With Respect — Working with Health Net is Worse than Chemotherapy

—This is PART I. If you’re ready, move on to PART II, PART III, or PART IV.

On February 9th, I’d had it with my health insurance company. They screwed up my entire 2015 in their system and hadn’t rectified the situation at least 5 months after I brought it to their attention. I took to Facebook and Twitter to get restitution. Here’s my (evolving) story.

This is my spirit animal. Soon I will write a piece on how he came to be.

It all started with an email to Jay Gellert, the CEO of Health Net, my insurance provider.

Dear Mr. Gellert,
I write to you in some distress. My employer — a small business — has just renewed (as of Feb. 1st) for our third year with HealthNet. In fact, we upgraded this year to a Platinum PPO plan. However, I am extremely concerned that your company is not up to the task of processing my medical claims. Additionally, when HealthNet does make a mistake, the company is not up to the task of fixing its mistake. I know your time is valuable ($23.75 per/minute by Bloomberg’s numbers assuming you work 24 hours per day) but please earn $50 (2 minutes) to read a little further. I’ve concatenated my list of issues for you below.
HealthNet incorrectly processed my claims for the entire year of 2015.
Once I discovered the issue it has taken 4 months to begin to resolve the issue. Claims are still outstanding for at least the last 6 months.
As a cancer patient, it has become my responsibility to hold the hand of my Resolutions Team representative in order to put her in touch with my providers, come up with solutions to problems, request documentation, and even track down my new RxBin number so I can stop paying out of pocket for my medication.
My Resolutions Team representative was too busy to call me back for one entire week (three un-returned calls). Eventually I had to spend 1.5 hours on the phone in order to get in touch with her by calling the main number and slowly working my way from India (I believe) back to California. It was 10 minutes on hold and answering questions — spelling and respelling my name, address, birthdate, over and over — before I was even allowed to ask for the transfer to the correct department. Fifty minutes later and I was finally talking to the right person. By that point, my provider’s office had closed for the day. We finally made that call together this morning. Another hour on the phone.
Every time I call HealthNet’s main number I can expect to spend 1.5–2 hours on the phone (good thing I have disability insurance and am able to take time off work. I’ve tried the online portal but the process of your staff (or your contractor’s staff) asking me questions, me answering them, and then the 48hour turnaround means than any one issue takes a full week to resolve. That’s a problem when you have more than two dozen issues (and counting!)
After we identified that my claims were being processed incorrectly and alerted HealthNet, the problem persisted. It might still persist today. I asked for a flag to be put on my account in Mid-January so that the problem could be stopped (because apparently it’s my job to ask for stuff like that and stay on the phone while the representative does her job). That flag still hasn’t been put on my account as of this morning. My representative is following up on it, but I’m not convinced it will ever get done.
So I ask you, what’s wrong with this picture? Why should a cancer patient who is receiving chemotherapy and radiation for a potentially fatal illness be responsible for doing the job of a health insurance company? I seriously considered declining the healthcare coverage offered to me by my employer. I almost made that decision purely on the basis that we’re going with HealthNet again.
The bigger point I’d like to make is this. I’m a college-educated, articulate, upper-middle class, white guy. I’m the definition of privilege (other than a chronic illness and cancer twice) and the system still doesn’t work for me. Can you imagine if I were a single, latino woman who is the mother of 3 children and has to work 2 jobs to earn $25,000 a year? It would break me. It would break my whole family.
Please tell me what you’re doing to fix the grossly understaffed and under-qualified customer relations and resolutions teams at HealthNet. You’ve been captain of this ship for almost 20 years now. What kind of legacy do you want to leave? How can you make it so sick people can focus on getting better? I know you can do it. Please try.
(aka Aaron Bramley)

Then I created this a Facebook post to help tell the story. I have copied and pasted here and I intend to continue to update the story as it evolves in both locations.

— — — — — — — Facebook Post on 2/9/15 at 10:28am (central) — — — — —

I wonder what it takes to get a CEO of a major insurance corporation to Google you? Standby for answers.

Are you on Twitter? I think I need some help getting noticed. RT, please. https://twitter.com/AaronMSB/status/697105314043170816

11:13 — Update. Sent email a little over an hour ago. It’s been opened 5 times in 4 cities. No response yet.

12:26 — Update: Email has been opened 5 times. Three of them are in New York. I wonder if that’s where Gellert works. Starting to get some strangers tweeting about it too. Keep up the good work! Going to experiment with some hashtags and see if I can get some journalists or bloggers interested.

1:44 — Update. No response yet. Did I mention that I included my cell phone number in the email. It’s cut off, but I put it in the original. That tweet has been RT’d or linked 38 times by people other than me. Mentions of @healthnet are through the roof! Keep it up, Make them listen! I’ll have a report on our efforts in a few hours after I take care of some health stuff.

2:00 Got a call from and unknown number. It’s Mike Estrada from the Executive Response Team. He received my case from social media and the email that I sent to Jay. He’s taking over my case to expedite it, which supposedly addresses my first issue.

I then asked him to address my email to the CEO. He said he was going to speak to the call center manger about the amount of time it takes to reach people.

I said, “No, tell me your plans to make it better, what’s being done? Don’t have a plan? tell me about your plan to make a plan.”

Mike is currently getting me Skye Davis, the Executive Response Team Manager…

2:32 — Update: Just off the Phone with Skye. I am tuckered out and giving up for today. He has promised to call me back to let me know if he’s “allowed to talk to his boss in order to get me in a conversation with the people who are actually in charge of making plans for the company as a whole.” Made excellent progress. Keep tweeting. I need a nap.

5:45 — Update; While resting I received a call from Larry Wong the VP of Customer Service. Call was received at 4:50 central (2:50 Pacific where he is). I called him back and scheduled a time to talk more fully tomorrow. In his voicemail to me he admits to “not really knowing the details,” but that he “has a team looking into it.” Will fill you all in tomorrow.

2/10/16–12:34 BIG UPDATE — Fifteen minutes ago I got off the phone with Larry Wong of HealthNet. He was not okay with me recording our phone call as you can hear ad this link. (https://call-recorder.yallo.com/webplayer?share_id=8a91514eaa33427698498969058e6ee6) I obliged him and did not record the call because I’m sure their (referenced) lawyers would love some billable hours.

When we resumed our call I thanked him for spending time with me. Told him I know how valuable it is. He insisted that this is a great way for him to be spending his time. I then asked him how my case was doing. He didn’t have an info on that, which is reasonable. It’s not his job, but I thought that maybe under the circumstances I would give him an opportunity to impress me. I offered to call Skye later on today to find out what’s going on with my claims.

I then went into my line of questioning about the systemic problems within their company. I asked for a few ways that they are working to fix them. He denied that there is a system-wide problem where call center representatives don’t have the time or know-how to properly assist their clients. Basically he said that mine was an unfortunate “outlier.” When I insisted that there were many other people like me, he said that he knows that there are but that they handle millions of calls a year “without incident.” He did agree with me — and even volunteered — that “even one situation like mine is one too many.”

After that he said that improvement of their systems is an ongoing process. They look at survey data and “outliers” like mine and make adjustments. I explained to him that survey data only reflects people who have the time to fill out the survey (referencing the latino mother of three who is working two jobs again). I also told him that surveys reflect the answers to questions that the survey creator wants. We all know survey data can be manipulated to show exactly what the surveyor wants so I let him know that as well.

I then asked what adjustments they were currently making as part of their process. He didn’t have details. I asked if I could see the data. He said he wasn’t sure he’d be able to get that together for me. I asked what his current goals are in general. He didn’t have details. I ask what his goals were in specific. He didn’t have details.

I asked how long their improvement systems have been in place. He didn’t have details but was able to agree with me that some form of Continuos Quality Improvement (CQI) has been in place since the founding of the company. At that I told him that clearly their systems don’t work if they’ve been working on CQI since the mid-90s and their company is still broken. He denied they were broken again.

I floated my idea that the systems are purposefully confusing and over-complicated so that money gets “lost” or so that people get frustrated and go away. Without acknowledging that he understands how it might seem that way, he said that I wouldn’t be saying that if I were in the room with him. I told him that I would absolutely be saying the same thing. To that he said that he wouldn’t be in an industry that did that to people. I didn’t have the heart to tell him that he’s smack dab in the heart of it.

Finally, I asked what his plan was on my case to analyze it as an “outlier.” Aha! He told me that they would “dig into it, identify opportunities [for improvement], and then adjust accordingly.” Finally, I’m getting somewhere. After about 20 more minutes back and forth I got him to agree to the following:

1. He and I will each use our own processes to come up with a list of the top three improvements that HealthNet needs to make based on my experience.

2. We will have another phone call together on February 24th where we will present our list and reasoning to each other.

3. On that call we will prioritize the improvements that need to be made, identify goals and metrics for the improvements, and come up with a plan to accomplish our goals.

Pretty wild that I have hold the hand of people at the VP level to get their job done. I guess that’s what it takes in this industry to make change. I still want to talk to Jay Gellert and make sure he got my email. Keep tweeting and sharing!

What do you think my 3 areas of improvement should be?

— — — This is PART I. If you’re ready, move on to PART II. — — —

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