Cindi Rountree knew she was fed up with her health insurer after she was told she had to drive 80 miles if she wanted to buy a new breast prosthesis at a lower, in-network rate.
That was not the only challenge Rountree, a breast cancer survivor, had with her insurer, the now-defunct Kentucky Health Cooperative.
She had to fight to have a colonoscopy designated as a screening—a free service under the Affordable Care Act. The test was originally billed as diagnostic, which led to an unexpected charge of $217.20. Her allergist's office also asked her to call the insurer about why the office's claims were not being paid.
Rountree's experience with the co-op's customer service began inauspiciously in 2014, when Kentucky Health Cooperative repeatedly misspelled her name on her insurance card and bills. Over the course of two years, the insurer inundated Rountree with numerous explanations of benefits for diagnostic tests, breast exams and other routine procedures that told her she owed money even though she thought she was in the clear. Rountree provided copies of the paperwork to Modern Healthcare.
“I was livid,” said Rountree, 52, who lives in Louisville with her husband, Doug, and their 12-year-old son, Caleb.
Rountree's experience provides a glimpse into the failures of the ACA's co-ops, which were both underfunded and underpriced. But her frustrations, and those of many other people who have voluntarily reached out to Modern Healthcare, also show that health insurance companies of all sizes still have not mastered the art of customer service. It's somewhat unsurprising that an August 2015 poll from the Kaiser Family Foundation found people ranked health insurance companies almost as unfavorably as pharmaceutical companies and oil conglomerates, due in no small part to insurers' reputation for poor customer service.
The Rountrees were among the thousands of people covered by Kentucky Health Cooperative, one of the not-for-profit co-ops that were funded with taxpayer loans authorized by the ACA. By the time the exchanges were set to go live in late 2013, an insurance broker directed Rountree and her family to Kentucky Health Cooperative.