I have just completed a marathon of an effort to get health insurance for my disabled brother for whom I am legal guardian. It began in March and was finally accomplished in August. I must have invested days or weeks worth of hours in what began as a simple question to find out if he qualified for retiree medical insurance from the company that he worked at for over thirty years.
I never spoke to anyone from the company he worked for. They shielded themselves by using an outsourced benefits administration company. The outsourced company was very limited in what they could do and if one needed something beyond their limited scope of services, the only recourse was to write a letter to the plan administrator. The benefits administration company could not even tell me if my brother qualified for insurance. So, I wrote a letter in April and never received a response.
Nearly every time I called, the benefits company could not find their copy of the Letter of Guardianship which allowed them to convey information to me about my brother. I sent it four years ago. It reached the point of ridiculousness and I must confess, I think my blood pressure must have skyrocketed when it happened for the third time within two hours.
My brother needs the insurance primarily for prescription coverage which left us with monthly bills in excess of $500.00, since he had hit the infamous “donut hole” in his Medicare prescription coverage, which called upon him to pay his total prescription costs out-of-pocket for the next $3,000.00 plus. His retirement income barely paid his expenses prior to hitting the donut hole. The new health care legislation allowed a rebate check of $250.00 for those in the donut hole for this year which was a drop in the bucket compared to his prescription expenses. At points his outstanding pharmacy bills were over $1600.00.
I can easily launch into an episode of fiery indignation when I think about how messed up our system really is. Millions of elderly people who must be totally lost trying to navigate interactive voice response systems that they encounter when they call their insurance companies and government agencies. These programs are designed to keep you from talking to a person who might be able to offer a simple answer to a simple question.
Customer service is what I am talking about… and it has gone the way of the dinosaur. It so awful, that whenever I encounter even semi-adequate service, I thank the person profusely. On those rare occasions, I become a cheerleader for that company.
Advocacy is the other issue. There are people with little relational capital, limited access to the Internet, limited knowledge of how to resolve their concern, a lack of understanding about the steps they need to take to improve their plight, and a frustration with a complex and fragmented system. Many have become cynical or have been taken advantage of.
Originally published September 1, 2010.
