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The perils of privatization under the Emanuel and Claypool regimes... Getting the COBRA runaround from CPS and the privatized vendors...

Joanne Cairo - January 12, 2017

Because I had to retire from CPS a year ago to have any insurance, I went on COBRA. But instead of paying my money to CPS, I have to go elsewhere. CPS is using a third party vendor, apparently located in Nebraska, which receives the payment for the insurance. This privatization goes to an outfit called "Pay Flex Systems USA, Inc.” I don't know how much extra Chicago's public school system is paying to have this work outsourced, as opposed to being done by CPS workers, but I can testify from bitter -- and dangerous -- experience that instead of getting the job done, their jobs (both the privatized vendors and CPS) seem to be to put people on a perpetual runaround. [The official U.S. Government explanation of COBRA is at the end of this article].

CPS headquarters at Madison and Dearborn in Chicago.As many readers know, COBRA can last as long as 18 months. I was on it less than a year when my latest challenges began.

The problems began immediately. I started with them last year, and the first month after paying, I had to pay my medication out of pocket. When I submitted the paperwork to receive my difference back, that never happened. I am still out all those dollars (and as most readers know, COBRA is not cheap).

My advice to anyone dealing with these people -- keep all of your own records. Because of these early problems, I make sure every month that I send my payment in two weeks before the end of the month we are in. I believed that by paying early I would not have any days without insurance.

When you make your payments you have to submit a "Member Information" slip with your payment. Why this should be necessary in an age of computerized medical records no one has explained, but every month I fill out the slip. Then, with my check, I make a copy for my files -- just in case something might happen to my slip and check. Such things tend to 'get lost.'

They only gave me slips for 2016. So last month, in December 2016, I called Pay Flex and wanted to know when I would be receiving my 2017 slips. "They will be mailed to you," I was told.

I'm still waiting. I hadn’t received the 2017 slips by January 4, 2017. I called Pay Flex again that day and I was told they were "in the mail." I also was told I had insurance until January 30, 2017, and I shouldn’t worry about it. But on Monday, January 9, 2017, I received a call from Walgreens asking me if I had changed insurance because I did not have any according to their records.

So on January 9, 2017 I called Pay Flex again, and they told me I was insured until January 30, 2017. They said I should call my insurance.

So I called BCBS and they told me to call Caremark.

I called CareMark, where I spoke to "Chelsie." Chelsie at Caremark assured me that I have insurance and said that that it is a Walgreens issue. She put me on hold, when she came back she said that Walgreens was waiting for the doctor's script.

On Tuesday morning, I called my cardiologist's office about the new script. That afternoon I went back to Walgreens to pick up my medication and again I was asked did I change insurances. Again I told them no. So the pharmacist called CareMart while I was there and he was told I don’t have any insurance.

I went right home and began the phones calls again, carefully taking notes while comfortably seated for the lengthy hold.

I called Caremark, and I got Chelsie again. This time she told me I have to call Chicago Public Schools Human Relations. But again she doesn’t tell me I don’t have any insurance. My point is that I have spoken to the same person two days in a row.

Today, Wednesday, I was told by another CareMark person that Chelsie never made any notes about my last two calls.

So I proceeded to the next stop -- back to CPS. I called CPS HR. It was 3:50 pm. I was on hold until 5:10 pm and no one ever answered.

I found out that the HR office closes at 4pm.

On Wednesday, January 11, 2017, I called CPS HR at 9:07 am. Fnally at 9:57 someone picked up the phone. She refused to tell me her name. Then she continued and repeated "You don’t work here we don’t have any records of you here."

She told me to call CareMark, and I told her "That’s funny. CareMark told me to call you."

Finally the anonymous person at CPS put her supervisor on. The supervisor told me that her name was Ashley, and she told me the first girl's name from HR was Cynthia.

Now Ashley told me to call Pay Flex. I explained to her that I have repeatedly called them and they say I have insurance until January 30, 2017.

There is another irony here, the one about "human" resources. CPS HR people are not nice. They are rude. It is very obvious where they got their training dealing with the public. But they had sent me down the same paths I had already been down.

So it was back to Pay Flex. This time I was talking to Danielle, and she said that she can send a message to my insurance to let them know I am insured -- but that will take seven to ten days. I mentioned that I ran out of my medication yesterday January 10, 2017. Then she said it can be done in an emergency 24 to 48 hours.

I called CareMark again and spoke to Deidra. Deidra gives me the phone number to COBRA (Pay Flex) and told me to call them that after she told me to call CPS HR.

So I called Cobra again and it’s Pay Flex. This time I spoke to Jamie. She explained that the insurance copies drop you, if Pay Flex doesn’t notify them if you are still insured. Then she told me that Pay Flex has received a lot of phone calls from several individuals in the same situation. She explained that COBRA keeps going, but it’s the others who stop the insurance.

I'm sure I'm not alone in this expensive and dangerous situation. My question is why is there not one phone number to call, where someone has the knowledge of what is going on. Dealing with CPS HR is an annoying waste of time, and CPS officials of course cannot explain why they need to privatize something as important and simple as COBRA in the first place. But that will be another story for another time.

Substance welcomes comments on this situation and others like it.

UNITED STATES DEPARTMENT OF LABOR EXPLANATION OF COBRA...

Health Plans & Benefits: Continuation of Health Coverage - COBRA

Subtopics

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.

COBRA outlines how employees and family members may elect continuation coverage. It also requires employers and plans to provide notice.

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