Angele Calderon needed help. She had maneuvered as far as she could on Washington’s health-insurance website.
Then, for two weeks, she tried unsuccessfully to get through to the toll-free call center to get answers for her health-insurance questions. When someone eventually picked up, she bounced for 45 minutes between folks who couldn’t solve her problem.
So on a recent evening, Calderon went to get help the old-fashioned way: sitting face to face with a real person.
As the Jan. 1 starting date for many health-insurance plans creeps ever closer, many people are scrambling to meet the Dec. 23 deadline by which they have to at least begin the application process on the exchange. That’s meant even more work for “in-person assisters,” or navigators, trained to help people enroll in Medicaid or buy insurance online through the state’s health-insurance marketplace, Washington Healthplanfinder.
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While everyone’s fingers are crossed that the state website will keep working after recent repairs and that the call center will zip through more calls, in-person assisters offer an alternative route to the insurance finish line. Many groups with assisters have their own toll-free phone lines and will help people fill out paper applications when the website is on the fritz.
“I’m seeing a crescendo in the volume of people coming in,” said Rudy Vasquez, director of managed-care operations for Sea Mar Community Health Centers, which has a team of in-person assisters. In just the first two weeks of December, the group had representatives at 57 outreach events.
“We’re out there informing people wherever we can,” Vasquez said.
The in-person assisters help people create logins and passwords, the first steps toward enrollment in Healthplanfinder. They guide people through numerous financial questions that will determine if they qualify for free health care through Medicaid, a tax break that will help them pay for their premiums, or if they will pay the full freight for their insurance. They help folks who stumble over technical “error messages” that can derail online enrollment.
And sometimes they teach on-the-fly Health Insurance 101. The health-care industry is a sea of jargon where doctors become “providers,” hospitals and clinics morph into “networks,” and medical bills turn into mind-bending terms like “co-payments” and “coinsurance.” The in-person assister can help navigate technological and conceptual rough waters alike.
Public Health — Seattle & King County alone has trained more than 600 in-person assisters who work for a variety of community organizations and health-care facilities. Assisters are being deployed everywhere from the Shoreline Library, where Calderon found help, to the slopes of Stevens Pass, where this month they enrolled the ski resort’s part-time workers for health care.
Calderon was struggling with the idea of deductibles and out-of-pocket expenses that for some plans are a flat rate, while others charge a percentage of a doctor’s bill. She wrestled with the choice of going with a cheaper plan for herself and her husband that included fewer doctors, or a more costly one that would pay for a wide range of hospitals.
“It’s hard to think through all of that,” admitted Jennifer Covert, an in-person assister with Public Health — Seattle & King County, who was working with Calderon.
As one of the lead outreach organizations for the state, and one with a lot of experience working through health issues in a wide range of racial, ethnic and economic communities, Public Health has tried to be nimble and strategic in making sure it’s deploying its people in the most effective way.
“It can feel really overwhelming,” said Patty Hayes, community health-services division director for Public Health. “Around every corner is something we’re not expecting.”
That has included answering questions for a surprisingly large number of Medicare recipients worried that their insurance coverage would be changing (it won’t) and figuring out how to enter homeless kids into the system.
It has also meant having staff work long days entering information from paper applications into the Healthplanfinder website because the state has its own backlog of applications.
State officials announced Wednesday that if people started applications by the Dec. 23 deadline — even if they weren’t finished by that date — and paid for their insurance by Jan. 15, the starting date for their coverage would be retroactive to Jan. 1.
Sea Mar has been ramping up its operations since the Oct. 1 launch of the health-insurance marketplace.
The group has increased the number of assisters answering its call line from two to five people. In addition to offering help weekdays at dozens of their clinics around Puget Sound, the organization added Saturday to its schedule at most locations. It has trained receptionists, dental staff and mental-health workers in some of the basics of the health-care overhaul; they’re not fully certified in-person assisters, but they can be a starting place for someone needing help.
WithinReach, a statewide nonprofit group that connects low-income residents to food and health services, is another outreach partner with Public Health. The group has nearly 30 in-person assisters and a phone line that’s been popular with folks trying to figure out their options.
“They are calling us because they are overwhelmed,” said Cathy MacCaul, director of community engagement for WithinReach. “They might be new to insurance.”
That includes the call it received from a young construction worker in Spokane. His answer for health care was paying out-of-pocket for emergency-room visits — except for the time he stitched up a gash in his arm himself because he couldn’t afford care. WithinReach staff explained how the new insurance system worked and got his family enrolled.
“It’s a societal shift. It’s a cultural shift,” MacCaul said. “It really truly is changing the way we view health care. It’s going to take time. It doesn’t happen overnight, and we’ve got to stop thinking short term.”
Lisa Stiffler, a freelance writer in Seattle, can be reached at email@example.com.This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation.