I was unintentionally uninsured, thanks to the Mass. Health Connector
I know my way around health care, but customer service mistakes made getting what I needed a maddening experience.
The Massachusetts Health Connector was the country’s first virtual market where people could buy health and dental insurance without going through an employer. Policy wonks call it one of the top such exchanges nationwide. In theory, it’s a wonderful option. In practice, it has frustrated insurance seekers since its launch more than five years ago.
Some of the initial problems have been addressed, but the Connector’s customer service still needs fixing to eliminate the confusion, misleading and false information, errors, and red tape that make it impossible for many of us to access the continuous coverage we need. Those problems have led to missed appointments, postponed surgeries, and days without essential medication — not to mention lost time and untold frustration.
Someone with my résumé should be able to navigate the Health Connector. I have a master’s degree in medical ethics, interned in a hospital, and was working in health policy at a nonprofit organization when my odyssey with the Connector began. I even have two doctor parents. But that wasn’t enough to get the insurance and health care I needed for the month of May.
I first called the health exchange in February, while still getting coverage from my employer, to ask about my options for the summer. I planned to leave my job in the spring and freelance before starting graduate school. A representative told me I’d have to wait to enroll until I no longer had insurance through my employer. I hung up smiling — she’d been so nice, and I’d crossed off one of the scarier items on my transition to-do list.
I waited until my coverage lapsed before logging into the Connector in early May. A drop-down menu allowed me to pay for coverage in either June or July, but it didn’t list May, so I called. The representative I talked to this time said I’d missed the deadline for May and there was no record of my previous call. Uh-oh. The rep asked if I needed coverage. I did. I have weekly physical therapy and see specialists. She reassured me: “If you need the insurance, I’ll get it for you.” She’d file a claim for me based on medical need. She talked me through the online payment process, and after it was completed we hung up.
Weeks passed. No word. I paid out of pocket for three physical therapy sessions. I had an upcoming appointment with a hard-to-schedule specialist, so I called the Connector — did they have any updates? The rep told me my claim had been rejected because I hadn’t paid. I explained that I had paid, with a rep’s help. After a hold, he told me it had been rejected because I didn’t meet their criteria for medical need. I could file an appeal, but, he cautioned, that process would drag into June, when I’d have coverage again anyway. I hung up and canceled with the specialist. By her next available appointment, I’d already be living in another state.
I’m relatively lucky — I had a safety net. If something catastrophic had happened to me, I could’ve re-enrolled in my former employer’s insurance plan. With very few exceptions, the Consolidated Omnibus Budget Reconciliation Act of 1985 allows recently unemployed people to access their former coverage for 60 days — but it’s expensive. One month of COBRA’s premium would have cost more than the physical therapy appointments I’d paid for in May.
Without a fallback option, a month without insurance can ruin your life. It only takes one accident. That’s why this is a social justice issue, not just an annoyance. Most people who use the Connector can’t get insurance through their jobs or spouses.
Though I didn’t post my complaints in Google reviews, a popular ratings forum, many frustrated insurance seekers have. They allege dropped calls, long holds, receiving false information, personal information not being updated after repeated attempts (leading to other problems), and coverage ending without grounds or warning. The average rating given to the health exchange by 209 people over the past three years is 1.5 stars out of 5.
An online Connector database captures official complaints and their outcomes, but those data don’t represent all of the Connector’s customer service flaws. In its recently released survey scores, almost 1 of every 5 customers in the first quarter of 2019 was either dissatisfied or very dissatisfied with the overall customer service. And, as my experience shows, a call that seems successful can later prove dissatisfying — yet there’s no mechanism to retroactively evaluate the call.
The Connector’s leadership recognizes that there are shortcomings. At a board meeting last December, Vicki Coates, the chief operating officer, said customer satisfaction scores are trending in the wrong direction and that “the customer experience is not where it needs to be for 2018, 2019.” To fix that, the Connector is switching its enrollment and billing provider from NTT Data to Softheon, a company that performs the same functions for Connecticut’s health exchange. The change in operations is scheduled to start June 1, 2020. And in August the board may choose a new vendor for its call center, according to Connector spokesman Jason Lefferts.
I’m skeptical this will help. Google reviewers rate the Connecticut exchange’s customer service poorly, and the Massachusetts Connector serves about 288,000 people, more than twice as many people as Connecticut’s. Massachusetts works with nine insurance carriers, compared with Connecticut’s two.
As of last year, the Connector’s in-house ombudsman team has been addressing all individual “escalated cases,” which Lefferts explains are “cases that require additional services beyond what the call center can provide.” Advocacy group Health Care For All credits the team with “quickly addressing” these cases. So yes, that helps resolve problems. But it isn’t the systemic fix that’s needed; callers like me shouldn’t be getting bad information in the first place. Is that a sustainable way to run such high-stakes customer service?
At the end of every Connector call, the rep asks, “Is there anything else I can do for you today?” Yes, there is.