It’s been a cruel couple of months for me and my family, courtesy of some unexplained computer system billing issues and all of a sudden our most important security blanket – health insurance coverage – was thrown into doubt.
The entire incident raises questions about the automated future of customer service within the health insurance industry and the silos in which the industry’s infrastructure operates. In fact, prepare to face rapidly declining customer service in the future.
The saga began three weeks ago when we received in the mail a letter from our health insurance carrier UnitedHealthcare that our coverage had ended of May 31. The company claimed that it had not received “payment on time” for our family plan.
This was strange. We’d paid our May premium of $722.84 and then our June and our July premiums, each for the same amount. Each payment was electronically debited from our checking accounts on or about the first of the month.
So I called the 877 number on the back of my health card I keep in my wallet and on the other end of the phone was the voice of a customer service representative, or CSR. By the sound of her voice it seemed like she was from India, but I can’t be sure.
According to her computer screen, that coverage had been dropped because I hadn’t paid the premium, but when I challenged her on it and said I had the bank statements to prove it, she told me to email the documents to the company’s secure email, which I did.
Good news. On July 26, I received the following message from a Nathalie Alexie Flores:
“Thank you for choosing UnitedHealthcare!
This is to confirm that your account is now showing as reinstated in our systems with a paid thru date of 05/31/2016. Kindly process your payments for 06/01/2016 and 07/01/2016 coverage on or before 08/25/2016 to prevent termination of your account.”
… and bad news. I’d already paid by June and July payments. Now it seemed as if the company was asking me to pay my June and July premiums, along with my August premium – in other words a sum of $2168.52 – and there was no written explanation about why the company seemed to think I hadn’t paid my June and July installments of $722.84 each.
At least I’d been offered a reprieve until Aug. 25.
So I called again, but this time I called the number on the 877 number listed on the secure email, and that seemed to get me to a number with a CSR who repeated the same story as the CSR I’d reached two weeks before.
I asked to speak to a supervisor.
As I waited, nefarious thoughts drifted forth. Was UnitedHealthcare just trying to get rid of us? I knew the company was losing money on federal health exchange members – which we are – and that the company was planning to ditch dozens of markets next year.
Were they just getting rid of low-hanging fruit paying $722.84 a month for a family of three on the bronze plan?
An “escalator specialist” came on the line, and by her voice she sounded like an American. I knew I was getting somewhere.
The escalator specialist was helpful and moved the issue forward, but not before a testy exchange in which she initially told me I had two choices: call the marketplace and choose another plan or pay the $2,168.52 – three months’ worth of premiums.
She then explained that a refund check had been cut July 18 in the amount of $926.28. This was for a $519.40 and two separate payments of $203.44, but the question at hand was still unanswered: why did the company think I hadn’t paid my premiums when my bank debits clearly showed $722.84 crediting UnitedHealthcare?
I asked to be transferred to billing, and there a CSR shed new light on my case: Despite automatic debits, two premium payments last year of $519.40 – for the month of June and November – were never withdrawn from my bank account.
This was news (though I’m not sure why we didn’t catch that either on our end), but the reason for it wasn’t explained.
It was likely a billing system snafu, or maybe a miscommunication between the insurer’s computers and the government health exchange computers, the CSR said. Last year, we received a subsidy courtesy of the Affordable Care Act, but this year we no longer qualify.
The 2016 premium payments were being applied to 2015 and that was the reason for the system flagging my account as not having paid on time, he said, though I still have my doubts about whether that was the real issue.
In any case, the fault wasn’t on my end, it was with the company. Good to know. And the company had given me until Aug. 25 to pay, which I planned to do once I receive the $926.28 refund.
Just to check, I called the insurer again Tuesday, Aug. 2, just to make sure coverage was still in force, or active, until Aug. 25 even as I’ve not yet paid my Aug. 1 premium.
Yes, it was, the CSR said, but there’d been a new development. The $926.28 refund check wasn’t in the mail quite yet. In fact, I may not receive it.
My case had been transferred to the finance department, and yes, they had received my spreadsheets proving automatic debits so with a bit of luck they’ll reinstate my account as current, allow me to pay my August premium and be done with it.
I’m expecting an answer Wednesday.
As for my policy remaining “active,” and in-force until Aug. 25? I called my pharmacy Aug. 3 to refill my generic statin prescription only to find out that my policy has been terminated.
And that got me to thinking.
Back in November, I remember getting my coverage through an agent, who called me after a lead referral from an internet aggregator site. It occurred to me that perhaps I should call him, but we’ve never spoken in eight months and I can’t remember his name.
InsuranceNewsNet Senior Writer Cyril Tuohy has covered the financial services industry for more than 15 years. Cyril may be reached at firstname.lastname@example.org.
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