THE BLOG
12/22/2014 02:08 pm ET Updated Feb 21, 2015

Diabetes and My Experience Obtaining Health Insurance Through Obamacare: Part 2

This is the second installment of a short series of posts about obtaining health care coverage with a pre-existing condition through Obamacare. I would suggest that you read the first installment, (http://www.huffingtonpost.com/peg-abernathy/diabetes-and-my-personal-_b_6003608.html) so that you will have a clearer perspective on this process.

Let's continue...

As I stated before, even though I have a very good idea of how Obamacare is supposed to work for a person with a pre-existing condition, I have no actual real life experience going through this process, so I first need to call for information regarding my specific circumstance. And because I am eligible for COBRA, I also wanted to compare the costs of the plans vs. COBRA. Also, what kind of access I would have to the special durable medical equipment necessary for my Type 1 diabetes. Because of my specific questions, I needed to speak with a live representative.

I called 1.800.318.2596 and explained that I was leaving my job and that I wanted to inquire about obtaining coverage with my pre-existing condition. However, I was told I couldn't sign up as I had missed the open enrollment period. She said I would have to see if I qualified for a "special enrollment period" option since my job was ending during a non-enrollment timeframe. When I asked her what a special enrollment period meant, she read from a script, and when I began asking specific questions that pertain to my circumstances, she hung up on me.

I waited a few days and I called 1.800.318.2596 for the second time. Even though I called the same number as before, a different recording asked me in what state I needed coverage and when I responded with California, the recording gave me the number 1.888.975.1142. I was told that I could wait to speak with a representative for more info, but I decided to call the state line directly as I didn't want to waste time on details that may or may not apply to me specifically. Why didn't the first customer representative just tell me to call the California line directly?

On my third call, I dialed the direct line of 1.888.975.1142 for Covered California and a recording said they were closed and to call back during regular business hours, which are: 8 a.m. - 6 p.m. (PT) M-F and 8 a.m. - 5 p.m. (PT) Saturday (non-enrollment times). After this last attempt, I decided to wait and call back during the official open enrollment period.

Once again, I called 1.888.975.1142 to find out about obtaining Covered California coverage. During the long wait time, the recording kept directing me to the website for quicker service and clearly, they wanted me to go through that channel. But what if I wanted to talk with a live person or didn't have computer access? At this point, the opportunity to speak with a live representative was beginning to look like an epic fail. After waiting for 35 minutes, I hung up. Out of desperation for a human touch, I went to the website and tried a live chat. The chat representative responded almost immediately.

Live chat:

Covered California: Hi, my name is #####. How may I help you?
Peg Abernathy: Hi. I've been trying to reach someone on the phone and after waiting 30+ minutes; nobody ever comes on the line. I want to speak with a live person
Covered California: Our phone number is: 800-300-1506... I do apologize for the inconveniences, but you should try calling at 12 p.m. to receive a more proper call flow.
Peg Abernathy: what is the average wait time?
Covered California: 10 min, around 12 p.m... f that long
Peg Abernathy: is that every day or just today
Covered California: today... on the weekdays you should try around 5 p.m. for a lesser wait time in queue.
Peg Abernathy: What is the average wait time at 5 during the week? I've called 3 times and never got through
Covered California: I can't say exactly but it's lesser than the normal wait time... 10-30 min.
Peg Abernathy: So the normal wait time is typically 10 -30 minutes?
Covered California: correct
Peg Abernathy: ok thank you
Covered California: You're welcome! Thank you for contacting us today. If you need further assistance after this chat, please call 800-300-1506 or contact us via chat, Monday thru Friday, 8:00 am to 8:00 pm and Saturday 8:00 am to 6:00 pm. For Medi-Cal questions please contact your county office. Have a great day!

I decided to call at the suggested time and I made another attempt by dialing the Covered California number, 1.888.975.1142. The recording said that they couldn't take my call "at this time" and they advised me to go to the website and then the recording hung up on me.

So next, I tried the number that the chat agent gave me: 1.800.300.1506. As per usual, I was advised, over and over to go to the website and then I was put on hold. I dug my heels in as this time I was determined to get through to a live person.

After 38 minutes, an actual living, breathing, human being answered the phone. I'm in.

This agent was absolutely stellar. Knowledgeable, courteous, and patient, she clearly and simply answered all my questions that pertained to my specific needs and situation. I came away with the feeling that I had a complete understanding of the process as it pertained to me in particular.

At that point, I was feeling more informed about the coverage but frustrated at the process itself and the time it took for me to speak with a live person. When a new process is introduced, (especially attached to a new program) it is critical to introduce a consistent and simple workflow to not only aid everyone in understanding the new process, but to also create value for the program. I understand that casting a wide net to reach as many people as possible is a daunting task, but there is a huge part of the population who don't have access to computers or don't understand how to use it. This could be a socioeconomic issue, age, or disinterest. Yes, those people are out there. LOTS of them. And they need coverage too.

Remember the website launch glitch and people said, "I told you Obamacare wouldn't work"? The importance and value of access to insurance coverage was lost on something that had nothing to do with health insurance at all. But it left its mark. Absolutely not fair but true. A breathing person coupled with a comprehensive, easy to navigate website helps to create value and encourage participation. It's as simple as that. During the few times I was able to reach a live person, I was very impressed with their professionalism, knowledge and patience. We just need more of them. The website is still evolving and probably will be for quite a while, but the need for live representatives standing by is still the quickest way to help people circumnavigate through the process itself. There are lots of moving pieces and individual details that must be addressed. I quickly found out that if you want to go beyond simply scratching the surface, you will need to speak with a live person.

But make no mistake about it, I am eternally grateful that I FINALLY have the opportunity to actually be frustrated with long wait times and understanding new processes as I know that ultimately, I will be able to buy insurance. And long wait times are better than dying from diabetes complications because I can't afford my supplies due to being denied the ability to purchase health insurance. Prevention, information, education, and access give everyone a better chance to stay healthy and thus help keep overall individual and social costs down.

I never thought that this second installment of my individual search through the Affordable Care Act would be about talking to a live person. But as I stated before, I believe that the process sets the tone for the value of the program itself. I will say it again, we need more live representatives.

Right now, I'm waiting for my COBRA package in order to compare the pricing based on my income, age, level of coverage and affordability. I've been told that COBRA will most likely be less expensive but I certainly want to compare. Clearly, COBRA isn't forever and runs out eventually. The days of always looking over my shoulder as the "end" of my coverage looms, just may be gone. Maybe.

The next post date will be announced on my twitter feed: https://twitter.com/DiabetesMedia

To be continued...