Pirate's Cove

The heck you say

Help! I can’t use my Obamacare benefits

Jeanne Patterson really needs to see a doctor but had to cancel her appointment last week.

Why? Because her new Obamacare benefits were not in order, forcing her to spend hours and hours on hold with her insurer, Independence Blue Cross.

Many folks who signed up for coverage through the state and federal exchanges are running into roadblocks now that they are trying to use their new benefits. And though exchange officials and insurers have urged consumers to call their insurers if they encounter problems, many say they either wait endlessly on hold or get the runaround. Coverage for the first wave of Obamacare applicants took effect Jan. 1.

Patterson’s journey started New Year’s Day, when she landed in the emergency room for a stomach ailment. The Independence policy number she received didn’t work and the hospital required her to sign a form saying she would pay for care herself, though it agreed to bill her later. She then received an ID card for her HMO plan in the mail a few days later, so she made an appointment with her primary care doctor and a gastric specialist for follow up.

But when the 59-year-old went to her doctor last week, she was told he couldn’t see her because she hadn’t designated him as her primary care provider. If she wanted to be treated, she’d have to pay for the visit and lab work and request reimbursement. She spent an hour on hold with Independence trying to fix the problem and left the office without care.

She hadn’t designated that doctor as her primary care physician, which is a requirement. A “mandate”, if you will. So, she could not make the appointment, at least in a manner that would be covered by the insurance. When she went online a did so, that meant she would have to wait til February for an appointment. So she spent hours and hours calling the insurance company, without being able to talk to anyone. Independence told CNN that everything was in order, and they do not know what the problem was, and to “give them a call”. So there’s obviously a huge disconnect between what everyone knows and what the insurance company is telling the doctors.

This, and similar stories, are happening all over the country with Obamacare coverage. And, let’s be honest, this is a short term issue, at least in terms of making sure that people have coverage and everyone, especially the medical professionals and all the systems and people at the insurance companies, know it. One would have thought that everyone involved, meaning the insurance companies and government, would have worked to make this work right off the bat, instead of giving fodder to those who are against Obamacare. Instead, this whole thing highlights why having the government intimately involved is a Bad Idea.

But, the poor customer service, the long phone waits, and other issues will most likely continue. And rationing is coming. For one thing, when you artificially reduce profit, something is going to suffer. That will be the number of low level customer service reps on-staff. I know lots of folks have always thought insurance companies are big meanies, and surely there are bad stories out there, but most have few problems. In all the years I’ve been working and had insurance, multiple companies, I’ve never had a problem. In fact, I’ve always had a good experience in terms of getting help (except for one time with car insurance, but I still received quick help, and I blame the small agent). Now Obamacare looks to add tens of millions to the insurance rolls (which would be a good thing if the legislation made sense and wasn’t a complete disaster) while controlling costs. Again, something has to give, part of which will be customer service on a permanent basis.

But, remember, “lane closures”.