You Can Lead Healthcare Providers to Reforms, But You Can’t Make Them Think

All of the politics, posturing, and punditry in Washington surrounding sweeping healthcare reform fail to consider one sad, yet important, fact: you can’t legislate common sense and customer service. Give away health care, hand out free prescription medication, provide total access to every living human being on the planet, and you’ll still have people and processes that fail to do the jobs for which they’re paid or for which they’re designed.

And that’s because you can lead healthcare providers to reforms, but you can’t make them think.

A recent incident placed me in the overlapping positions of unhappy customer and curious journalist. My frustrations began last month when my group health insurance expired after I lost my job at a Texas university because of a reduction in force. The confusion stemmed from statements from the university’s human resources personnel who assured me I would have no break in coverage if I signed up for COBRA, the Consolidated Omnibus Budget Reconciliation Act that allows the continuation of health plans for a limited time period and under certain circumstances. The HR people should have said my regular coverage would cease at the end of my last pay period, but that COBRA coverage would be retroactive. There’s a big difference between “no break in coverage” and “retroactive” coverage, especially when doctor visits come before the arrival of the COBRA enrollment forms, as happened with my wife.

When the paperwork finally arrived, I asked the university’s benefits coordinator where to send the form to verify the university booted me to the street for no fault of my own, but she didn’t know much about COBRA and gave me to the data control clerk who said to send it to her attention. Several days later, I learned the data control clerk took medical leave two days after we spoke and that my form was unopened in a folder on her desk.

Several more days went by before I could send the form and payments to the Employee Retirement System of Texas, which administers my insurance benefits. I called ERS on a Thursday when a week went by without word that my COBRA was activated. The man checked and said it was activated on Wednesday, retroactive to Feb. 1, which was good because I had to pick up my wife’s epilepsy medicine on Friday.

Imagine my dismay when the pharmacist told me I did not have prescription-drug coverage. Over the next 30 minutes, I learned I didn’t have medical or prescription coverage. Both providers accessed the ERS data base during my telephone call and saw the activation, but they could not re-enroll me for at least another 24 hours. They explained this happens frequently because ERS doesn’t notify third-party administrators until the end of the day on Friday, even though ERS activates people all during the week. Knowing my circumstances and appreciating my agitation, both providers manually reinstated me that afternoon.

When I got home, I traded my ERS-member hat for my journalist hat and tried to contact an ERS spokesperson for an explanation that I could include in this column. ERS, however, does not publish contact numbers other than the main number for benefit inquiries. No media contacts listed on the Web site, news releases, newsletters, annual reports, or on any publication.

Drilling into the Web site turned up a telephone number for the chief financial officer, which went to a voice message from someone else who said to dial “0” if I needed immediate attention. A recording told me the operator was not available before the system disconnected me.

Undeterred, I called the main number and waited for the phone tree to connect me with a real person who found someone who might have answers. That person was not available, though, but another person listened to my tale and my request to speak to an ERS spokesperson. She suggested I visit with the director of communication and research, but the director was out of the office. She said she’d ask the director to return my call.

The person who handles media relations called instead Monday afternoon. She said she would check around to see if my situation was common and if ERS could change its procedures to provide more frequent updates to third-party administrators. As far as she knew, no one has complained about the procedure.

My experience was a minor irritation. Imagine the frustration associated with this scenario: A father takes his child to the emergency room at 10 p.m. because the child has sliced open a vein, only to learn he has no COBRA coverage (because it’s Tuesday night and ERS won’t send out updates until Friday afternoon). Even if the father stopped taking care of his child to call his health-insurance provider, there’s no one to answer the phone after regular business hours. Yes, everything will be straightened out the next day, but the anxiety and anger and frustration will build throughout the night because of a system designed for the convenience of ERS personnel, not for customer service.

The current debate has exposed many areas broken within the nation’s healthcare system. Most of them fall under the headings of common sense and customer service, factors no amount of sweeping legislation can correct.