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ObamaCare "Help" Hotline (Another Chat Script)

Rainbow Girl's picture

I'm collecting scripts from people that are self-employed and self-insured (or uninsured) in NYC and therefore are investigating ObamaCare seriously, and asking a lot of important questions. Here's a script where a question about whether the ACA federal law has a specific requirement that any exchange must offer a plan that allows out-of-network coverage. The answer by Mona seems to be "yes" -- who knows whether this is accurate. As with all the Q&As I have seen so far, the pattern is that in response to specific Qs, the helpers type paragraphs from a script. Here there's also a non-responsive first answer that punts to "go check out [your State] exchange for the answer."

[10:54:37 pm]: Thanks for contacting Health Insurance Marketplace Live Chat. Please wait while we connect you to someone who can help.
[10:54:41 pm]: Please be patient while we're helping other people.
[10:54:45 pm]: Welcome! You're now connected to Health Insurance Marketplace Live Chat.

Thanks for contacting us. My name is Mona. To protect your privacy, please don't provide any personal information, like Social Security Number, or any other sensitive medical or personal information.
[10:55:03 pm]: Mona
Hello, how may I help you?
[10:55:06 pm]: Sarah
Hi, I was in a chat with Dale about 2 hours ago. I had to log off and forgot to save the transcript . Is it available? Thank you!
[10:56:02 pm]: Mona
I do apologize, it is not available.
[10:56:24 pm]: Sarah
Is that because I would have to save it during the chat?
[10:56:46 pm]: Mona
Yes ma'am.
[10:57:02 pm]: Sarah
I see. Well, thank you very much. Have a nice evening!
[10:57:28 pm]: Mona
Your very welcome. Do you have any Marketplace questions I can assist you with?
[10:58:24 pm]: Sarah
Yes. I would like to know if the PPACA requires that all exchanges (even if they are state run) must provide at least one plan option that allows the patient to go out of network.
[10:59:24 pm]: Mona
I would be more than happy to research that for you. May I ask what stat you live in?
[11:00:21 pm]: Sarah
Sure - I'm in New York State. However I am trying to understand if the PPACA has a requirement in the legislation that requires the exchanges (including in NYS) to provide an insurance product that includes out of network doctors.
[11:01:21 pm]: Mona
I understand, one moment please while I research that.
[11:05:52 pm]: Mona
Thank you for holding. Here is the only information we have at this time, for choosing a doctor. We will have more information as of October 1, 2013.
[11:05:58 pm]: Mona
If you currently have health insurance and are thinking of switching plans, you may want to keep your current doctor. If you buy insurance through the Health Insurance Marketplace, your health insurance company will provide a list of doctors and hospitals that accept your plan. Your current doctor may or may not accept your new health insurance plan.

When comparing Marketplace plans, you'll be able to review the providers in each plan's network. Many tools are available to help you search, compare, and assess doctors, hospitals, and other care providers so you can make better decisions. You can also find quality information about doctors, hospitals, and other care providers by using our quality compare tools. These tools are available on HealthCare.gov under the Prevention, Wellness, and Comparing Providers tab.

Health insurance companies contract with doctors and hospitals to take care of people in the plan. The cost of hospital care depends on the type of services you receive and whether the hospital is in your plan network. Depending on the plan you buy, your health insurance company may only pay for your care when you receive it from a provider in your plan's network.
[11:07:31 pm]: Mona
I do apologize. New York will be running it's own Marketplace. Here is the information you will need to be able to contact them for assistance.
[11:07:37 pm]: Mona
New York Health Benefit Exchange is the Health Insurance Marketplace that will serve you. New York Health Benefit Exchange is a new Marketplace where residents of New York can find out about their health coverage options. New York Health Benefit Exchange will help you find what programs you may qualify for and shop online, over the phone, or in person to find the right health care insurance options for you. You will use your state's New York Health Benefit Exchange website, instead of HealthCare.gov, to find out more about the Health Insurance Marketplace and how you can get ready to enroll. It will open later this summer to receive calls. In the meantime, I am happy to answer your questions, or you can visit or healthbenefitexchange.ny.gov to learn more
[11:08:50 pm]: Sarah
Sorry if I'm a little dense. It seems that what you are stating (or what the literature you are quoting is stating) is that Exchange policies are NOT required by PPACA to provide a policy that is NOT limited to a policy-HMO. Is that correct? If New York State wants to provide one, then that would be something NY State does on its own volition, but not because the PPACA requires it to do so. Is this accurate?
[11:12:33 pm]: Mona
I do apologize, we will have more answers for you as of October 1, 2013. If you would like, you can go to the HealthCare.gov web site and enter PPACA in the search bar. It will bring you to the link to be able to read the Affordable Care Act.
[11:13:08 pm]: Sarah
Also, the roll out date for enrollment is October 1 -- 3 weeks from now. It's past the summer -- does the NYS government have a working information system where I can call them or email them today? I would like to have sufficient time to perform adequate research on these very important issues (my healthcare and the cost of insurance) with enough time to make an informed decision.
[11:14:38 pm]: Sarah
I'm sorry Mona, I don't understand. Are you saying that you are unable at this time to advise me one way or the other whether the PPACA requires all exchange marketplaces to include a plan (or plans) that allow the customer/patient to obtain reimbursable care outside a network? Or that the PPACA required plans are strictly HMO-type plans where the patient is limited to receiving care to in-network providers?
[11:15:06 pm]: Mona
I do apologize. You will use your state's New York Health Benefit Exchange website.
[11:16:22 pm]: Mona
I do apologize. Here is the information on the types of plans that will be offered.
[11:16:24 pm]: Sarah
I am somewhat surprised that health.gov is unable to answer this question since the PPACA is federal legislation, not New York State legislation. In addition, the NY website is not even operational at this time.
[11:16:26 pm]: Mona
The Health Insurance Marketplace offers different types of health insurance plans to meet different needs. Starting October 1, 2013, there will be many resources available to help you choose the plan that's right for you and your family. When these resources are available, you can find them by visiting HealthCare.gov or by calling us here.

The different types of health insurance plans include:
Health maintenance organizations, known as HMOs, and exclusive provider organizations, both of which may limit your coverage to providers inside of their network. If you use a doctor or facility that isn't in the plan's network, you may have to pay for the full cost of these services.
A preferred provider organization plan, which gives you the choice of using doctors and other health care providers both inside and outside the plan's network. Generally, you pay less out-of-pocket when you see an in-network provider. You do not need to get a referral from a primary care physician to see a specialist.
A point-of-service plan, which allows you to use any health care provider, either in-network or out-of-network. You pay less for an in-network provider. To see a physician outside of your network, you need a referral from your primary care physician, and are responsible for most of the cost. [So according to Mona, PPACA (maybe, or maybe not) ensures that every state exchange offers a plan where you can go out of network -- not that 99% of people would be able to afford it -- but still, something to watch for
A high deductible health plan, which provides coverage for high-cost medical needs, such as hospitalizations. This type of plan has lower premiums than many other health insurance plans, but you must pay a higher deductible before your health insurance company contributes to the cost of medical care.
A catastrophic health insurance plan, which covers essential health benefits but has a very high deductible. In the Marketplace, catastrophic plans are available only for people under 30 years old and for some low-income people.
[11:17:32 pm]: Sarah
I see. So all of the plans that you mentioned will have to be made available -- per the PPACA -- by any state-managed exchange marketplace?
[11:18:06 pm]: Mona
Yes ma'am.

[11:20:15 pm]: Sarah
Ok, so that is helpful. Do you have a section of the statute or the regulations that speaks to this subject? It's such a thick law it's hard to find stuff if you're not an expert :)
[11:21:20 pm]: Mona
I do apologize I am unaware of what section covers this subject.
[11:21:43 pm]: Sarah
I see. I guess your materials don't reference those things ...
[11:22:17 pm]: Mona
I apologize, that I am unable to assist you with that.

[11:23:00 pm]: Sarah
Ok, thanks for your help. Good night!
[11:23:19 pm]: Mona
Your very welcome. You have a good night also.
[11:23:21 pm]: Mona
Thank you for contacting Health Insurance Marketplace Live Chat. We are here to help you 24 hours a day, 7 days a week.

[10:54:37 pm]: Thanks for contacting Health Insurance Marketplace Live Chat. Please wait while we connect you to someone who can help.
[10:54:41 pm]: Please be patient while we're helping other people.
[10:54:45 pm]: Welcome! You're now connected to Health Insurance Marketplace Live Chat.

Thanks for contacting us. My name is Mona. To protect your privacy, please don't provide any personal information, like Social Security Number, or any other sensitive medical or personal information.
[10:55:03 pm]: Mona
Hello, how may I help you?
[10:55:06 pm]: Sarah
Hi, I was in a chat with Dale about 2 hours ago. I had to log off and forgot to save the transcript . Is it available? Thank you!
[10:56:02 pm]: Mona
I do apologize, it is not available.
[10:56:24 pm]: Sarah
Is that because I would have to save it during the chat?
[10:56:46 pm]: Mona
Yes ma'am.
[10:57:02 pm]: Sarah
I see. Well, thank you very much. Have a nice evening!
[10:57:28 pm]: Mona
Your very welcome. Do you have any Marketplace questions I can assist you with?
[10:58:24 pm]: Sarah
Yes. I would like to know if the PPACA requires that all exchanges (even if they are state run) must provide at least one plan option that allows the patient to go out of network.
[10:59:24 pm]: Mona
I would be more than happy to research that for you. May I ask what stat you live in?
[11:00:21 pm]: Sarah
Sure - I'm in New York State. However I am trying to understand if the PPACA has a requirement in the legislation that requires the exchanges (including in NYS) to provide an insurance product that includes out of network doctors.
[11:01:21 pm]: Mona
I understand, one moment please while I research that.
[11:05:52 pm]: Mona
Thank you for holding. Here is the only information we have at this time, for choosing a doctor. We will have more information as of October 1, 2013.
[11:05:58 pm]: Mona
If you currently have health insurance and are thinking of switching plans, you may want to keep your current doctor. If you buy insurance through the Health Insurance Marketplace, your health insurance company will provide a list of doctors and hospitals that accept your plan. Your current doctor may or may not accept your new health insurance plan.

When comparing Marketplace plans, you'll be able to review the providers in each plan's network. Many tools are available to help you search, compare, and assess doctors, hospitals, and other care providers so you can make better decisions. You can also find quality information about doctors, hospitals, and other care providers by using our quality compare tools. These tools are available on HealthCare.gov under the Prevention, Wellness, and Comparing Providers tab.

Health insurance companies contract with doctors and hospitals to take care of people in the plan. The cost of hospital care depends on the type of services you receive and whether the hospital is in your plan network. Depending on the plan you buy, your health insurance company may only pay for your care when you receive it from a provider in your plan's network.
[11:07:31 pm]: Mona
I do apologize. New York will be running it's own Marketplace. Here is the information you will need to be able to contact them for assistance.
[11:07:37 pm]: Mona
New York Health Benefit Exchange is the Health Insurance Marketplace that will serve you. New York Health Benefit Exchange is a new Marketplace where residents of New York can find out about their health coverage options. New York Health Benefit Exchange will help you find what programs you may qualify for and shop online, over the phone, or in person to find the right health care insurance options for you. You will use your state's New York Health Benefit Exchange website, instead of HealthCare.gov, to find out more about the Health Insurance Marketplace and how you can get ready to enroll. It will open later this summer to receive calls. In the meantime, I am happy to answer your questions, or you can visit or healthbenefitexchange.ny.gov to learn more
[11:08:50 pm]: Sarah
Sorry if I'm a little dense. It seems that what you are stating (or what the literature you are quoting is stating) is that Exchange policies are NOT required by PPACA to provide a policy that is NOT limited to a policy-HMO. Is that correct? If New York State wants to provide one, then that would be something NY State does on its own volition, but not because the PPACA requires it to do so. Is this accurate?
[11:12:33 pm]: Mona
I do apologize, we will have more answers for you as of October 1, 2013. If you would like, you can go to the HealthCare.gov web site and enter PPACA in the search bar. It will bring you to the link to be able to read the Affordable Care Act.
[11:13:08 pm]: Sarah
Also, the roll out date for enrollment is October 1 -- 3 weeks from now. It's past the summer -- does the NYS government have a working information system where I can call them or email them today? I would like to have sufficient time to perform adequate research on these very important issues (my healthcare and the cost of insurance) with enough time to make an informed decision.
[11:14:38 pm]: Sarah
I'm sorry Mona, I don't understand. Are you saying that you are unable at this time to advise me one way or the other whether the PPACA requires all exchange marketplaces to include a plan (or plans) that allow the customer/patient to obtain reimbursable care outside a network? Or that the PPACA required plans are strictly HMO-type plans where the patient is limited to receiving care to in-network providers?
[11:15:06 pm]: Mona
I do apologize. You will use your state's New York Health Benefit Exchange website.
[11:16:22 pm]: Mona
I do apologize. Here is the information on the types of plans that will be offered.
[11:16:24 pm]: Sarah
I am somewhat surprised that health.gov is unable to answer this question since the PPACA is federal legislation, not New York State legislation. In addition, the NY website is not even operational at this time.
[11:16:26 pm]: Mona
The Health Insurance Marketplace offers different types of health insurance plans to meet different needs. Starting October 1, 2013, there will be many resources available to help you choose the plan that's right for you and your family. When these resources are available, you can find them by visiting HealthCare.gov or by calling us here.

The different types of health insurance plans include:
Health maintenance organizations, known as HMOs, and exclusive provider organizations, both of which may limit your coverage to providers inside of their network. If you use a doctor or facility that isn't in the plan's network, you may have to pay for the full cost of these services.
A preferred provider organization plan, which gives you the choice of using doctors and other health care providers both inside and outside the plan's network. Generally, you pay less out-of-pocket when you see an in-network provider. You do not need to get a referral from a primary care physician to see a specialist.
A point-of-service plan, which allows you to use any health care provider, either in-network or out-of-network. You pay less for an in-network provider. To see a physician outside of your network, you need a referral from your primary care physician, and are responsible for most of the cost.
A high deductible health plan, which provides coverage for high-cost medical needs, such as hospitalizations. This type of plan has lower premiums than many other health insurance plans, but you must pay a higher deductible before your health insurance company contributes to the cost of medical care.
A catastrophic health insurance plan, which covers essential health benefits but has a very high deductible. In the Marketplace, catastrophic plans are available only for people under 30 years old and for some low-income people.
[11:17:32 pm]: Sarah
I see. So all of the plans that you mentioned will have to be made available -- per the PPACA -- by any state-managed exchange marketplace?
[11:18:06 pm]: Mona
Yes ma'am.
[11:20:15 pm]: Sarah
Ok, so that is helpful. Do you have a section of the statute or the regulations that speaks to this subject? It's such a thick law it's hard to find stuff if you're not an expert :)
[11:21:20 pm]: Mona
I do apologize I am unaware of what section covers this subject.
[11:21:43 pm]: Sarah
I see. I guess your materials don't reference those things ...
[11:22:17 pm]: Mona
I apologize, that I am unable to assist you with that.
[11:23:00 pm]: Sarah
Ok, thanks for your help. Good night!
[11:23:19 pm]: Mona
Your very welcome. You have a good night also.
[11:23:21 pm]: Mona
Thank you for contacting Health Insurance Marketplace Live Chat. We are here to help you 24 hours a day, 7 days a week.
[11:25:02 pm]: Your chat session is over. Thanks for contacting us, and we hope we've answered your questions. Have a great day.
[11:25:02 pm]: 9/9/2013

Comments

Alexa's picture
Submitted by Alexa on

obvious to me that the reps are really limited to answering very broad questions--with no specific issues or details available to them.

Great that you asked for a "regulation," even though none was forthcoming.

I figured that would be the case, although I meant to, but forgot to ask, when I spoke to the Marketplace rep.

It's worth a try to ask.

Probably for reasons of "time," and maybe even "liability"--this type of information will not be forthcoming.

Look on the bright side, RG--at least NY will have it's own Exchange, which MAY be more informative and efficient than this federal "outfit." (I hope it does.)

I think your friend (or any of us) would be better off sticking with what she (us) already have (if it's affordable), rather than dealing with these customer service reps.

I really have a feeling that they don't "know squat" about the ACA. Seriously.

Rainbow Girl's picture
Submitted by Rainbow Girl on

They do seem limited to the very broad, which is not terribly helpful for the individual "customer," which begs the question as to why all this money is being spent on "help" resources that do not help the intended audience.

Btw, this was not a chat I had with healthcare.gov, but a friend's.

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