Sunday 30 March 2014

The Health Insurance Answer That Took 3 Months

Photo
Credit Christoph Hitz

Email haggler@nytimes.com. Keep it brief and family-friendly, include your hometown and go easy on the caps-lock key. Letters may be edited for clarity and length.

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In this episode, a rare collision of the Haggler and the news. Our letter comes from a couple who have been trying for months to sign up for health insurance through Healthcare.gov, also known as the Obamacare website. And Monday, March 31, is the enrollment deadline, though the administration recently announced exemptions for people who had trouble signing up.

In other words, this column is sort of timely. The Haggler would like some credit for this. He'd also like to note that it is unlikely to ever happen again.

Q. As a regular reader of your column, I know that you have successfully slain many corporate dragons. But do you have what it takes to take on the United States government? In particular, the health care exchange set up by the Affordable Care Act?

I signed up for health insurance for my wife and myself through the online marketplace last November. But in January, my wife, Mindy, was denied a benefit from the pharmacy and was told she was not listed on the policy. This is a disaster. My wife has survived cancer, and she needs health insurance.

Numerous calls to the Health Insurance Marketplace have ensued in which it has been established that Mindy's name was, in fact, on the application I submitted and that for some inexplicable reason her name was not communicated to our insurer, Blue Cross and Blue Shield of Florida. We have been told on successive calls that there is no logical explanation for this, and that our complaint will be "elevated" and "expedited."

I write this in mid-March. Mindy has had no health coverage since Jan. 1.

I think it only fair to tell you that employees at my congressman's office have had no success in trying to rectify this situation. Is the Haggler ready for a big-time challenge? I hope so.

RICHARD AGLER, TAVERNIER, FLA.

A. The Haggler does enjoy a bit of goading. So, he contacted Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which oversees Healthcare.gov.

It would be fun to turn what follows into a lengthy tale, one in which the Haggler's swashbuckling tactics, cunning and perseverance triumph over an intransigent bureaucracy. But the truth is duller. A day or two after an email to Mr. Albright, Mr. Agler wrote, "I think we have good news."

A Blue Cross rep had contacted Mr. Agler, telling him that his wife's name had been added to the policy. Well, the Haggler is condensing a bit. It ultimately took a conference call involving the Aglers, Florida Blue Cross and C.M.S. (For some reason, those are the initials used by the Centers for Medicare and Medicaid Services. Maybe C.M.M.S. seemed too obvious.)

Within a few days of that "we have good news" email, Mr. Agler said that someone from the federal Department of Health and Human Services called, apologized for the problems and smoothed the way for the purchase of a policy.

"He said that he had spoken to Florida Blue and C.M.S.," Mr. Agler wrote. "He assured me that he will be 'tracking it closely' and gave me his office and cell numbers to call if I needed him."

On Wednesday, a rep from Florida Blue Cross called and confirmed that Ms. Agler is now covered.

Great. Case closed.

But what happened? Why was the simple matter of adding Ms. Agler's name to an insurance policy a three-month ordeal?

Continue reading the main story

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Here is where our yarn takes a turn for the inane. When asked for a reckoning, Mr. Albright of C.M.S. said that he could not discuss the matter because doing so would compromise the Aglers' privacy rights.

Fine. Mr. Agler promptly wrote an email to C.M.S. waiving those rights.

So. One more time. What happened?

"Unfortunately, I can't discuss individual cases," Mr. Albright wrote in an email.

Hmm.

"Here's a question that perhaps you can answer," the Haggler wrote back. "Why can't you discuss the Aglers' case?"

"We do not discuss individual cases," Mr. Albright responded.

"You mentioned that," quoth the Haggler. "My question is, why can't you discuss individual cases?"

"It's our office policy not to discuss individual cases," came the reply.

"I get that," the Haggler wrote, warming to the game. "Your office has a policy. My question is, what is the reason for this policy? If you don't want to answer that question, then just say you don't want to answer that question. But please, don't keep repeating 'Our office has a policy.' "

There was silence for a few days. When the Haggler tried one final nudge, Mr. Albright took to his keyboard again.

"We don't comment on individual cases," he wrote.

Perhaps Mr. Albright has since stepped back into the Franz Kafka short story from which he came. Or perhaps he's a real person, and a dedicated public servant, constrained by a policy that forbids employees from explaining the point of a policy.

Or maybe the C.M.S. is just badly in need of better public relations. It is hardly a secret that Healthcare.gov had a difficult start. People want to know that the government has learned from mistakes. Being willing to discuss those mistakes would suggest that it has. Deflecting questions about why it is deflecting questions leaves the opposite impression.

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