Administrative Cost Waste

This is a totally banal tale of waste associated with private insurance schemes. Thankfully I do not have a horror story, dropped coverage, or preëxisting condition, but the inane interactions recounted below relate to the vast waste of “administrative costs” that private insurers generate.

ID and registration

WU switched back to Aetna Chickering health insurance, after a few years ago switching to Cigna through some outfit called Great West. These switches alone are incredibly wasteful, but users are shielded from those costs. Trying to stay on top of things, I wanted to check that I could find a doctor, my ID card if necessary, etc. online, if I needed to. The plan web site promised that the Aetna Navigator could help me with all of these things. It told me to use my WU ID to register, but that didn’t work. When I called customer service, they first asked if I was entering it “with four zeros in front of it.” (The site itself says, “In the field titled "Primary Member's ID Number" enter your 5 or 6 digit WUSTL Student ID #, NOT your Social Security number.”) When that didn’t work, the customer service representative told me to try again in “about 24 hours” and I would be “in the system.” This worked the next day (with the zero-padding; I did not first try without). But, I couldn’t find anything like an ID card to print, or address to update.

I called customer service. This time they claimed that I had been sent an ID card and they asked me to confirm my address. They asked this as if it were a password, so I told them my current address, office address, and, for good measure, address of three years ago. I failed the test: none was the “correct” one according to my new insurer. Customer service was wary now, but in medical-administrator world I had to be legit since I knew my date of birth. What address did they have on file? One Brookings Drive – no campus box, no department: the address for all of Washington University. Well, that explains why I never got an ID card. Like most people, I would prefer my health related correspondence go to my home rather than my office, so I gave them my correct address, which of course is the same one the graduate school has on file as my primary address.


I decided next to tackle an eye exam – I’m out of contacts and it is nice to have a current prescription. My plan advertises that although it does not include vision coverage, it does offer a considerable discount. The web site explaining the discount program was vague, so I called customer service to ask what I needed to do to get the discount. “Just give them your member ID that starts with a W.” ”I can find that online through the navigator thing?” “Yes.” I logged on to the ‘Navigator’ but the only temporary card and ID listed is the dental one which does start with a W but is not the same.

When I called to make the appointment (and one was available within two days, which is nice) he asked for my ID number and Group number. I didn’t have a group number since I never got an ID card and couldn’t print one. So I gave him the customer service number from the page about the vision discount, and he said he would verify my coverage. He called back later and said they got an error when using my number. I apologized for their wasting his time, and gave him another customer service number. He called back, successful this time, and confirmed my appointment.


No dental coverage was offered the past two years, so this year, presented the option of paying $114 for a plan that includes at least two cleanings, I enrolled. (It is worth noting that Scott’s plan has always included dental at no extra charge and ours never has. A few years ago, last with Aetna, we had the option to pay $40 to join the negotiated discount program Vital Savings, now included by default, but no option for actual dental coverage.)

Annoyingly before I could pay for insurance I had to select a dentist from their list. So I picked the first one and figured I would change it after I actually did some research and perhaps even made an appointment with one. Of course, the dentist I had picked from the top of the list received some horrible feedback via the internets, so I wanted to change to another one.

Also, I can’t make an appointment until the office receives the ‘roster’ from Aetna, which they explain happens around the beginning of the month, so call again in October. I looked into it later that day, and when I called to change it, I was told I was not yet “in the system” and to try again the next day, or easier still, that I could do that online too. Indeed there is a button to make changes on the list page but when you click it, it warns, “Important: This feature should NOT be used for requesting a change in your primary care physician (PCP) or dentist (PCD). If you wish to change your current PCP/PCD, please use the Change PCP link located on the Details page for each provider.” (Said link opens the same page with the same warning.) I called customer service, explained the situation, and requested the change.

The next day, I got an email confirming my “change” of primary care dentist, but now it warned, “If you chose your dentist after the fifteenth of the month, your selection will be effective on the first of the second month following your selection. For example, if you sent us your selection on August 20, you can begin seeing your dentist on October 1.” Well, that’s unacceptable. While I’m ok with waiting for the “roster” system in October, two months is absurd, and I would have been more careful in making my first choice if there had been any indication at all that changing could even possibly delay my coverage by two months. They confirmed that I will in fact be on the roster in October, so hopefully I’ll get an appointment then.


Gordon said...

Better than I've done. All I've ever gotten from their Web site is error messages. Perhaps I have to be using an operating system that cost money in order to access it?

joshie said...

That all sounds pretty typical.

When I worked for a Pittsburgh-based company while living in Chicago, I had "out of area" coverage and the insurance company (which was part of the company I worked for) contracted with another company for a network of physicians around the country.

I made sure any doctor I went to was on the list and therefor considered in-network. Every single time I had to call customer service because they paid the claims as out of network, meaning a higher deductible and a lower payment percentage. They always fixed it, but what a pain.

Anonymous said...

Your card is in your mailbox in the office (we share the M mailbox). Send an e-mail with your address and I will use the department post office services to send it to you :-)