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Health plan help line swamped with calls

Email|Print| Text size + By Alice Dembner
Globe Staff / November 5, 2007

People seeking help with the state's new subsidized health insurance plan are overwhelming the phone center set up to serve them, leaving 10 to 20 percent of calls unanswered in recent weeks.

State officials say they are working to solve the problem, but the volume of calls is expected to soar over the next eight weeks as people rush to get insurance so they can avoid a tax penalty. Under state law, all Massachusetts residents must obtain insurance by Dec. 31, unless the state determines it is unaffordable.

"It's a product of growing too fast, but it needs to be fixed," said Celia Wcislo, a board member of the Commonwealth Health Insurance Connector, which oversees the state's health insurance initiative. "I don't want people's first experience to be spending a half-hour on the phone waiting."

Callers are typically seeking to enroll or to get help navigating the health plan. Call volume is four times what the state predicted, reaching nearly 13,000 in the last week of September, according to the most recent numbers available. Twenty-two percent of those calls were "abandoned" - that is, people grew tired of waiting and hung up before an operator could help them. Similar overloads have occurred since late August.

"That's high," said Brad Cleveland, president of the International Customer Management Institute, which trains and sets standards for customer call centers. "You want to see 4 to 6 percent" abandoned calls at most, "but not more."

The flood of calls is due in part to higher than expected enrollment in the state-subsidized program, Commonwealth Care. Enrollment is nearing 140,000, the total the state projected for July 2008. Commonwealth Care is open to people without access to work-based insurance whose annual income is below 300 percent of the US poverty level, or about $31,000 for a single person.

"People are really eager to sign up, and we're hearing from people who say, 'I waited for 10 minutes and then hung up. What should I do?' " said Brian Rosman of the advocacy group Health Care for All. "Call abandonments are a breakdown in the system."

Many enrollees are seeking insurance for the first time and have questions about how the coverage works, its benefits, and its costs. Other callers are impatient about the processing of their applications, which can take weeks. A surge in calls is expected in the next six weeks because people already enrolled are being allowed to switch among four health insurers. Also, state officials expect to hear from many of the 45,000 people who were mailed notices of possible eligibility last month.

The call center "is the public face of the program" and "we're trying to set a gold standard of customer service," said Melissa Boudreault, who oversees Commonwealth Care. "But I never expected this level of calls."

The state contracts out management of the call center to a private company, which is being paid $13.2 million over two years to answer calls and e-mails, handle billing, and work on marketing and outreach. The contract sets standards, including the requirement that no more than 3 percent of calls each month go unanswered, and that the average time on hold be no more than a minute. The actual average is 7.4 percent of calls unanswered in the last six months. In September, the average was 15 percent, and callers were on hold for nearly four minutes.

The state has not imposed the stiff financial penalties set out in the contract because the volume of calls is so far above specified levels. The contactor is training more operators, a process that takes two weeks because of the complexity of the insurance program. By next week, the state expects to have about 50 people answering calls.

The state and contractor have added more automated information and developed a better system to triage calls, Boudreault said.

The Commonwealth Care call center is staffed between 8 a.m. and 5 p.m. Monday through Friday at 1-877-623-6765. Information is also available at mahealthconnector.org.

Phone overload


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