Read On: An unhealthy backlog on insurance

A Southland health insurance broker named Brad Reichman — whose clients run from Santa Barbara to the Inland Empire and include Burbank, Glendale and La Canada — called me the other day to share a horror story borne out of the Affordable Care Act.

He had helped a 29-year-old female heart patient get insurance late last year. Her mother had to rush her to the hospital this past week with breathing problems, an outgrowth of her chronic affliction. But while checking in at Ronald Reagan UCLA Medical Center, the clerk abruptly told her she couldn’t be seen and would have to leave the facility. It seemed she had no health insurance.

What happened?

The woman had applied for insurance in plenty of time last year to be effective on Jan. 1, Reichman explained. But after signing up at the new California insurance website www.CoveredCA.com, she never received an invoice.

Without an invoice, no membership ID is generated. Without a membership ID, you can’t make payment. Without making payment, you are not in the system. If you aren’t in the system, you aren’t seen as being insured. And there is no way to prove it.

“Once the website has processed the application, it’s up to the insurance companies like Anthem Blue Cross to process them and send the bill,” Reichman says. “But they have such a backlog of applications that it’s taking weeks and, in some cases, months to process them. And meanwhile, people in desperate need of insurance are getting screwed.”

You can call the Covered California hotline. But that introduces you to a whole different version of hell. I placed a call and was told I was “Caller No. 478” in line. Approximate wait time: Longer than two hours.

“But even when you get through,” Reichman added, “they can’t really do anything for you. The system is the system, and right now it isn’t working. It’s seemingly designed to be backlogged.”

Yes, Reichman believes that Anthem Blue Cross and Blue Shield essentially did this on purpose. They understood that a huge influx of new customers would be coming and yet failed to adequately staff up. Why? Well, maybe they know they couldn’t lose and the blame would be affixed to President Obama, anyway.

Reichman thinks the companies likely figured that the influx of new customers would be temporary and thus felt little need to train and hire new people for three or four months of processing overflow.

Then again, the insurance companies claim that the bottleneck is actually at the Covered CA level, which gains some credibility when you try to navigate that world and find little satisfaction. Then again, the website isn’t designed to provide customer care, but simply to be a conduit, a window to the insurance-carrier world.

So why not just go straight to the carrier and bypass the ACA site entirely? Good idea, except…

“You could go to Anthem Blue Cross, say, and get covered right now,” Reichman acknowledges, “but then you wouldn’t receive the tax credit or government subsidy. You’d have to just pay full price and receive no break in return.”

This is no small issue. Reichman used as an example a family of three whose premium is $1,410 a month for medical insurance. Their personal cost is a mere $36.75. Their savings is roughly $1,373 per month. If they went straight to the insurance carrier, their savings would be precisely zero.

In the case of the client with the heart issue who couldn’t get Ronald Reagan UCLA to admit her and was sent home with severe breathing problems, Reichman kept calling and calling Anthem, but could not get a returned phone call or email.

He finally decided to simply walk into the company’s headquarters and directly confront the representative who wasn’t responding back.

“Within five minutes, I had an email sent to my client with her payment information,” Reichman said, “the thing that I’d been struggling for weeks to get.”

So this story has a happy ending?

“Not exactly,” he admits. “Well, maybe this particular one. But the larger issue must be addressed now because the people who can’t have their coverage confirmed are really suffering needlessly right now. And I don’t see it changing anytime soon.”

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RAY RICHMOND has covered Hollywood and the entertainment business since 1984. He can be reached via email at ray@rayrichco.com and Twitter at @MeGoodWriter

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