Great health plan, lousy service

Federal Report

Great health plan, lousy service

If customer service is the most important factor when it comes to picking a federal health plan, how can you judge it unless you try it?

Mike Causey@mcauseyWFED

November 13, 2017 1:00 am

3 min read

Is having a health plan with low premiums and excellent coverage worth it if its customer service stinks? Is it really a bargain if you are constantly mired in red tape, or dealing with a series of not-so-helpful claims reps?

When most people shop for health insurance, they look at premiums, coverage for services they need and whether their primary doctor is in the plan’s network. And that’s smart.

Often overlooked, however, is customer service. During the open season — which starts today — we’ll have a series of columns and radio shows featuring Walton Francis that will rate and rank plans by cost, coverage, catastrophic limits and, of course, their customer service rating.

Francis writes the annual Consumers’ Checkbook Guide to Health Plans for Federal Employees. Many agencies subscribe to the online version for employees. Our first show will Wednesday at 10 a.m. ET. One of the things we’ll talk about is the customer satisfaction rating for plans, thanks to this nudge from a reader/listener:

“Every year during open season, you have articles or Your Turn radio programs quoting experts about the benefits of shopping around for the best health insurance plan for the individual’s situation, which may not be the one the person is in currently.

However, one thing I never see or hear discussed is the satisfaction level from those currently enrolled in the various plans. While the coverage or price of plan A vs. plan B may be better, the customer satisfaction with the current plan may be a key deciding factor for most.

I’ve heard horror stories about dealing with a health insurance company over a dispute from people that I formerly worked with (I’m retired now) and have one of my own when I was in my 20s. Who really wants to chase around after an insurance company, when for $2 a month or pay period, I can remain in a plan where the customer service excels? I may be in a better position than most to deal with health insurance insurance companies, because I worked for the Centers for Medicare and Medicaid Services (CMS), and I’m familiar with DRGs (diagnosis related groups), CPT codes (current or common procedure terminology) and ICD codes (international classification of diseases) and much more. And I really don’t want to have to deal with the situations where an error is made either by the insurance company or the provider.

I worked in the systems area at CMS as an IT project manager and I also had projects that dealt with managed care.

My point is that I have more knowledge than most and may be better equipped than most to handle disputes, and I would rather not have to deal with it. And, yes, I know that as a last recourse, you can always appeal to OPM about your case. But this is only after you’ve exhausted the appeals from your plan (which, in and of itself, is time-consuming).

I believe that most employees or retirees base their decision on whether to remain in a plan or search for a new plan on their satisfaction level with their current plan, rather than price or even the range of coverage.

Can you discuss this on either a Your Turn segment or in a future article? If so, have the expert explain where we can get information on customer satisfaction for the various plans that are offered. If you can address this, it would be very helpful. Thanks.”

—Anthony C.