By Katie Kerwin McCrimmon
It took 37 days of waiting in a bureaucratic black hole, 22 minutes on hold, two dropped calls and a switch to a new health system, but Donna Smith finally succeeded in signing up for new health insurance.
She is one of 6,001 people who have bought insurance through Connect for Health Colorado during its first six weeks of operations.
If people can get through the Medicaid process, I think theyll be pleasantly surprised, said Smith.
After finally getting a Medicaid denial last week, Smith worked with an exchange phone agent whom she found to be extremely helpful and extremely knowledgeable.
Smith, 58, currently is paying $875 a month for individual insurance. Her husband has his own insurance through Medicare and their children are grown. The Connect for Health agent helped Smith find a mid-level silver plan that will cost $450 per month after a $72 per month federal tax subsidy. Its still expensive, but Smith is a two-time cancer survivor and is facing a relapse. Now she can schedule tests and treatment and will have the peace of mind that shell be covered come Jan. 1.
Smith shared her struggle to navigate Colorados new health exchange with Solutions. (Click here to read Stuck in Colorados black hole.) Smith also appeared in Michael Moores movie, SiCKO, and writes about health issues on her blog.
An Obamacare supporter, she was eager to sign up both to ensure that she had coverage and to get away from a costly plan that she didnt like.
Smith tried to log in to Colorados exchange on day 1. At first she was unable to create an account. She waited a few days, then spent about three hours over two days filling out an extensive Medicaid form, which she found endless and invasive. Medicaid officials have since removed many of the financial questions that Smith had to answer. After completing her form, Smith then got stuck waiting for a Medicaid denial for 37 days.
Smith testified during last weeks health exchange board meeting. After hearing her story, the states Medicaid director, Sue Birch, approached Smith and told her she would help her. Birch later told Smith that she had entered her Social Security number wrong, but Smith had a written copy of her application and it was correct.
The day after the meeting, Smith received a call from Medicaid agents who told her they had finished processing her application. They never explained the delay, but gave her the denial code she needed. Finally, Smith could shop for insurance. She had reviewed some of her options weeks earlier and decided to call the exchanges center to get help.
She had to wait 22 minutes on hold, then reached the young woman who helped her. (On average, exchange officials say wait times are going down, but they concede that some times of the day are busier than others.) Twice while Smith and the agent were talking, the call mysteriously disconnected. The service agent called back both times.
With the womans help, Smith decided to switch to a Kaiser Permanente plan. She is nervous about having to change to a new team of providers, but decided that Kaisers price and services were right for her. After helping Smith make her choice, the Connect for Health agent connected her directly with a Kaiser agent who went over locations where she can get care and described how the subsidy will work. (It goes straight to the insurance carrier and customers pay their share.)
Ive been in the middle of some diagnostic tests so I dont know how seamless this is going to be, Smith said.
Still, shes relieved to have made the decision and very excited that she was able to pay additional $16 per month to get dental insurance, which has not had since she left her last job.
Smith wasnt quite done after she got off the phone. She had to scan and upload her passport to prove shes a U.S. citizen. She also had to upload some pay stubs and income information for her husband. The manual uploads indicate that the federal data hub was not working at the time Smith applied. Its supposed to provide real-time proof of citizenship and income verification when customers apply. But Colorado exchange managers have said it frequently hasnt worked.
While Smiths insurance dilemma is resolved for now, she worries about others who havent even tried to get insurance or those who may be stuck like she was and unable to move forward.
I have no idea why it took so long. Those of us who were stuck just entered some kind of black hole, said Smith.
As executive director for a small nonprofit called Health Care for All Colorado, Smith advocates for a single-payer Medicare-style insurance for everyone.
While Smith supports Obamacare as an interim step toward universal coverage, her experience over the past six weeks has underscored the need for additional changes.
Oh my goodness, do we need a simpler system, Smith said. The cost to administer this and the frustration everyone is experiencingI cant imagine when we get to January what people are going to experience. Some providers are going to have to absorb new patients. And other people will have to leave their providers just because of insurance.
It could be so much simpler than this.