Insurance Disasters: How You Can Avoid Them: Part 2 – Trust, but Verify

You called the call center and the nice Customer Service Representative did everything for you – created the account, completed the application and helped you buy a plan. Everything is all done – right?

Should be, yes – but don’t bet on it. The nice rep was hired a month before Open Enrollment began and only finished training a week before Open Enrollment began. Lucky you – you are their very first enrollment.

What you can’t see is the hectic rat race that is the Open Enrollment Call Center. Most reps are new – few will have been there more than a few months at most. Many will be hired during Open Enrollment – that’s right, they are training as Open Enrollment is happening. They have to know how to create accounts, how to handle applications, how to complete enrollments and the answers to about a million questions – for which they have about three weeks training. By the time their on-the-job proficiency has really reached excellent they are getting pink slips – because it takes a good three or four months to get up to speed and Open Enrollment only lasts three months.

So yes, the nice rep did his best  – but he isn’t up to speed. The result – you have a lovely plan in your cart but you are NOT enrolled. The rep has made a mistake.

What can you do? Well, start by asking the rep what to do next, after enrollment. The answer should be to look for the Welcome Pack from the insurance company – or something similar. If you get an unreasonable answer – or worse, told you don’t need to do anything else – ask politely for a supervisor and ask the supervisor to review your enrollment, right then.

Don’t get mad at the rep – this is completely the fault of management. The rep didn’t set up the hiring or training schedules. Don’t bother yelling at the supervisor – in reality, he’s probably just a team leader and has little true supervisory power. Do get the enrollment squared away – the supervisor can make sure it’s right – and then call your state’s department of insurance. Only the DOI is going to have the clout to get procedural changes made that avoid this kind of mishap – and they will only do it if they are getting a LOT of complaints. So, help the next guy – complain!

Okay, the rep gave a sensible answer and you’ve gotten off the phone. Go online and look at your pretty enrollment – if possible, do this while on the phone. Make sure it’s what the rep said it was – you did take notes, right? Go ahead and save a screen print of it – yes, really. Make sure you can see it – if not, or there is anything you aren’t happy with or sure about, call back immediately.

Well, you got sensible answers but you were calling in the first place because you don’t have a computer. Hey, it happens – so call back. Ask the next rep to verify the plan for you. If you just happen to get the same rep – that happens, too – ask them how to find it online. Then call back and ask someone else to look at it for you – if the rep really didn’t know how to enroll you, they may not be able to find an enrollment, either.

Does that seem overly harsh or too much to bother with? Here’s the hard truth – only your enrollment counts. If you find out too late that you were never enrolled, you won’t be enrolled. You’ll either have to appeal (which may not work), have a Qualified Life Change Event (QLCE) (which may not happen) or wait until NEXT YEAR to have insurance. Verify now – save a heck of a lot of grief later!


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