Friday, December 11, 2015

Would You Like Fries With That?

What happens when you take a complex product, say like health insurance, that is tendered via a legal and binding contract drafted by lawyers and allow the public to decide what is good coverage?

And then further complicate it by allowing(?) lawyers in DC, most of whom have never held a real job, much less in the insurance field, draft new rules for designing, rating and distributing this product.

As if that isn't bad enough, you allow someone who completely botched the state workers comp program software overhaul, to oversee the implementation of a completely new software build. The new build is the Marketplace, originally named the Exchange.

For the piece de resistance you hire "navigators" with no prior health insurance experience to explain how coverage works and help consumers make wise choices.

Well, you decide. This is from a colleague:

I got a call from a client I enrolled in 2015. She tells me she had major issues with the carrier she had this year and wanted to go with a different carrier for 2016. She also told me she called and the rep told her she could switch to a different carrier for about the same price as she is paying now. Client is a heavy usage consumer (many claims) and will be having neck surgery in January.

Did  the Navigator look up her doctor and scripts?

No, should that have been done?

Would you mind if I reviewed the carrier and application on

Sure, go ahead.

In reviewing her application the Navigator failed to set her as smoking status. Also they didn't look up Dr.'s or scripts.

When I told her that her plan was going to be $221 per month vs. the $96 she was quoted by the Navigator she hit the roof accusing me of trying to put the screws to her. I tried to explain the error but this woman just flipped out. I tried to move on to the Dr. search part which I eventually was able to do. In searching for her Neurologist I found he was out of network for the new carrier chosen by the navigator at

Her upcoming surgery had been planned for a year and everything was in place to move forward.

Everything except her doctors were not in the new carrier network.

I tried to explain it to her and I realized I had more intelligent conversations with walls.

In the end I get another call from her telling me that she contacted the new carrier and they stated that the Neurologist was in network. She told me to cancel everything that I had done to keep her with her current coverage. I asked for the number so I could call. When I called the customer service agent stated the doctor was in network for some plans, but not for exchange-based plans.

I tried to call her back last night to re-explain things to her for her own well-being.

Then I realized something....I've given enough to try to help this person who clearly was going to be an on-going problem and in the end a loss to having to be heavily involved.

This is not my client, but one that I would have fired a long time ago. The situation above was relayed by an agent I know and is his account of the challenges consumers face when dealing with yo-yo's that answer the phones at

Two weeks ago they were asking if you would like fries with your order.

Today they are giving health insurance advice.


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