HEALTH PLANS/TECH/POLICY: Health plans and brokers — pathetic, pathetic, pathetic

I’’m on my way to HIMSS today but in the meantime, more on my ongoing personal struggle to get health insurance…..

Remember that I was kicked out (or the association that I bought my insurance through was kicked out) from the PacAdvantage buying group? So my choices are to go back to the individual market or, luckily as I’m now “domestic partnered”, to pay some $450 a month for the rich benefit plan on my partners insurance.

So I finally got around to fixing myself short-term insurance while I’m being underwritten by Blue Shield and Health Net for standard  individual insurance. For the short term insurance from Blue Shield the application I initially started last year puzzled me because the common generic medication I take for gout wasn’t on the approved drug list (It costs $40 a year!!) but a whole bunch of much worse medications were! I’d saved my application from last year because it itself didn’t enable you to change the desired date of coverage but you could restart it and it would start on the next effective date. But if you went “back” to change the date, you lost all you’d put in. A stupid UI screw-up which I wrote about when it happened last year. When I re-continued my “saved application” it denied me. But I had in between talked with the Blue Shield people who told me that the drug list had been discontinued as part of the short-term program. So I started a new application (start counting how many I end up filling in) on eHealthinsurance, and got approved — or at least got accepted and later (with no new email informing me) got a form in the mail saying I was approved. Oh, and for the short term coverage, you can’t set up automated payment or credit card even thought you pay for the first month in advance online with a credit card. Instead, you have to send a check. Pathetic.

Then I started the next application for normal individual HDHP insurance with HealthNet, also on eHealthinsurance. It asked me a bunch of the same questions, none of which carried over from page to page. It even asks you to fill in the same doctor’s information on 3 different pages (it asks about conditions, then drugs, then visits — all were the same one shot visit to one doctor for me!!) It never gives you the chance to carry over the information or tick a box saying “same”. And of course nothing came over from the short-term application I’d just filled in, even though it’s all in eHealthinsurance’s database. The UI on the form and the user experience is pathetic.

Now of course I get an email from eHealthinsurance saying that HealthNet needs more info, and will be mailing me a form to fax back! So much for the “e” in their name.

As this was going on I’d called Blue Shield to ask about their guaranteed issue plan (Over $400 a month for dreadful coverage). Later on Blue Shield had a different agent call me to direct me to her website where I could download a PDF application, fill it in bt hand and fax it back. Don’t forget, AHIP tells us that this is one of America’s most technologically advanced health plans! Ten years ago they allegedly did a deal with Healtheon to help their customers apply and manage their benefits online—oh, how far we’ve come! Oh, and the PDF crashed my system because I didn’t have the latest version of Acrobat, so I had to download that too. Pathetic

And of course the joke is I am already a Blue Shield customer via the group plan (or was till the end of January) and am on the short-term product right now!  And I was a customer on their short-term product back in 2004 when I last had surgery. So I’ve been constantly covered by them since 2003. They could look in the claims database for everything that I’ve had in the past 3 years. But none of that information appears to be available. Pathetic

In the end I thought that I’d go back to eHealthinsurance rather than fill in a paper form. So I find the same plan and the same price as Blue Shield offered me direct, and applied for that. They of course wanted all the exact same information that HealthNet wanted. Of course all that information is in the eHealthinsurance system. The eHealthinsurance customer rep told me that it was fine to apply for multiple plans at once. I asked her if, when I gave the same information to a different health plan, would they underwrite me the same way and come back with the same price? She said, no they vary greatly.

BUT I could not transfer the information from the HealthNet form to the Blue Shield form even though it’s all in the same damn database! So I had to re-key it in. She told me that I wasn’t the first person to ask for that function by a long chalk. And once again I couldn’t even carry physician information over from page to page of the application, even though you can go via eHealthinsurance to HealthNet’s electronic provider directory to find out information on the exact physician. But you cannot import it into the application form. Pathetic.

Now the interesting part will be figuring out a) what else the plans think they need to know and b) what rates they will charge once they figure out that I had knee surgery in the past — even though it’s only a minor indicator of whether I’ll need it in the future.

Meanwhile, eHealthinsurance says that when you look at its plans it gives you a comparison between them, but it doesn’t even put the most important single feature of a HDHP on the front page— that is the maximum out of pocket (i.e. your maximum exposure if you have a catastrophic event). And it doesn’t even define the maximum out of pocket the same way when you click through to it — for some plans the number includes the deductible, sometimes it doesn’t.

I had an email conversation with the preeminent medical director working in the corporate benefits world about this exact topic. He told me that he came to realize what a mess this all was when he was unable to figure out what was the best option for his mother among the multiple competing plans with different premiums and benefits in Medicare Part D. If I’m in the top 1% of Americans on this topic he’s in the top one or two period. And he can’t figure it out.

This is a world of deliberately confusing plans and benefits, presented in a deliberately confusing way, taking advantage of none of the technology that makes our lives easier in other areas of business. Pathetic. pathetic, pathetic.

And it’s a world that many many more people will be heading for.



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8 replies »

  1. > Sounds like we need better IT consultants
    Mostly we need better managers — the kind who understand the market and their own internal processes, and how to make the two meet in the middle: often in the information system. You can’t blame the techies for doing what they are asked to do, even if it takes them too long and they fall so short of perfection in the doing. Most (all?) of the time, they’re given a ‘suboptimal’ target.
    It would be like telling the WWII fighter pilots “Only shoot at the propellers of the enemy airplanes — that’s what makes them fly and we don’t want you wasting bullets shooting other parts of the plane. And don’t bother with bombing runways or fuel tanks or shooting at cargo planes either — those things don’t shoot at us. Just focus on the propellers.” When the conscripted pilot says “But Sir, enemy planes don’t fly without fuel, runways, pilots, wings, oil lines, or spare parts either, so propellers are a really, really small part of the problem of enemy aircraft, and they’re hard to hit.” Then he is thrown in the brig for pointing out the obvious, er, I mean insubordination.
    The problem runs much deeper than this, but I’d have to get all philosophical to talk about it…

  2. Wow. What a brutal story. I went from reading the HIMSS coverage, which I sadly missed to this. Funny thing, last week’s BusinessWeek article “How Good is Your Online Nurse” discusses how *certain* insurer sites are offering personalized advice (hmmm) to plan members. The article mentions WellPoint, UnitedHealth Group, and Aetna and talks about how great the Aetna portal is. Even if it is, it doesn’t sound like it integrates lifestyle features that are on sites like myfooddiary.com and coolrunning.com. Still a long long way to go. Good luck with your insurance search.

  3. PS: We don’t use online enrollments because the clients would go to a different underwriting team than our current dedicated underwriting team. It’s basically that my wife would lose a little bit of control and she is a control freak.
    Besides, online enrollments make the clients really stupid like ehealth clients. Stupid clients create a Customer Service headache and we can’t have that. That’s why after 9 years we have never had one customer complaint. Different than Blue Cross (The Beast) by far.

  4. So your babe is on an employer-based health insurance plan. You did tell her that if she got ovarian cancer and couldn’t work she will be put to a short COBRA for insurance termination, too funny.
    Are you 2 so broke and strapped that she can’t afford real health insurance that she won’t lose if she gets cancer or in a terrible car accident? Your’re a hoot Matthew. You need to make some money.

  5. and Ron is a health care expert who can’t tell the difference between Blue Cross and Blue Shield of California, and whose own web site has NO ability to sign up online….

  6. Matthew you are not in the top 1% of IQ when it comes to health insurance, that’s for sure. You can’t even fill out a short term application, too funny. I told you how worthless Blue Cross is and after they dumped you and your damaged knee, you go limpin’ back for more, that’s pathetic. You know how ehealth is bid riggin. Their sponcered blogger never came back and answered our questions like she said she would.
    With our short term you can pay anyway you want. That’s just one difference Matthew. Now all of a sudden you finally disclose you suffer from Gout. What else haven’t you told us? Also, you are a Domestic Partner and can get insurance without being married? Who does your babe work for? It is a girl, right?

  7. Matthew – yet another excellent argument against the so-called CDHPs; although a unique angle – preventing claims by making it so hard to sign up.
    I’ve been warring with economists over at http://www.managedcarematters.com, and looking forward to you returning from your conference hopping and rejoining the fray.