Editor’s note: This commentary is by Dr. Milton Marasch, a psychologist-doctorate in private practice in Shelburne who has signed up for his third year of health insurance through Vermont Health Connect. He has served on the board of directors of the Vermont Psychological Association since 2007, and, in his spare time, can be found swing dancing with dancers in the local Lindy hop community.
[I] had a dream the other night. I was in a college-town record store — the kind where you can still find vinyl on the racks — and was looking for the “Silver Beatles” album. I was told they had what I was looking for and was proffered an album with a plain, silvery jacket, without labeling of any kind. Though new, the jacket was thin and flimsy and already starting to show hints of a ring pattern outlining the album within. Curiously, the size of the pattern in this LP-sized jacket was more consistent with that of a smaller EP inside.
I accepted the album and purchased it from the young man behind the counter, but could not help the feeling that something was off about my find. The cashier did not hand me a receipt. As I started to walk away, I hesitated, turned and said, “I’d like a receipt, please.”
Cashier’s matter-of-fact reply, “We don’t give out receipts.”
Finding this a strange business practice, I steeled myself and said, “I’d like to speak to the manager.”
“I am the manager.” As if a needle was skipping, “We don’t give out receipts.”
A health care provider myself, I did not like the idea of having to choose between going to the second-best health care provider in the field and lose out on the benefits I had paid for because the first-best provider did not happen to be on my insurance panel.
Upon awakening from the dream, it dawned on me that I had just resolved a 73-day encounter with Vermont Health Connect the day before. Indeed, throughout the more than two months of what should have been a rather simple process of registering a change from one metal-level plan to another, every hallmark of the experience was present in the dream — problems with product quality, usability, proof of purchase and customer service.
The first problem is with the product. While online and print media reported the modest increases in premium from 2015 to 2016, I noticed that the bronze high deductible package’s contents were smaller — significantly so. Indeed, the bronze plan that I had previously enrolled in would have gone up by only $22.84 per month. Not too bad. However, upon closer inspection, the deductible for that package would have more than doubled — from $2,000 in 2015 to between $4,100 and $4,400 in 2016.
And there is another, longer-term problem about the product. Since its inception, not a single plan in the exchange has contained an out-of-network benefit. I had had a small business insurance plan with MVP the year before the roll-out of the exchange. I chose this plan specifically for its affordability and the presence of an out-of-network plan. As a health care provider myself, I did not like the idea of having to choose between going to the second-best health care provider in the field and lose out on the benefits I had paid for because the first-best provider did not happen to be on my insurance panel.
The second problem is about what happens when I attempted to put the needle on the exchange record. The online database simply did not play when I tried to register my change in choice of policy online. It is hard to believe that such problems persisted in the third year of enrollment.
The third problem is with getting proof of purchase. Not only did the online database not play for me, apparently it did not play for the MAXIMUS personnel either. It took from Nov. 24 through Feb. 5 before my insurance — or I — had any proof of plan change, this despite my inquiries to Vermont Health Connect, Blue Cross and even the governor’s office.
The fourth problem is with public relations. I note a nearly complete lack of transparency by the governor’s office, the Department of Vermont Health Access and the Vermont health exchange media sites. Nowhere has there been plain, transparent communication with exchange subscribers about what the exchange problems were, why they were happening, what was being done to correct them, what the workarounds were, and how long before the resolution.
While I daydream of a smooth, efficient, government-sponsored exchange, what the people of Vermont have actually been getting is more like a bad dream and, for some, a nightmare. It is high time for independent oversight of Vermont Health Connect, so Vermonters can obtain the quality product and process for which we are paying.
