I posted a couple of notes about heatlhcare.gov in its early days (see, for example: Major Conflict of Interest with QSSI, the Contractor for the Health Insurance Exchange). Although CMS is boasting about a relatively large enrollment, things are far from rosy regarding the quality of this system. Here's an excerpt from an article by David Segal, the "haggler" who responds to requests for help directed to the New York Times (see: The Health Insurance Answer That Took 3 Months):
Our letter comes from a couple named Agler who have been trying for months to sign up for health insurance through Healthcare.gov, also known as the Obamacare website....
Q. ...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....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.”....
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 ultimately took a conference call involving the [the complainant], Florida Blue Cross and C.M.S. [to solve the problem]....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....“Why can’t you discuss the Aglers’ case?”“We do not discuss individual cases,” Mr. Albright responded.“....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.
I have had a similar experience with healhcare.gov and a state health insurance company. Here are the basic details:
- Working on behalf of a male relative, we applied for a health policy in late January of this year.
- Simply creating an account on healthcare.gov was frustrating. The first attempt failed due to a software glitch and we had to create another one with a different password. This was a portent of rough seas ahead.
- We were then advised on the web site that the state insurance company was "complete" and we would receive a bill shortly.
- In the latter part of February, about a month later, we called the state insurance company. They said that they had never received our application from healthcare.gov so there was no way that they could bill us.
- We called healthcare.gov again and the representative said that our problem would be escalated. We were told that we would be called back in about a week by a member of the escalation team. A week later, we called again and were told the solution would now take at least a month and we should just sit tight.
- We asked for a case number or trouble ticket number for future reference and were told that there was no such thing. We were told that they were making notes in our file.
- Calling healthcare.gov repeatedly in subsequent days, about half of the representatives told us that our record did not even exist. The other half found the record immediately but said that there was no progress on the case.
- We next called the state insurance agency. The representatives said that they could do nothing without their own nine-digit customer account number.
- Without any resolution for a month on the healthcare.gov side, we decided to work the state insurance side harder and asked them for an escalation of the problem. We had not thought about this earlier because we believed that the problem would get resolved on the federal side
- About eight days later, we received a call from the state health insurance company indicating that the policy was now in force retroactive a week to the time when his previous policy had expired. They offered no explanation about the failure for the completed application to be transferred to them.
Looking at these two episodes, I would describe this as an example of major incompetence regarding healthcare insurance on the part of healthcare.gov and at least one state health insurance company. I don't know where the blame lies. Here are my reasons for this conclusion:
- The lack of adherence to a standard approach for creating a web account and tracking a problem when errors were encountered.
- Once created, the inability to access that account on a regular basis by the customer service representatives.
- Interactions with poorly trained customer representatives and the inability to solve customer problems in a reasonable time.
- Placing responsibility on the customer to track problem resolution without any acceptable response on the part of the responsible parties.
- Worst of all, near-total opacity in terms of explanations by a government agency about the nature of a problem. In short, no willingness to accept responsibility for system failures.
The problems continue for healthcare.gov (see: Software Bug Takes Down Health Care Site). This latter article also references one Aaron Albright, Director, Media Relations Group at Centers for Medicare & Medicaid Services, mentioned above. Mr. Albright continues to be a font of optimistic news about healthcare.gov on Twitter. I also feel somewhat vindicated that I was unable to get any straight answers about my problem given that a representative of the New York Times had a similar experience.