Dear Madame HR,

I have a question about benefits. My company’s plan year began on July 1^st and guess what? For the third year in a row they have switched our carrier again! Why do they keep doing that to us? To make matters worse, I had made a doctor’s appointment for this week with a pediatrician for my 2 young kids. It took me forever to get this appointment with this doctor at a time both me and my wife could go. Well, guess what again? I didn’t get my new insurance card in time for the appointment. When I called my HR Department to ask what to do, I literally heard the HR Manger in the background tell the person I was on the phone with “tell him not to go to the doctor!” I am stunned, and apparently screwed. What do I do now?

–Why do they hate me?

Dear Mr. Why,

Not to be technical, but you started by saying you have A question and then proceeded to ask me 5 questions. But that’s ok, I can take it, keep it coming! I will answer your many questions in order:

Question 1: Guess what?

I don’t know, chicken butt?

Question 2: Why do they keep doing that to us?

Money honey. There is nothing worse in the whole wide world than trying to convince a CFO to accept a double digit increase in benefit premiums. It’s ridiculous, outrageous, but benefit carriers get away with highway robbery. And they love to throw out the dreaded phrase Obamacare as a reason to justify these increases. I don’t know, maybe it is going to cost them 20% more to administer the quagmire that Obama and Congress has thrust upon us. Maybe, but I don’t buy it. And, to be honest, I don’t really know that much about it, it just doesn’t make much sense to me. Especially since as an employer, most of the burden is on YOU, but maybe I’m missing something.

It doesn’t matter though, for purposes of answering your question. Carriers are notorious in my experience for giving you a really great “introductory” price to get companies to sign up and then in year or two, it’s rate hike city. Companies counteract this by looking for that next carrier who wants to give them that next “introductory” price and so begins the dance. Eventually it all catches up with you and carriers don’t want to touch your jumpy ass with a ten foot pole, but until that happens, hop away I say!

Depending on your rate structure, your company demographics, etc., etc., etc., I don’t know, blah, blah, blah. The bottom line is that no matter how annoyed you are right now, I’m sure your HR Department is equally annoyed. It’s not easy to administer a carrier switch. If you have a big company, aren’t automated, have lots of employees who are pregnant or annoying or both, this gets even worse.

I don’t know if it helps, but this is the reason, there you go.

Question 3: Guess what again?

Jeez, I don’t know again, I’m going to stick my original answer: Chicken butt.

Q4: What do I do now?

Don’t get mad at me but I literally laughed out loud at your story of what the HR Manager said when you called asking for help so you could take your kids to the doctor. I mean, if I had been you, I would have been PISSED, but since I’m not you, I thought it was pretty amusing.

Usually I try to defend the HR Manager in situations like this, but in this one, it’s hard. I could give her the benefit of the doubt and say she was joking. But I don’t think you thought it was funny, and it doesn’t seem like she then called you back and told you the real answer.

Sorry, it sounds like your HR Department kind of sucks. Usually, when a company switches to a new carrier, the broker the company works with, along with the HR Department, and the new carrier come up with a transition plan so there are no lapses, no situations like this.

Here are the steps I would take if I were you: (Yay! Numbered list time!!)

1. Call HR (this failed, so feel free to skip to the next step)
2. Call your company’s broker. Did you go to your Open Enrollment meeting? Usually they give you the customer service line or something for the broker. This is just the type of situation where brokers are useful.
3. Call the new carrier, explain your situation. Chances are it’s not news to them that your company is switching to them. Hopefully they have already assigned a group number to your group, and an ID number to you. If so, sweet! Just get those numbers and give them to your doctor. If not, they should instruct you what to do. This happens all the time. Most likely they will tell you to tell the doctor’s office to call them and verify coverage.

There are a couple of things that could muck it up:

1. The doctor you are going to see isn’t covered by the new insurance carrier. This happens a lot in HMO situations. Your old primary care doctor (PCP) is not in your new plan. Oh the horror. What you can do in these situations, especially if you are in the midst of being treated for something (i.e. pregnancy) is to apply for a continuation of care that will allow you to see your old doctor until you have completed treatment (i.e. given birth) and find a new doctor. If you are in this situation I strongly recommend you skip ahead to #3 in the list above and get advice from the carrier asap.
2. I can’t think of a second thing. However, I feel compelled to have a second point because I started this list with the words “a couple of things.” Insert your own here.

Here is some good advice:

1. If you are on an HMO, do your gosh darn darnedest not to pay up front with the hopes that you can file a claim later and be reimbursed. HMO’s are not designed that way, their contracts with doctors are weird and impossible to understand. If this were a dental HMO, you are kind of screwed, but under NO circumstances should you EVER EVER EVER EVER pay full price with the hopes of getting reimbursed later in a dental HMO plan.
2. If you are on a PPO, you don’t have as much to worry about in regards to paying first and getting reimbursed later. However, keep in mind that the insurance companies have negotiated with doctor’s what they can charge them for services. This is called “reasonable and customary.” If you are paying cash out of pocket, the doctor can charge you whatever they want, however, the insurance company will only reimburse you what is the “reasonable and customary” fee (less your deductible, coinsurance, etc., etc., etc.). You might not get a full reimbursement. Proceed with caution.
3. Just because you haven’t received your card in the mail doesn’t mean you aren’t in the carrier’s system. Go to their website, try and register, if you can, usually you can also print a temporary card. Then you are in like Flynn!

Basically, in a nutshell, you need to get your doctor’s office to call your new carrier and have them verify you are covered, what your copay is, etc. Hopefully your doctor’s office is willing to do this. Some doctor’s offices get persnickety and won’t do anything unless you have a card.

Nothing could possible go wrong. Wait…ok, everything could go wrong. But hopefully it won’t. Carriers are usually pretty good about stuff like this, they deal with it every day. Thumbs up! Everything is going to be fantastic!

Question 5: Why do they hate me?

I don’t know. This is a loaded question. HR Departments have a complicated relationship with the employees they serve. I mean, yes, we love you guys. You’re why we are here, right? But, come on, many times you don’t freaking listen, or you do some pretty stupid stuff, or you just won’t shut the heck up already. But we love you—basically, pretty much.

I wouldn’t take this benefit switch so personally. I guarantee they were not thinking of you and your 2 adorable little kids specifically (unless one of you has some sort of horrible disease and has run up a fortune in hospital bills. In that case, it probably is your fault). This was purely economics. And ultimately, it’s great for you. You and your kids have health insurance. Hopefully it is adequate. Hopefully you don’t pay too much out of pocket. See, all sorts of silver linings. So just call your new carrier and all will be well (Literally!).

Good luck out there,

Nurse madame

This post originally appeared on Fierce and Nerdy July 7, 2013.

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Written by: Madame HR on October 20, 2013.