ACA Admin Nightmares - Welcome To Reality!

With 14 days left in this Special Open Enrollment period for the initial sign up period of the Affordable Care Act I feel a bit exhausted and vindicated that many of my predictions about the roll out have come to fruition. This post isn't about "I was right", it is really about perspective and trying to craft a strategy that will help us navigate the current environment.

Let me dive straight in and offer a quick summary of the current situation and provide some guidance.

Technology Has Failed Us

It is obvious that the technological issues with Obamacare's rollout including the government website, quoting platforms, and front-end systems at each carrier were not well designed or prepared for the initial opening of the Open Enrollment season. Even now, the government still reports issues with enrollment data transfer problems and clearly we should have no confidence that your sensitive information will be protected when shopping for coverage online on the government site.

Security concerns with the government "" site remain high, so I think that clients should avoid that method of obtain coverage. If you feel like you might qualify for a financial subsidy, please contact us and we'll help you get through the process and approved without using the government internet site to apply. Please click here to connect with us - CONNECT.

Blue Cross continues to suffer from computer issues. A great example that highlights the trouble is that agents often cannot confirm if a client has paid their initial premium. We traditionally email clients with their policy # and confirmation that their policy is active, in this new environment, we can't verify their payment status!

Insurance Company Struggles

For the most part, our clients have avoided the nightmares of lost data or fouled up payment issues. Having said that, we have seen about 3% of our clients suffer some issue related to their specific administrative cases. These problems result from issues such as double creation of policies (double billing), inability to receive pharmacy benefits or confirm health insurance policies in force (even though premium was paid), and finally the loss of applications that were mailed in or faxed in.

Stress Reveals Weakness

I've always said that high stress environments reveal character and unfortunately cracks in the armor of organizations and people. I think we can classify these times as stressful for all of the health insurance carriers. To give you an idea of what I'm seeing right now, I'll highlight issues we deal with daily. Obviously this information is based on personal experience (yours may be different), but it does bear heavily on the recommendations we make as we wrap up the Open Enrollment Season.

Sit Back and Relax - You'll Hold For An Hour (If You Are Lucky)

Texas Health Design works hard to provide world-class service to our existing and new clients. We absolutely hate to tell any client, "just call the insurer" and thus we spend a lot of time each week dealing with the insurance carrier to save our clients time and frustration. Over the last several months, we've noticed our time on calls with carriers increasing. In December all the firms were overwhelmed by call volumes and the massive wave of people signing up or trying to make initial payments simply was too great for the carriers to handle. Now, several months later, we've noticed that Cigna and Humana consistently answer quickly and are able to address problems immediately. Unfortunately, Blue Cross is plagued by massive holds and many service issues that go unsolved. Over the last week, I've spent more than 10 hours on hold or on calls just with Blue Cross! As you can imagine, we discuss this inability to provide service as a key consideration in the purchasing decision.

No One Takes Ownership (Blue Cross)

After extended holds and long conversations with insurance companies I've found that several firms address problems quickly and at least one is not equipped to help. I've had many experiences that simply make you laugh and others that want to make you cry. I have had several examples in the last week where representatives at Blue Cross have suggested the strategy of "just wait and hope that it gets fixed", one told me that I needed to call another number (the government help-line) which is wrong since it was an OFF-EXCHANGE Blue Cross Plan, another rep suggested that I was expecting too much to have a clients application and policy established after 14 days, and another that simply told me there was no solution to my client's problem and since I was an agent I had called the wrong number! Laughable and sad in a twisted way. The best way I can describe Blue Cross now is that they are simply overwhelmed and the volumes have destroyed their ability to help and show ownership of any problem they create. They are a perfect illustration of what I think of when I envision government bureaucracy (except they aren't the government, yet). To be honest, I've had flashes of interaction with reps at Blue Cross that want to help and have asked me to send them copies of applications to expedite the process......the only problem has been that they don't do anything once they receive them!!! The examples certainly highlight the breakdown of an organization flooded with too much business.

14 Days Left!

Yes, I'm not happy with Blue Cross, and I'm certainly mentioning the customer service issues so that you'll examine all the facets of the insurance purchasing decision. Blue Cross has solid plans, good pricing, but ranks absolutely last in my evaluation in terms of client service for individuals and families. Can you imagine needing a claim issue resolved in this environment?

You have 14 more days to obtain coverage unless the Obama Administration extends the purchase deadline (they should!). If you are in the Austin area, Humana and Cigna have great plans that are priced well below comparable plans from Blue Cross. In the Houston market Blue Cross seems to be priced much more competitively and thus we've sold more of those plans. In the Dallas area, Cigna seems to be our best priced option. No matter what pricing has been for other clients, we will help you evaluate your situation and then help compare the plans to find the one that fits your budget and needs.

Please contact us at or simply click here to GET A QUOTE - to begin the process.

Do you know if you qualify for financial assistance? We can help you go through the process without risking identify theft on the government website. Please contact us at 713-422-2935 as soon as possible. You have 14 days left!

Jason Bohmann
Texas Health Design