This post originally appeared in part on Yelp.
People of Yelp: I give you the ongoing trials and tribulations of one man’s struggle against the inimical monolith of public-sector despair that is the MA Health Connector!
Let me start by getting a few things out of the way:
I like paying my taxes;
I’d gladly pay more taxes to support a single-payer healthcare system;
I like bureaucracy and big government and citizen welfare;
I voted for the President who put the Affordable Health Care Act into practice;
I have called the Health Connector 36 times and counting (no exaggeration here, as my lengthy account will bear out below) and my health insurance is STILL a mess.
The MA Health Connector is an administrative abomination. If ANYTHING goes awry in your application process, or anything is slightly out of the norm, you’re in for a ride. Here’s the gist of what’s wrong with this organization:
The Health Connector routes its calls to call centers all over the country, meaning trying to talk to the same person about your case is like playing Russian roulette without bullets in a padded room because you’re not allowed to even shoot yourself in the face. CSRs at the Connector do indeed have ID numbers assigned to them, but good luck trying to find someone you talked to in the past. They refuse to transfer calls (even though they can find fellow employees, even across call centers), they won’t do conference calls, and they can’t provide confirmation numbers for anything they do. In short: it is impossible to hold a CSR accountable for anything they promise over the phone.
The Health Connector’s staff are, on the average, jaded and lacking in compassion. Actually, they remind me a lot of Donald Trump: they eschew facts for bald-faced lies about the organization’s policies whenever dealing with the truth becomes inconvenient. I don’t blame these CSRs entirely: I once worked as dispatcher at AAA, so I know what it’s like to do thankless work and get irate calls all day. However, if I screwed up as many cases as the Health Connector’s crew has screwed up in my tenure at AAA, at least AAA would have the good sense to fire me. On Yelp I see the names of CSRs who are still working there, even after having also screwed up my account months and months later. The Health Connector is so poorly managed that it handcuffs its staff through lack of training, technology, and escalation, and we the people get to deal with the fallout.
The Health Connector tracks status information by entering things into a spreadsheet that gets passed along for processing in order of the entry of rows of instruction. Let me repeat: this is done in a spreadsheet. By hand. I learned this from a supervisor after a great deal of painstaking interrogation. Meaning that at no time can any CSR actually know the status of your account. It is like “the stack” in Magic the Gathering, except you are a blind person and your opponent is a doorknob. Let me further illustrate the insanity of tracking the status of a case in a spreadsheet that you pass back and forth between departments: If one line of the spreadsheet instructs, “Invade Poland,” and 670 lines of Greek poetry follow before a contradictory instruction to “Not Invade Poland,” Poland will be burned to the ground before anyone realizes. This is the single most ridiculous flaw in the Health Connector’s entire system, and it’s a miracle that they haven’t killed thousands of people already by preventing them from getting affordable access to medical services.
The “Billing Department” is a shadow organization within the Health Connector, more secretive and inaccessible than I daresay the Syndicate in the X-Files. Proclamations will come from the Billing Department in one of two ways: mysterious, inexplicably wrong balances sent by mail and usually out of date by a few weeks, or oracular pronouncements enunciated by the lips of mere mortal CSRs who can do nothing else except obey.
No matter how many times you call into the center, you will always have to reiterate your name, phone number, address, email, and social security number to begin discussing your problem. A mild annoyance, perhaps, until your 36th time doing so.
The complex, branching voice menu system that deposits you into Connector’s Sisyphean den of torments is useless and will only ever lead you astray or keep you on hold for 20 to 40 minutes. Always, always choose the option that’s phrased as “I have questions about my premium bill.” Because this involves money, it will get you a CSR almost immediately. All the CSRs solve all the same problems, so it makes no difference who you speak to. In fact, you could probably speak to your therapist and get your problems solved faster.
The distinction between “supervisor” and “CSR” is a slim one at best: the only difference seems to be that supervisors are slightly more knowledgeable than their counterparts, kind of like what the Uruk-hai are to the Orcs in Lord of the Rings. The moment a CSR becomes combatative or demonstrates his/her ineptitude, it is advisable to demand a supervisor and threaten to just wait forever on the phone until one becomes available.
Be aware, however, that there are no secret doors beyond the supervisors. These class of managers, beleaguered and apologetic at best, have no power to speak to the Great and Powerful Billing Department, nor to make any changes to your account. Think of them as dimwitted mice in a laboratory experiment forced to push tiny objects into a chute so that they can feed themselves. Except that the tiny objects—your pleas for help—fall uselessly into Mount Doom whilst the dark lords within the Great and Powerful Billing Department laugh mercilessly at your misfortune from atop Barad-dûr.
And so begins my journey into the Health Connector, one April evening after having left my post at a publishing company in a hurry, to become a freelancer full-time. I was young then, full of aspirations and hopes, eager-eyed with long locks of scarlet hair and all the women in Hobbiton thought I was a catch. But anyway:
April 24. Like a good little hobbit I buy my overpriced health and dental plan from the public exchange on April 24, 2015, shortly after the “enrollment deadline”—the first and worst mistake I can make. Word to the wise, my friends: always end your employment when it is convenient for the government, or else there will be dragons. In any event, ending one’s employment is a “qualifying event” to purchase health insurance, the only problem is that if you buy between months, it doesn’t start until the next month. So by buying in after April 23, my “effective date” is June 2015. However, I need medicines in May, so the helpful CSRs at Neighborhood Health Plan (kind of like the elves of Rivendale) tell me that I can put in a “retro-request” with the Connector to move my effective date to May.
May 8. I call into the Connector to have my effective date retroactively moved from June to May, so that I can pick up prescriptions during the month of May and go to previously scheduled doctors appointments. This first call takes two hours of speaking with several different Health Connector automatons, one of whom tells me it is impossible to receive a confirmation number or written proof of the retro-request, that the whole process can take up to 60 days, and that I must call back in two weeks to check on the status of the transaction.
May 18. I call back to check in on my friends at Mordor. I am told that the previous CSR I spoke with hadn’t indicated the “reason” for the retro-request in “the notes” and so it was rejected by their “processing department.” Curious facts, I think! For not only was my retro-request filled AND denied in less than 10 days, but it was done so with the added benefit of REMOVING information from the case! So, after speaking with a supervisor, I am told that while it will take up to 60 days to process from today, I can go ahead with my appointments anyway as the coverage will be retroactively valid once everything gets sorted out. She is again unable to provide me with either a confirmation number or written proof that the retro-request is filed, and I leave the call with the comfort of knowing nothing definitive.
May 19. I call the elves at Neighborhood Health plan to verify this bit of lore espoused by the Health Connector, but my insurer sagely assures me that it will charge the hell out of me if I decide to go to my appointments or pick up prescriptions during that limbo of 60 days when my “effective date” is up in the air. I instruct the insurer to make a note in my account that I do not want my effective date moved. The elves, being carefree creatures of nonconformity, toss my note out the window.
That same day, I gather a small army of wits and call back Mordor to cancel the retro-request, sternly and with lots of halberds. The CSR explains that she was canceling the retro-request, “effective immediately.” Again, I request proof, but the CSR insists that the proof is in the pudding, and I cannot have any. I lost this battle, I realize, but perhaps not the war. I cancel my doctors appointments and am forced to wait to pick up my prescriptions in June.
June 12. I receive five bills from the Health Connector, all postmarked on the same day, each with different amounts due, to my tearful glee and consternation:
Dated 06/01/2015 for “Coverage Month” Jul 2015, $34.64 due by 6/23/2015
Dated 06/01/2015 for “Coverage Month” Jun 2015, $0.00 due by 6/23/2015
Dated 06/01/2015 for “Coverage Month” Jul 2015, $670.10 due by 6/23/2015
Dated 06/01/2015 for “Coverage Month” May 2015, $0.00 due by 6/23/2015
Dated 06/01/2015 for “Coverage Month” Jun 2015, $335.05 due by 6/23/2015
Perplexed by these bills, I call Mordor that very same day to demand some answers. The CSR, surprisingly whimsical and friendly this time (I suppose she is a goblin, they are not really so bad once you get to know them), explains that my request from May 19 to cancel the retro-request was never processed, because the previous CSR failed to submit it to the “Billing Department.” A chill goes down our spines, because to forsake the will of the Billing Department is to forsake life itself, we know. As a result, the May 8 retro-request was approved, moving my effective date from June to May. Hallelujah, I thought, for now I can claim benefits from my plan after I finish building my time machine! Weary of the Health Connector charging me for May automatically through my EFT account with them, I ask my goblin friend to process an “EFT cancellation request” and submit another retro-request to move my effective date back from May to June. Together, we collude to pay for my next month’s insurance by check, that way I’d still maintain coverage while all of this is going down. “Two days,” she says, “and we will be forever free of Mordor’s tyranny!” and we go off into the sunset together.
June 23. The Health Connector withdraws money for May and June anyway, on top of the check I mail to them manually. This totals in a whopping three months of health insurance and one month of dental insurance: $1005.15 and $34.64. All coming out of my bank account at the same damned time.
June 29. Deeply saddened by the Dark Lord’s betrayal, I call to inquire about the Health Connector’s vicious pillaging of my bank account. The CSR, fearful of Sauron’s rage, hangs up on me during an extended hold, and the second one I speak to explains that the EFT cancellation request I made on June 12 was never actually filed, but that the effective date of my plan had since been moved back to June. He also insists that the EFT cancellation request will actually take 30 days to process (a falsehood! But who can know, really?), and refuses to allow me to speak to a supervisor by lying that there are none available. He says he will file a “refund request” for the amounts indicated and file another EFT cancellation request: also a lie! Ah, but at least the Health Connector is consistent in its inability to tell the truth, ever.
July 8. I call to check in. I’d text, but you know we’ve gotten so close now, I think it rude not to call. Determined to gather evidence for a dispute I am about to open against the Health Connector through my bank for the stolen two months of funds, I grill the CSR about the time it takes to process an EFT cancellation: 2 to 3 business days, she says–but like most Health Connector-related “facts,” this cannot be substantiated with any physical documentation, except the sound of her monotone voice reading it aloud from her computer screen. My quest for evidence leads me to a supervisor named Michelle, who in turn admits that the second EFT cancellation request I filed took effect on June 30, and confirms that the original EFT cancellation was not filed because of the Health Connector’s mistake, meaning that the Health Connector wasn’t authorized to break my bank. So with little faith that the Connector will refund me what they stole, I proceed to open a dispute through my bank.
Bankers: They may be evil incarnate, but they do see reason! By mid-July, the bank gives me back my money and rules against the Health Connector. Are the bankers dwarves, or men? I cannot say, for the metaphor is getting spread too thin. But now the Connector owes me nothing, and I think myself free for a time. I send a check to get coverage for August on July 24 with the dim hope that perhaps everything will finally be in order.
July 13. Alas: I receive a fascinating bill instructing me that I am past due a month, and that my insurance is soon to be canceled. Impossible! I say to myself, but the Health Connector itself is a feat in Kafkaesque impossibility. A random CSR answers the phone and says she will send another “note” to the Billing Department, as she can see nothing wrong with my account. Nothing wrong. Nothing wrong.
August 18. I need some medicine. So far I have not used my insurance for anything, I am just sending the government money, for no reason really when it comes down to it, gambling every month in an absurd game against my destiny. I decide to pick this medicine up at the local CVS, and learn that my insurance has been rendered “inactive.” I am refused the medicine unless I pay full-price ($400 for something that costs $25 with insurance). I feel like the hobbits returning to the Shire after it has been taken over by the dark wizard Saruman. That same day, I receive another fascinating bill that declares I owe (negative?!) -$300.41 for my dental plan (a plan that costs $34 a month, mind you), and $1005.15 for my health–an account for which I was overcharged nearly $700 but a month before. Fascinating. Does the Billing Department practice its own non-Euclidean mathematics, unknown to all but the fetid worshippers of Cthulhu? Knowing that I owe nothing to the Connector except an upcoming payment in August and a swift kick in the face, I call Mordor to begin my investigation. The CSR explains that likely the Billing Department applied my payment from July 24 to my dental insurance, because they need to have monies deposited to them in two separate checks, on a silver platter, delivered with the seal of the king in a golden envelope, at the third hour of the blood moon. She also says she can do nothing about the maniacal balance her overlords have cooked up except to “put in a request to billing” again.
Undeterred by her uselessness, I sit on the sidewalk that same day in an attempt to reach Michelle, who like Galadriel may possess the tools I need to defeat the dark lord. Of course, because the Health Connector routes each call to a random call-center-kingdom anywhere in the country, I must first find where she may be hiding. I reach a CSR named “Creal” who promises to send Michelle a message to call me back. I am not hopeful.
August 18, 4pm. Michelle calls me back, but I fail to pick up the phone in time. Despair! It is like the Ring falling out of one’s fingertips into a dark pool! I call back the next hour, but the number she leaves in my voicemail leads to the black hole of the Connector’s main line. I encounter a combatative CSR named Lucesha, who insists it is impossible to reach Michelle and won’t listen to me, so I immediately escalate to a supervisor. The supervisor, a rather congenial man whose name escapes me, gets up to date on the Billing Department’s mysterious math, and he discovers a note from Michelle: the Billing Department still hasn’t reset the effective date of my plan back to June (despite the “confirmation” offered to me on June 29 by yet another know-nothing CSR), so they think I owe them the month of May. May! A month I spent nearly 8 hours on the phone over several days trying to get coverage! This supervisor is sympathetic, which only raises my suspicions further. He says he will put in “a note” to my insurance to take off the hold while billing sorts itself out, and promises that Michelle will call me back up to 3 times in the next few days. I do not hold my breath.
August 19. I call my elvish insurer in search of sanity. Nothing has changed: Neighborhood Health Plan spoke to the Billing Department, but the Billing Department still thinks I owe them $670 dollars. I insist that the insurer call the Health Connector and get the latest information. By sheer luck, I reach a call center in the Health Connector that actually physically contains the elusive Michelle: a lowly CSR relays messages to her across the vast gulf of space and time, and there is a commitment to call me back by 4pm on the same day. Such expedience is beyond comprehension for the Health Connector.
And so we reach the present moment, People of Yelp. At 4pm on August 19th, I speak to Michelle, who tells me the most confounding detail of my story yet: on May 8, when I first requested the retro-request that would move my effective date from June to May, it actually took only three days to approve my request, despite a MONTH of the Health Connector informing me, by way of no less than five different CSRs and three supervisors, that it would take 60 days to alter my plan. What does this reveal? Either that the Health Connector’s CSRs can never actually know anything about your case in real time, or that they’re all shockingly incompetent. (The real answer is both.) What’s more: the Health Connector refuses to move my effective date back to June and thereby make my insurance active–despite the fact that I have paid in full for my coverage and am required by law to do business with this public exchange–until this powerless supervisor can prove to it that her own CSRs mismanaged my case. So I am effectively forced by the State to pay for insurance I cannot use!
To make sure that we fully grasp the implications of this system:
The Health Connector does not and is systematically incapable of providing its customers with evidence or confirmation of anything it does on their behalf, nor access to the notes it takes from call to call, meaning any dispute against you is one in which you, as a customer, cannot participate;
Its Billing Department is completely inaccessible to its customers, even though it is the sole decision-maker in the organization;
There is nowhere to write to anyone with authority greater than the call center;
Supervisors and CSRs can do nothing to alter your account, because they’re at the mercy of the Billing Department.
Imagine if I needed medicine from this system that was actually keeping me alive? Imagine if I didn’t have the luxury of time to make this elaborate account of the Health Connector’s incompetence because I had to keep down two jobs or take care of three children? The fragility of this system represents an enormous risk to the public health of the people who depend on it as the sole (and mandated!) provider of insurance in this state. As a public service, the Health Connector is a disgrace to the Commonwealth, a byzantine, completely opaque system, inured from accountability within and without. I don’t know who we should call, or who we should write to in order to fix this system. But we need to fix it, and fix it fast.
Update, August 20. The ever-faithful Michelle calls back to inform me that “things are moving” and “being processed.” She seems quietly amused by the flatness of my resignation. The unknowable Billing Department has decided to move my effective date back to June, which would make my account current, but these are words, words, words, Lord Polonius! My insurance still remains “inactive,” and I wait.
DQuinn.net - Boston freelance web designer Daniel J. Quinn's WordPress-powered Web portfolio.