Might Be In Over My Head…Maybe?

“Patience is a virtue.”

So I don’t ever like giving excuses but over the last several days its has felt like 2014 has been setting me up for what I can only feel will be an interesting year. Only 14 days in to this new year and I feel like saying…”Oh BOY what else is in store for me!?” And while not my normal, my excuse for missing my regular schedule of posting has been this interesting last several days.

It has been marked by two sad notes and lots of being on hold. First, a dear friend of our passed this Sunday morning. Up until his passing he was the longest living survivor for the City of Hope Cancer Center to be living with cancer. He was diagnosed in his mid 20’s with cancer and up until this last year had been winning his long battle with cancer in his 7th decade of life. I can honestly say I wish you all could have been blessed by knowing him, I know I was and I will miss him.

Second, this weekend I received a call that a woman I love dearly and consider my second mother found a lump in her breast. Monday it was confirmed to be stage two breast cancer. I know she will beat this yet I know from having been there with my own mother, a 17 year breast cancer survivor, the roller-coaster of emotions she and her family are going through. I have said it before and I will say it again, Please make sure you are doing your self-breast exams and are proactive in your awareness and understanding of the risks for breast cancer. For more information, please see my breast cancer awareness month post.

Despite these two sad notes, my new year has also been filled with joy of watching my son’s basketball team in some extremely stressful nail biter match ups…and yes they won them all! I am enjoying planning my husband’s 50th birthday party…and finding it very hard to believe that I am married to a half-century husband…I am so not that old…29 plus forever! Its been fun forming new relationships as I explore and work in my new role this year of basketball  golf tournament chair. And I have been super excited about a new series I will be launching on the blog. However, much of my 2014 (and some of 2013) has been spent on hold as I try to add my son to my insurance.

Whether you are pro or against our current health care reform act, reality is if you have individual or private family insurance (i.e. not group insurance through your work) you will be facing the very real possibility of needing to change your insurance to a new health care reform approved plan. Unfortunately, I would say many people needed to go through this process between December and January. I am not going to debate the health care reform act as to whether it is a good plan or a bad plan, although I will say that I am glad to some kind of health care reform has taken place. What I would like to do is share my story and offer some suggestions to those who may find themselves going through this process soon.

First, I was one of many who received a letter in late September that I would need to select a new plan as my current plan would no longer be offered. In October I received a letter stating that my health insurance carrier, Anthem, had mapped me to a new plan and sent me the details on the plan. As it happened, my husband’s open enrollment came due December 1. So in November, we started looking at a variety of options. As it turned out, in reviewing the new Health Care Reform Act approved plans, even by increasing to a “gold” level plan for myself and adding my son and without any subsidies, we were still paying less per month for health insurance than had we kept me on an individual plan and our son on my husband’s plan and WAY WAY WAY less than had we all been under my husband’s plan (but what health care companies charge to add a spouse to a group health care plan is highway robbery as compared to the spouse getting an individual plan but I digress…another post perhaps).

So around November 15, I called Anthem, who with only one exception has always been great from a customer service stand point and continued to be during this process. After a short 15 minute hold, I spoke with a wonderful gentleman who answered all my questions. Call took about 45 minutes total. Discussed with my husband…$250 savings, definitely adding son to my plan, especially since it was a BETTER plan. Called the next day and after a 10 minute hold, spoke with another nice gentleman. He mapped me to my new plan and shared that I would need to do a paper application to add my son since I was already mapped to my new plan AND an existing member. However, the application was not ready and I would need to call back on December 1 or 2 to have it emailed to me. As long as I had it in by December 15, I should be good for a January 1 effective date.

December 1 called back with no holding time but was informed the application was not ready. Suggested calling on December 15 or 16 and that the new deadline was December 23 for January 1 effective date. Called back on 17th and hit a hold time of 15 minutes. Spoke to nice lady who said she would email me the application and if I had any further problems to email her. Unfortunately, she sent me the wrong application. Emailed her on the 18th. No response by the 20th. So Saturday, December 21 I spent about a two hours on hold and met with my one and only rude experience in the whole process. After a rather tense interaction, it became very clear this particular individual had no clue how to handle my case so he placed my on hold again only to disconnect me. I had no success on the 23rd getting through so I called on the 26th but this time I called member services. Now I was on hold for two hours but she was extremely helpful and despite missing the deadline suggested I see if they would grant me a January 1 effective date since I had done everything right. Sadly she had to transfer me to Plan Advisors to get my son’s application BUT that was a success too. After only 30 minute hold, I spoke to someone who got me the right application AND a granted January 1 effective date from their department. I had to call in one more time but I was able to get my son’s application in.

Now the real waiting began. In order to cancel my son’s policy through my husband’s work and NOT be hit with the deduction for the cost of the insurance, we had to notify his work by January 10. Over the course of January 3rd, 4th, 6th, 7th,  and 9th , I spent a combined total of 15 hours and 20 minutes on hold and another 2 hours in actual conversations. This effort got me a January 1 effective date from Underwriting and Member Services BUT Enrollment was the end decider. Even today I had to call in and at this point, if the wait is at a certain point, they actually tell you to call back. At the end of this, I do have some knowledge to pass on that will hopefully help during the challenging time of enrollment.

Holding for Health Insurance Companies www.wifemomhouseohmy.com1. Expect long waits on hold so be prepared. There is nothing they can do about it. And from my own experience, each of my calls were at least 30 minutes to an hour of talking to someone to figure things out. Even at a three or four hour wait on hold, that would mean the person helping me had only helped about 3 to 8 people before me. That’s really not a lot. So call from your cellphone. Put an ear piece in your ear so you can monitor the call. Multitask by working on something else. Plus many of these companies are open late and on weekends to field all these calls.

2. Be patient. I took the standpoint of if I didn’t laugh at the situation, I would go insane. Believe me this helped as I worked with the agents at Anthem. First, they were much more pleasant than had I been annoyed and having been in customer service for more than 14 years I have learned one very important lesson. If someone isn’t nice that doesn’t mean I won’t do my job BUT it does mean I won’t do more than my job. When you are calm, patient, understanding of their being inundated, then they are more willing to go that extra mile for you.

3. Listen to what is being said in the recordings. I learned so much from those recordings and I would say that much of the information probably would answer a fair amount of questions. I learned the payment extension due dates and when they changed. I learned there was a problem with prescriptions since that was THE first option. I learned where to send payment information. I learned about penalties for not having insurance. I learned my ID number had not changed and SO SO SO much more.

4. Wednesday-Friday are the best times to call. As odd as it seems, these were the “less” busy times. My waits, despite being monstrous, were not nearly as bad on these days.

5. Get it ALL out. They do have technical difficulties. In fact, two of my calls were dropped while I was on the phone with a live human. So I highly suggest that you give them a contact number to call back if you are disconnected and ALL the reasons you are calling first before the rest of the conversation. That way they can call you back and so they know whether or not to call you back. One of the calls was dropped at the end of one topic but the agent didn’t know I had another topic to discuss so after one of my hours long wait on hold I was forced to call back. She didn’t know to call me back.

6. Notes are important. If you don’t already, any time you talk with someone be it health insurance, credit cards, banking, whatever, always take notes by getting their name, connection number or ID number, date of call and notes on what is said. However, ask the agent what notes already have been documented regarding your previous calls. I was really surprised at how well all my previous calls had been documented…in triplicate. It was really easy for them to verify what I was saying. So before you hang up verify what notes have been made about your conversation.

7. Enrollment is “GOD” and there is no way to contact them. Yeah sad but true. Enrollment makes the final decision on effective dates and at least at Anthem there is no way for someone in underwriting, member services or plan advisors to contact them. Hence why the notes are so important.

8. Remember, they are just the messengers. I have heard tales of people screaming at these agents because people are upset about the pediatric dental and maternity found in all plans. However, there is nothing they can do about it. These were laws that were enacted in the reform bill and they are just the messengers. Yelling at them really not going to change anything in your immediate other than make them less likely to be helpful.

9. Platinum, Gold, Silver, Bronze mean nothing outside of a government site. These are levels of coverage that are used to describe coverage plans on government run sites such as Covered California. However, when speaking with the insurance companies themselves, they mean nothing. You would need to use their term.

I hope this helps. Last word of advice…breathe. It is a long process.

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