American’s don’t hate the programs and goals of government. They hate working with government bureaucracy. If the recent experiences with California’s Pre-Existing Condition Insurance Plan (PCIP) are any indication of how healthcare reform will play out; bureaucracy will kill Obamacare. The PCIP is a great program that inadvertently sabotages its effectiveness with poor customer service and burdensome regulations.
Full disclosure; this is the point of view of an insurance agent that fully supports healthcare reform and the extension of health insurance to American’s regardless of income or condition.
Great idea to help people today
The PCIP was included in the Affordable Care Act as a way to get health insurance immediately to those who had been denied previously because of pre-existing conditions. As a gift to the health insurance carriers, eligibility was limited to those who had been denied health insurance in the previous 12 months and had been without insurance for 6 months. In other words, these are people the health insurance carriers can’t make a dime from by insuring or represented an unacceptable expense risk. For all the negative baggage insurance companies carry, they at least understand how to run a business that allows the insurance agent to provide the necessary service to clients. By contrast, the PCIP cuts off the important insured advocacy role of the agent.
Special needs of clients not recognized
One of my most vulnerable clients was a gentleman that is autistic. He has virtually no communication skills and his bills are taken care of by a family trust. After we jumped through all the paperwork hoops, including submitting his birth certificate to prove he was a real American citizen, he was finally approved for the PCIP. Almost immediately after submitting the paperwork, with my name as the submitting agent, I could get very little information about the status of his application. Somewhere in setting up the billing address for the third party trust to receive the bills, not his residence, the ball was dropped.
Dead silence of the customer service representative
Shortly after approval, he was dropped for lack of payment because the trust never received an invoice. With a traditional insurance company, the agent is notified when a client has a late payment. The PCIP would not let me navigate the bureaucracy on his behalf to resolve the billing issue. They insisted they could only talk to the policy holder. Hello? He can’t communicate, he’s autistic. He doesn’t answer the phone in his apartment or open up the mail. When I explained all this to the PCIP customer service person all I got was dead air. Hey, thanks for your initiative to help my client! They wouldn’t even talk to his care givers that hold his Power of Attorney. There is a separate healthcare POA that they would accept.
Permission to share and make it difficult too
The only way any of us could discuss his billing issue was after we submitted the Permission to Share form. Unfortunately, the form is good for only one phone call. If we wanted to submit additional information and follow up, we would have to file a new Permission to Share form. At this point, the care giver and I were banging our heads against the wall wondering how this bureaucracy missed the big picture of helping the most vulnerable in our state.
PCIP has their own rules
In another instance, I have a client that travels out of the country frequently. His late payment caused an automatic cancellation of his policy. Obviously, the PCIP doesn’t have to follow the cancellation protocol and time periods standard for health insurance companies. Even though this gentleman is going through the appeals process for PCIP to recognize his late payment, if the cancellation holds, he must wait 6 months before he can reapply. Why? Because you have to have been without health insurance for 6 months in order to qualify.
Pick up the fax and TALK TO ME
Since I was familiar with the Permission to Share document, I was able to fax it over to the PCIP the next day after talking to my client. I called an hour after I faxed it over only to be told it takes up to 2 days for the form to get into the system. Why are they making it so hard for the insurance agent to advocate on behalf of the member? Agents only receive a one time payment of $100 upon the acceptance of an application they submit on behalf of a client to the PCIP. There is no residual commission. I am making the calls to the PCIP because my clients either can’t communicate because of disability or are working. That’s the job of an insurance agent.
Customer service is of little service
With my other health insurance carriers I have access to a variety of client information right through the agent internet portal. If I do have to call a customer service representative they are pretty knowledgeable and if they can’t take care of the issue, they quickly get me to another department that can address the problem. While I respect the customer service folks at the PCIP, it is evident that they have limited knowledge of health insurance and are further hobbled by excessive bureaucratic restrictions on offering assistance.
Ghost of DMV past
If the Covered California health benefits insurance exchange is any where near as frustrating as the PCIP, folks will label it a failure, even if it does work. Government is still saddled with the image of the overly bureaucratic Department of Motor Vehicles that everyone loved to hate. The DMV of today is nothing like the old slow and disinterested bureaucracy of 20 years ago. However, the ghost of DMV past has been resurrected in the new PCIP. May the PCIP die a quick death in 2014 and be replaced with a responsive health benefits exchange, Covered California*.
*The California Health Benefits Exchange announced in late October that they had decided to rename the department Covered California with a new logo. As of November 16th, they still had not added the logo to the California Health Exchange Website. If you Google “Covered California” the top search listing is for California Health Benefit Advisers that has a page called Covered California. They are a private company selling health insurance but all the text is about the California program making it look like an official government website. I think Covered California has already lost the marketing war and may lose the battle as they let confusion creep into the market place.