Insurance Disasters: How You Can Avoid Them: Part 1 – HELP!

Probably the second most common thing a call center rep hears is “I just want a plan!”. But ACA plans AREN’T from Burger King – you get it their way or no way – and they DO NOT come with a guarantee. It is very much a buyer beware world – and if you aren’t careful in your shopping you can be stuck with an inadequate or even useless plan for the entire year!

First off – it’s YOUR job to look after YOU. No one else has your best interest as much at heart as you do. You have to be in the driver’s seat – or you’re likely to be under the wheels instead.

This sounds great – but in reality not everyone really understands insurance and some people are simply not going to be able to chose a plan based on what is best for themselves – and, although fun, the pin the tail on the donkey method of plan selection is not a good idea. So what are folks that just can’t get their heads around all this stuff supposed to do?


Whether or not you ever understand the difference between coinsurance and copay, you are still the person responsible for getting insurance. But there is hope. Brokers are available – in most cases at no cost to you (the insurance company pays them for the enrollment). These are licensed professionals who can make recommendations – they can look at plans based on what you’ve told them about your needs and recommend the best plan for you. If you are totally clueless – or have a patience measured in half-lives – this is a great option.

Enrollment Centers:

Okay, you get the difference between premium and deductible – but your head is swimming every time you look at the website. For folks that just need a hand – or those who find computers too challenging – there are enrollment centers and assisters all over the country. Depending on the center, they can answer some questions over the phone, or you can go in and have them handle the entire process. They generally aren’t brokers but often work in the industry. It’s worth the trip to know you are getting the help you need.

Also, enrollment centers are an especially good idea if your enrollment has ever given you fits – those who routinely have issues enrolling usually have something going on that triggers a problem in the system – the enrollment center folks are knowledgeable and can help – and have the call center on speed dial!

Call Centers:

For those who know their way around a keyboard but have no earthly idea where to start once logged in, a call to the call center can get you squared away. Call centers can usually do anything an enrollment center can do – but if at all possible, either go to the enrollment center or do the sign up and application online yourself. Why? Because you know how to spell your name, what your phone number looks like, and how exactly is spelled – and the rep doesn’t. Over the phone, it really sounded like you said your name was Ami Gowillyou Helpme. It won’t be funny when you’re trying to log into your account later.

And of course, there are times when it just doesn’t matter that you have two degrees in computer science – the stupid application makes no sense and you can’t even find your determination, whatever that is. Grab a cup of coffee, take your medication, and call the call center – they can and will help you. Just remember, the person answering the phone did not design this insanity – and wouldn’t be answering the phone if they did.

Online DIY:

Okay, so you’re a broker – or at least savvy enough that you know you can chose your own plan – and the website and application were a breeze. You don’t need specialized help – but you DO need to do your homework. if you haven’t already checked out plans on the plan finder, then spend the time you need to look at ALL your options in the enrollment. Have an idea what you need, keep a pad and pencil handy to jot notes and do some serious comparison shopping. There are a bunch of tools at your disposal – use them.

The biggies to keep in mind: Are your medications covered? Can you go to the doctor you have now? – ┬áif unsure, make some phone calls to the insurance company and the doctor’s office. The online tools may not be guaranteed (they aren’t in Colorado) – so do not trust them on anything critically important to you.

In Open Enrollment, you have some limited options to change plans if you goof – but in a Special Enrollment Period (SEP) you probably don’t. After Open Enrollment, if the plan you picked doesn’t meet your needs, you’re stuck with it until next Open Enrollment or you happen to have a Qualified Life Change Event (QLCE). DO YOUR HOMEWORK NOW – the sanity you save will be your own.



Oh, and for the curious – the most common thing heard by a call center rep is ‘I just have a quick question’. FYI – this is almost never true.


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