[See the update here.]
Dear Tufts Health Plan,
I am fortunate to have had the privilege of working for more than three decades in white-collar jobs which provided decent employer-sponsored health insurance. I’ve therefore been a member of many different health insurance companies, and I’m not sure any of them has given me so much trouble in so little time as Tufts Health Plan (“Tufts”) has.*
I’m writing this letter because I’m the kind of person who gives uncaring bureaucracies the benefit of the doubt and hopes that there’s some chance that if I share my concerns and experiences with them, someone will do something about them, to make things better for me and others in the future.
So let’s cut to the chase and talk about all the ways large and small in which Tufts has let me down in the past seven months. Or, at least, all the ones I can remember; there have been so many that I’ll probably forget some.
This morning, I received an email notification from Tufts with the subject line “Summary of Payment (SOP) Ready for Viewing”. Four hours later I received a second copy of the same email. Why did I receive two copies of this email? One would have been sufficient.**
The “From” line of both emails looks like this:
Why does this say “Test”? You should not be sending “Test” emails to your members.
Also, is no one at Tufts aware of the negative UX and information security implications of sending a transactional email like this from a domain that you don’t own? This email should come from “@tuftshealthplan.com” or “@tufts-health.com,” not from “@clarityssi.com.”
They body of the email begins as follows:
An Explanation of Benefits (EOB) has been posted to your Tufts Health Plan online member portal – Tufts Health Member Connect – . To log into your account and review your explanation of benefits (EOB):
1. Go to tuftshealthplan.com/memberconnect
2. Enter your Username (email address) and Password
3. Under My Health, click on the Claims tab at the top of the page
Member claims are listed by date, with the most recent claim appearing at the top of the list. To view an EOB, choose Claims under My Health Plan. Then click on the pdf icon under View EOB for the claim you’d like to review.
There are so many errors in this one short email message!
The Subject line refers to a “Summary of Payment (SOP),” but the body of the email refers to an “Explanation of Benefits (EOB).” These are two different things, and indeed, both of them are available — separately — on your web site. This email is confused, and confusing, about what it purports to be notifying me about.
The punctuation of the first sentence is absurdly messed up in many different ways. There shouldn’t be hyphens in it at all: the phrase “Tufts Health Member Connect” at the end of the sentence should be separated from the rest of the sentence by a comma. If you’re going to use hyphens, they should both be the same size. And putting a hyphen immediately before a period is ludicrous.
Does anyone who knows how to write English look at these emails before they are sent out?
The URL given in the email, tuftshealthplan.com/memberconnect, is not the URL of the portal I’ve been using since I became a Tufts member, members.tufts-health.com. Why does this email refer me out of the blue to an entirely different portal that I’ve never used before?
When I click on the URL in the email and try to log in with the credentials I have for members.tufts-health.com, they are not accepted. Apparently this new portal requires different credentials from the credentials I already have for the portal I’ve been using until now. This is unreasonable.
The home page for this new portal has this block on it:
If you click on the “Registration Information” link, it brings up a four-page PDF, in the same browser tab, which essentially tells you to go back to the previous page and click either the “MA Residents” or “RI Residents” link depending on where you live and follow the instructions to complete registration (like people can’t figure this out on their own?). The fact that this is a PDF is terrible UX design. The fact that it doesn’t open in a new browser tab is terrible UX design. The fact that you seem to think you need a four-page PDF to explain how to register for your site, rather than providing that explanation inline as part of the registration process, is terrible UX design.
Here’s what I see when I click on the “MA Residents” link and try to register:
Even though I’m entering the correct registration information, I’m apparently not able to register on the site which your email told me to use. That’s both astoundingly absurd and and astoundingly annoying.
Having failed to log into this site, I gave up and logged into your other portal to view my SOP.
When I clicked on the SOP, the new window that opened to display it was so small that the text of the SOP was illegible. I had to first enlarge the window, then tell the browser to zoom in on the SOP, to be able to read it. More stupid, terrible UX!
Here’s what I see on the first page of the SOP:
This information is egregiously wrong. Nothing about this is correct.
The “Summary of Submitted Charges” shown above includes the figures from only the first claim listed in the SOP, when it should total the figures from all nine listed claims. The deductible and out of pocket max figures are also entirely wrong. As proof, here are the very different deductible figures shown on the web site (not in the SOP PDF):
What appears to have happened is that although the SOP is supposed to cover the first quarter of 2020, for some reason the first listed claim is from the end of 2019, and this triggered a bug in the ETL which generated the SOP which caused it to include only the one 2019 claim in the summary of submitted charges and to include 2019 deductible and out of pocket max information rather than the correct 2020 information. Yikes.
Let’s move on. Here’s one of the claims displayed in the SOP:
Here’s the footnote at the end of the SOP for code “C5”: “THIS CHARGE IS DENIED. THE ICD DIAGNOSIS DOES NOT SUPPORT THE SUBMITTED PROCEDURE CODE. UNLESS THE MEMBER HAS EXECUTED A VALID WAIVER PRIOR TO SERVICES RENDERED, THE MEMBER IS NOT RESPONSIBLE FOR PAYMENT.”
First of all, WHY ARE YOU SCREAMING AT ME? Another footnote in the same SOP is properly set in mixed case, so there is clearly no technical reason why this one needs to be in all caps. It’s just yet another unnecessary annoyance.
Second, as a patient, I really shouldn’t need to know anything about what an “ICD diagnosis” is or what “procedure code” was submitted by the lab that performed this procedure. What I do know is that it should come as no surprise to anyone — least of all any halfway decent health insurance company — that I would have a PSA screening test just a couple months after my 50th birthday, since that is the prevailing standard of care. Therefore, there is no legitimate reason for Tufts to have rejected this claim. Given my experiences to date with Tufts, my suspicion is that Tufts imposes some asinine billing requirement regarding routine PSA screening that other insurance companies do not, so even though the lab submitted the same billing code to Tufts that they typically submit successfully to other insurance companies, Tufts arbitrarily rejected it. However, even if this was due to an error by the lab, Tufts could have picked up the phone and called them to resolve it, rather than simply rejecting the claim. It’s simply absurd for a PSA test for a man who just turned 50 to be rejected by his insurance company.
I’m over 1,300 words into this letter, and I’ve only told you about the issues I’ve encountered with Tufts today. Let’s move on to problems I’ve encountered in the past. Fortunately, I do not need to explain all of them in detail here, because I’ve written about them before.
There’s the egregious HIPAA violation:
There’s the terribleness of your member portal:
On the heels of that, there’s the fact that your IT people are apparently too incompetent to implement DMARC properly (a problem which, I admit, you share with a large number of other organizations, many of them quite large and well-known):
And there’s your Orwellian attempt to redefine what “inpatient” means to justify refusing to preauthorize a surgery I need:
Let’s dig into that last one a bit deeper, because it’s even worse than what I wrote to you about it in the letter linked above.
You’ve elected to outsource preauthorization and appeals processing to a third party, a decision presumably justified by “efficiency” or cost savings. I can’t say whether it in fact saves you money, but I know for certain that it comes with a cost: the imposition of an unnecessarily klunky, bureaucratic process on your members. It also reduces accountability and gives Tufts plausible deniability, making decisions detrimental to members more likely and more difficult to overturn.
Leaving aside these process issues, there are also substantive issues with how Tufts has responded to the appeal which I sent you, or, to be more accurate, hasn’t responded. In addition to appealing the preauthorization denial, I also included in my letter several specific questions which I need Tufts — not the third party that handles preauthorization and appeals — to answer.
Having received no response over a month later, I reiterated these questions in email to one of your employees ten days ago, asking her to either answer them or refer me to someone who could. That email has not been acknowledged, let alone responded to. After a month and a half, I still don’t have the information I need — that only Tufts can provide — to schedule my surgery.
So, what does all this mean? I think Tufts is an organization that does not care about creating a positive, high-quality experience for the people it serves, and I’m betting that there is no one at Tufts whose job is to improve that experience and whose job performance is judged on how much they do that.
Here’s how you can prove me wrong:
- Tell me the name of the individual at Tufts who has the responsibility and authority to make your members’ experience better, and confirm that this person has read this letter and my previous complaints.
- Answer the questions about my surgery which I’ve been waiting a month and a half for you to answer.***
- Fix even just one of the other issues I’ve contacted you about in this letter or previously, and tell me in clear, specific, convincing, straightforward language how you’ve fixed it.
I am not at this point so foolish as to expect any of this to occur, but I hope you prove me wrong.
*The closest was ReliaStar back in the 90’s, which was so negligent about processing several claims that I was still cleaning up the mess — including threats of a lawsuit by a provider — three years later. But that’s a story for another time, and one which is moot anyway since ReliaStar is fortunately no longer in the health insurance business.
**I realized after writing this letter that the reason why I received two copies of the SOP email was because two different SOPs were generated, one for me and one for one of my children, and notifications about SOPs for minors are sent to the primary insured member. Note that there was no indication of this whatsoever: the email about the SOP for me and the email about the SOP for my child were exactly identical. This is yet another stupid, sloppy UX error.
***Subsequent to publishing this letter, Tufts did finally answer my questions, and their answers do not make them look better. If my doctor believes after my upcoming surgery that I need to stay overnight in the hospital, he needs to call Carelink and ask them to approve the stay. If they overrule his judgment and refuse to approve the overnight stay, I can appeal the decision, but doesn’t it seem a bit unlikely that I will be in any condition to deal with my insurance company hours after I’ve undergone a surgical procedure involving multiple incisions and global anesthesia, when apparently I’m in sufficiently bad shape that the doctor thinks I need to stay in the hospital overnight? In short, because Tufts refuses to preauthorize an overnight stay after the procedure if my doctor decides it’s necessary, I may be forced to choose — when I am groggy and either in pain or drugged — between discharging myself from the hospital against my doctor’s advice, and spending the night at the hospital with the distinct possibility that I will be forced to pay for it because my insurance company refused.
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