California independent agency owner Susan Lundy didn’t have a Thanksgiving or a Christmas last year. Neither did Texas producer Kelly Fristoe, who missed out on Christmas shopping and a New Year with friends and family.
Both, however, are still manning the phone lines and answering calls at all hours of the day from clients who can’t verify their new health coverage
purchased through state and federal exchange plans.
“I’ve definitely had clients who have tried to use their insurance,” said Lundy, who owns Larkspur, Calif.-based Benefits by Design. “Their money has been paid, their check has been cashed, they’ve got contingent approval, and they don’t have their card yet.”
Some elementary producer work—including telling clients to print out “absolutely everything that says you’re contingently approved” and taking over phone calls to doctor billing offices and carriers—generally helps out, Lundy said.
However, while all health professionals Lundy has spoken to are willing to take standard co-pay in exchange for services (to be reimbursed by the insurer later), putting out these kind of fires is no picnic—particularly when it comes to dealing with carrier customer service.
“You can’t get through easily to anybody, and no, agents do not have a secret line that gets us through quickly,” she said. “I’m in the middle of a contest with two other agents [comparing wait-times] and whoever gets the award will buy lunch for the two other ladies. So far, 132 minutes with HealthNet is leading.”
Down in Texas, Fristoe said he has spent “a three-hour period” on the phone with Blue Cross Blue Shield, despite a reported 500+ employees manning phone lines.
“It’s total chaos,” he said. “I was looking forward to having some time to myself [after the Dec. 24 deadline], but healthcare anxiety is still at an all-time high.”
The extra work also leaves Lundy feeling very tired, and ruefully amused by her compensation
“I figured out that if I stop and calculate how much I’m making per hour, I’ll have to sue myself for not paying myself minimum wage,” said Lundy, who owns Sacramento-based Benefits By Design Insurance Services. “No one is going to stay in this business who does health insurance only.”
That level of weariness is shared among most health producers across the country, who are grappling with the problems created by a backlog of customers who purchased insurance late in December. The last-minute surge
means insurers must process applications, receive payment, print ID cards and return the verifying information in time for consumers to use their coverage.
Many have failed, meaning carriers must promise refunds to consumers who are paying co-pays not specified under their new insurance plans.
Public health officials are blaming the backlog on the carriers themselves.
“Insurance companies of this size should have been far better prepared,” Katherine Kokko, a New Hampshire public-health consultant told the LA Times. “They knew it was coming.”
Lundy, however, defended carriers from the criticism.
“What person would blame a carrier when they didn’t even have the information of who was enrolling?” she said. "I’m no fan of carriers any more than I’m a fan of [health exchanges], but I don’t think it’s a justifiable blame to assign to a carrier. I don’t think they got enough information early enough to be able to set things up the way they should have.”
Fristoe agreed, saying the extension of government deadlines for the open enrollment period meant insurers didn’t have a chance of responding in the necessary timeframe.
“When you sign up on the 24th of December, that doesn’t give the insurance company time to get your card to you in an already overwhelmed postal system,” he said. “Even UPS and FedEx didn’t make it on time.”
Lundy said she doesn’t expect carriers to catch up with the many demands on their time until at least the second quarter, which means producers’ days of “putting out fires and reassuring people” are far from over.
“After the first quarter, and not until then, do I anticipate we’ll probably have a breathing spell here,” she said.