Cat in the Hat at The Exchange

CatHat_HeaderLet me state up front that this post is about accountability.  It could have been an indictment of the Affordable Care Act, a political party, a specific company, or a member of government.  It is none of these.  This is solely about a characteristic I consider to be the single most important component of personal and organizational integrity.

In November 2014, I overpaid my health insurance.  It amounted to one month’s premium and occurred because of a unilateral decision made by a computer system at the Washington Health Benefit Exchange (The Exchange).  It was an individual health plan so it was a meaningful amount of money.

My experience with the The Exchange has been an unhappy one from the beginning.  This is because the systems were implemented based on a sloppy design driven by sloppy thinking and followed by sloppy delivery.  Key systems that ordinarily share information did not do so in timely ways.  This left consumers – forced to transact all business through the web portal – looking at incomplete information.  Presentation of data made it impossible to determine exactly how the balance due was calculated.

The most important flaw in this technical hairball was that the systems were designed to apishly implement the law without any human oversight or accountability.  Thus, if a consumer were accidentally to drop a zero from his annual salary when entering the requisite financial information, he and his family would be summarily put on Medicaid and his regular insurance terminated without his knowing it.  There would be no notice that this was happening either at the time the computer made the determination nor later in written form.  The consumer was left to find out the next time his Primary Care Physician tried to bill the insurance. It happened to us, and it took months to set right.

It was a similar situation that resulted in my overpayment.  The computer made a unilateral decision behind the scenes without any requirement to share that decision with the consumer, leaving the consumer (in this case me) to figure it out weeks later.  At this point, I did what any reasonable person would do and called customer service.  The answer I received – that The Exchange could not issue refunds and that I would get it credited as part of my income tax return – was utter hogwash. There began my personal Odyssey Through the Land of Zero Accountability.

Enter The Cat in the Hat (with apologies to Dr. Seuss).  Do you all remember the big pink bathtub ring in The Cat in the Hat Comes Back?  Well, hang on to your hat.  My next step was to call customer service again and open a ticket requesting a refund. The agent informed me that it might take three to four weeks.  After four weeks had elapsed, I called to find out the status of the ticket.  “It is in process.”  “Where in process is it?” “I don’t have visibility to that.”  I played this game for a number of weeks until finally I convinced an agent to escalate the ticket.

It turns out that escalating a ticket at The Exchange is akin to one of those fake knobs on TV sets back in the fifties that were just on there for show; you can turn it but nothing happens.  Over the ensuing weeks, I “escalated” that ticket three times.  I talked to supervisors.  Nothing.  “Well, what’s happening with this issue now?”  “It’s over in Finance.”  “It’s been there for six weeks.  Where in the process is it?” “I don’t have visibility to that, Sir.” “Please transfer me to Finance.”  “I’m not authorized to do that, Sir.”  “Let me talk to your superior, then.” “I’m not authorized to do that, Sir.”   “Then put me in contact with someone who is accountable.”  “I’m not authorized to do that, Sir.”  Ladies and gentlemen, I’m not making any of this up.  There is no service level agreement of any kind at the Exchange.

Being resourceful, I decided to perform an end run around customer service.  But it turns out that when it comes to accountability, The Exchange was designed like a medieval keep.  There is a single drawbridge and that is customer service.  On the website, it is the only phone number.  If you want to register a complaint the number is the same.  There is not a single shred of accountability anywhere.  All of the executives and board members have bright smiling pictures along with glowing biographies, but no contact information.  There is a web interface for filing a complaint, but without any service level agreement.  Dead end.

In desperation, I wrote to my state legislators.  I was stunned two days later when my representative’s legislative assistant called me.  I was the third such complaint that week and she was preparing to walk them across to The Exchange herself.  Accountability at last!  Within a week I was in contact with a real live human being at The Exchange in the form of an Operations Analyst.  Within another two, she had researched the records, determined that the money had been paid to the insurance carrier, worked with the carrier to calculate the exact amount owed (they actually found an earlier overpayment I had given up on), and agreed that the carrier would issue the refund within two weeks.  Wow!  Talk about accountability.

It turns out that what happened only made the pink cat stain worse.  When no refund materialized after a few weeks I called the carrier and started over.  All anyone could tell me was that it was “in process.”  Once again I began demanding accountability and talking to supervisors as the weeks accumulated.  Finally, I was able to get someone’s attention.  At first, it appeared to be more of same as there were several phone calls with no actual information exchanged.  But she seemed genuinely hurt when I suggested that the next voice she might hear would be that of my lawyer.  Low and behold, she called back within the hour.  As it turns out, the carrier had refunded the money to The Exchange two weeks before I even opened that initial ticket.  Would you be surprised to learn that The Exchange has no record of this transaction? My contact at the carrier has promised to follow this up and to send me a status email weekly.  I think she means it this time. Besides, it’s my management style to give folks enough rope either to own the solution or to hang themselves.  And in the latter case, my legislative contact is ready to step in again.

Here’s the score.  A large amount of money that has been out of my control for 56 weeks cannot be adequately accounted for by the State of Washington AND a major health insurance carrier.  In my mind, the picture looks like this; the good Doctor captured it perfectly.

Cat2What this teaches us is the importance of personal and institutional accountability. The Exchange itself is organized in a manner that banishes accountability altogether.  Nevertheless, it is that single Operations Analyst from whom the organizational model should derive instead of The Cat in the Hat. For those of us who understand the difference, our customer’s problem is our problem and we must mobilize at our inconvenience to own the solution.  We need to empower our employees to make it right for our customers now (with appropriate controls), and worry about squaring the general ledger later.

I think that The Cat in the Hat Comes Back is the perfect parable for this lesson and I am delighted to have rediscovered it after so many years.  As for my personal pink cat stain, we may only be at Little Cat M.  I will amend this post as events develop.

Are your employees empowered to own customer solutions?  Do you have a pink cat stain story to share?





One thought on “Cat in the Hat at The Exchange

  1. bimuse says:

    Just a short follow-up to this post. In the first paragraph, I stated clearly that this was not an indictment of any specific organization, The Exchange included. That said, I have been astonished at the outpouring of responses I have had back channel from colleagues and friends who are going through similar tribulations with just about every other leg of government in this country. Some of these include the Veterans Administration, Social Security, and the IRS (several instances). I know that lack of accountability is not exclusive to government entities, but it certainly seems to be most prevalent there.

    Also, we are still nowhere close to a resolution of my issue.

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