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.