they’re eligible for medical care that fewer and fewer private doctors are willing to provide? The insurance companies can’t even get paid, so you know the physicians won’t be and are not willing to work for free or at best for peanuts. This in turn drives ER visits…oh, wait. You already wrote about that.

    I can sympathize with those agents–there’s little point in explaining that which does not work, and if they do actually understand what they’re trying to explain I’d fear for their sanity….

  2. Steve Says:

    GLOBAL WARMING UPDATES:

    http://commoncts.blogspot.com/2014/01/global-warming-updates.html

  3. Ray Says:

    One of my friends is self employed and he says he can’t afford Obamacare so he is going without. His attitude is “screw them” or words to that effect. He said that will pay the fine and next wear he will sign up for medicaid.

  4. Mr. Frank Says:

    You have to sign up and pay for the plan and then try to use it to learn what is in it.

  5. Yancey Ward Says:

    There are going to be a lot of new policy holders who are going to be shocked at how little their insurance actually covers before the out of pocket cap is reached.

  6. Ymarsakar Says:

    It’s like you can sign your soul away, your firstborn, and your house without even realizing it….

    Oh wait, maybe that’s already happened in the US.

  7. KLSmith Says:

    Saw this last night, maybe from Byron York : what Pelosi really meant was we have to hurry up and pass it before we find out what’s in it.

  8. Jess Says:

    My advice to Obama is to seek out Edsel Ford and ask how he handled having his name stuck on a lemon.

  9. Don Carlos Says:

    Neo’s fun sounds a lot like dealing with the IRS. And yes the IRS is involved in this putrid mess.

    But the American public has become so used to being regulated in so many ways that they’ll just shrug their shoulders yet again. Remember the concern about high gas prices? So what happened?
    That’s my point.

  10. OldTexan Says:

    Imagine if you went into a casino and sat down for a game of 21 with the promise that you will walk away from the table a winner. Then the cards are dealt out of a deck of about 40,000 cards and as you play some people are told that they won’t bust until they hit 25 and the person next to them will bust at 19.

    If you are in the right group of people who walked in $20 will get you $100 worth of chips and if you drove in, in your nice car you will pay up to $200 for $100 worth of chips and you mumble and pay and sit down and then throw a pair of dice to see if your dealer will allow you to play at that table or if you have to go buy more chips.

    So the people coming in the door say what the hell kind of game is this and the rules or changed or delayed or something but you entered the door and you have to stay and play even if the house is now confused.

    And that is just about the fix millions of people are in right now and heaven help them when the the morbidity numbers kick in and a certain percentage get injured and sick and it is time to cash in on this wonderful affordable health care plan.

    And by the way, people who furnish all of the food and drinks and parking, i.e. pharmaceuticals and those who provide security and protection like the lawyers and support staff of politicians are making out like bandits because they and not Obama designed this game years ago as a wish list never dreaming politicians would be stupid enough to pass it without reading the fine print.

  11. Ann Says:

    This is not meant to defend Obamacare in any way, but I’ve gotten the same sort of bad service/misinformation from the customer service representatives at my bank, and it has cost me dearly a couple of times.

  12. neo-neocon Says:

    Ann,

    Yes, it’s endemic.

    This was worse than usual for me, though. But I agree that “customer service” has become an Orwellian term.

  13. Mr. Frank Says:

    There are numerous meanings for “serviced.”

  14. Matt_SE Says:

    Can you imagine how much harder it would be to fight this if Obama and his minions weren’t completely incompetent?

    This is like a gift from heaven…or maybe a punishment.

  15. parker Says:

    Its a gift. Millions, never before subjected to the gross incompetence of the lazy, uncaring bureaucracy will find that ‘free’ obamacare is not as easy to negotiate as ‘free’ obamaphones of ‘free’ extenstions of unemployment benefits.

  16. KLSmith Says:

    parker: you would hope so. but bet you, half the country will be convinced it’s the insurance companies fault and gee it will all be fine if we could have single payer.

  17. Mike Says:

    I’m amazed you went through that.

    I think the Obama admin is just hoping that a) people die on hold; b) people become millionaires creating start up companies while on hold and then pay their own medical bills.

    A government person asks me a question about anything? They’ll never get the opportunity unless it is completely unavoidable.

  18. q Says:

    i work for an auto insurer. if we performed the way the government has performed, we would be audited, fined, have executives forced out, and possibly shut down. what more proof do people need that government is ineffective at anything except imposing…

  19. Don Carlos Says:

    The outcome of the fight against Obamacare and the people and party that conceived, nurtured and shoved it down our throats is far from certain.

    In a post-WWII convulsion, the Brits elected Labor, and the Labor party enacted the National Health Service.

    Despite all types of objective data showing its myriad and chronic failures, the NHS lives robustly on. It is now the largest single employer in the UK, and was a sponsor (?!) of the London Olympics.

  20. rickl Says:

    OldTexan Says:
    January 4th, 2014 at 6:38 pm

    So the people coming in the door say what the hell kind of game is this and the rules or changed or delayed or something but you entered the door and you have to stay and play even if the house is now confused.

    Good description.

    Obamacare = Calvinball

    Literally. Obama is Calvin, and he can change the rules on a whim.

  21. Lizzy Says:

    That’s sounds frustrating, Neo!

    Their choice in contact number sorta gives it away, though: 1-800-F1UCK-YO.

  22. Ymarsakar Says:

    But I agree that “customer service” has become an Orwellian term.

    Japanese tourists and those living overseas are usually too cultured to say this, but Japanese service is always best and highly rated in their eyes. The rest of the world… not so much.

  23. neo-neocon Says:

    Lizzy:

    No. I was talking to Anthem directly, not to the government people.

    Although insurance companies are now becoming so merged with the government they’ve all got the same “customer service” attitude.

  24. T. Hollingsworth Says:

    I’m sure they will be going to the
    Lower reimbursement rates – my wife is a provider and has seen reimbursements drop 20-30% since 2007 or so. As they go down further she will have to find a new career or we will go bankrupt. Good luck motivating young people to go into healthcare!

  25. Dinocrat » Blog Archive » One cancelled plan, thousands of wasted hours Says:

    [...] and Mrs. Sundby, the broker or brokers, the hospitals and doctors, the insurance companies and the endless line of ill-informed government bureaucrats (not to mention the commentariat’s time) — thousands of hours have been spent in the [...]

  26. johnt Says:

    Your government in action. Good at some things, feathering the nests of it’s civil servants, running up mega-deficits to no discernible effect, distributing largesse to it’s coterie of camp followers, called contributors, abandoning embassies & staff in ugly, islamic countries, the latter to their death, and to keep this short, transporting the first lady,? to her multiple never ending vacations, accompanied by her coterie of hangers on and parasites, all of them presumably as ignorant and gross as she is.
    In other words they’re good at what they ruin.

  27. Ymarsakar Says:

    Humans are just rats that are put in a maze by God, who created evil.

    But if you change the Leftist doctrine slightly, you can say American patriots that are treated as animals are just rats that are put in a maze by human Democrat rulers, who created evil.

    Cosmology and metaphysics reconstructs itself even if they kill God. Killing God won’t kill evil, though.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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