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BY COURTENAY EDELHART Californian staff writer firstname.lastname@example.org
Employees in the billing office of San Dimas Medical Group have been tearing their hair out since the new year, when patients who had purchased health plans made possible by the Affordable Care Act began streaming into the group's southwest Bakersfield offices.
First, the medical group of OB-GYNs, physician assistants and nurse practitioners was surprised to learn it was in the networks of two insurers who sent paperwork asking providers to opt out, not in. Because it did nothing, the group was automatically included at the insurers' default reimbursement rates, which it says don't cover the cost of providing care.
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And then there are the hold times.
A phone call to any of the insurers selling subsidized or non-subsidized Covered California plans is a major commitment of time for patients and doctors alike. It's frequently an hour or more to reach a human being, longer if you have to be transferred.
That's bad enough for patients who only have to troubleshoot for themselves. For medical billers making those calls all day long for numerous patients, the red tape is suffocating because they have to confirm that each customer is current on premiums or they won't get paid.
"If you get through at all it's 30 to 60 minutes, and then you have to get to the right person because rules change daily and too many times you aren't given good information," said San Dimas business manager Kandi Knudsen.
Sometimes one person with an insurer contradicts another, she said, or she'll be told by phone that a service is covered only to find out after billing for it that it wasn't.
"It's a burden for staff, but it's really hard on the patient to find out they're responsible for something they thought was covered," Knudsen is. "That's not a good business practice."
From Feb. 23 to March 1, consumers made 80,798 calls to the state agency Covered California seeking information about low-cost health insurance. The average wait time to get through was 46 minutes, according to Covered California.
That's humane compared to Blue Shield of California, one of the private insurers selling Covered California approved plans. A reporter who called Friday waited one hour, seven minutes and 34 seconds for a live person to answer the insurer's customer service line. The precise hold time was clocked on a stop watch.
During the wait, a recorded message said the best times to call are early or late in the day.
Covered California and the insurers working with it admit they've been overwhelmed by the volume of calls since the ACA took effect at the beginning of the year. All of them are now scrambling to bulk up staffing at their call centers.
"We're certainly aware that customers haven't received the service they deserve," said Blue Shield of California spokesman Sean Barry.
Unfortunately, it's not just the number of calls but the complexity of those calls that is taking so much time, he said. Among other things, personnel are having to investigate situations in which Covered California data hasn't synced properly with Blue Shield's systems.
To relieve some of the pressure, Blue Shield is increasing the capacity to take online payments so that some inquiries can be diverted from phone lines to websites.
Anthem Blue Cross spokesman Darrel Ng said that "we added hundreds of new customer service associates to help with the additional call volume" before Obamacare took effect, and "since then, we've added hundreds more.
"We've had many more calls and longer calls than were forecast, but hold times have significantly improved since January."
They haven't improved enough for the American Medical Billing Association, which says the debacle could not have come at a worse time.
Medical offices are already swamped with preparations for a new medical billing code overhaul that's taking effect in October, as well as the daunting task of converting paper medical records to a digital format, said Executive Director Cyndee Weeston.
"This is the last thing they need," she said.