Money For Nothing

February 27^th.  The client and I, after several failed attempts, finally got all of the way through healthcare.gov on February 27^th.  We chose a policy for him and his son and hit the final button.  The Congratulations screen was anticlimactic.   We were both so relieved that this was over that we just sat there in my office staring at the monitor.  He was IN!  His new policy would begin April 1, 2014.

The client, R.S., and I did have some questions about the policy.  Information was provided on a “need to know” basis and the insurer (who will remain nameless for obvious reasons) decided that my client didn’t need to know anything until he sent in his first premium.  R.S. sent in his check and his card arrived a week or so later.

R.S. may not be an insurance expert, but even he knew that he had a problem the moment he saw his insurance card.  The card said that his coverage had improbably begun on January 1^st!  Worse, a bill for February, March and April quickly followed.  R.S. was being charged for three months of coverage that he had not had.  He had been insured by a different company all the way through the month of March.  Worst of all, the federal government, YOU and I, were being charged for these three months as well.

Billing issues are not insurmountable.  In fact, these are some of the easiest messes to resolve.  Well, usually.  I sent a copy of the erroneous bill and the February 27^th award letter from the exchange to the Agent Services desk at the insurance company.  I acknowledged that this could possibly be a government error or an internal mistake and asked that this be corrected.

I received the following response a little over five hours later:

The member will need to contact the exchange to initiate the eff date correction.

Translation:  We like getting Money for Nothing.  We aren’t going to do anything about this.  Your client can either pay the extra money or fight the government.

Is this problem unique to R.S.?  How has the insurer handled similar situations?  SILENCE.  I immediately asked the following questions:

• Does the insurer have access to his application?
• Does the insurer have access to the date of his application?
• Will the insurer acknowledge that there is a problem?
• What is the insurer’s official position on the client’s issue?

 That was yesterday.  Here is the response I got late this morning:

We do not have access to the on exchange application.  The information we received was provided by the exchange.  All changes or corrections to an application for an on exchange policy are handled by the Exchange.  Thanks,

 In the immortal words of Freddie Prinze, “It is not my job, man”. 

But you know what my real question is.  I want to know what this insurer would have done if the situation were reversed.  How would they have pursued this if the client was scoring three free months?  I suspect that they would be more engaged.

My biggest problem as an insurance agent isn’t the government’s intrusion into my business.  It is our nation’s business schools’ invasion of our industry.  Thirty-five years ago the board rooms of the insurance companies were populated by insurance people, men and women committed to the pooling of risks and to solving our clients’ problems.  Our people worked daily with the nation’s hospitals which were led by physicians who had not forgotten the importance of patient care.  Now the clients are widgets and the patients are units of care. 

Widgets are interchangeable.  Units stack up nicely.  And money stacks up best of all.