My Experience as a Self-Appointed Secret Shopper of the Kentucky Department for Medicaid Services

When I was a child, my mother worked as a secret shopper for various banks. I still remember going with her as she pretended to be interested in obtaining a car loan or open a bank account. We always had to go to the bathroom to see how clean it was as that was one of many things she had to rank. The banks that hired these secret shoppers were committed to providing their customers with quality service in a comfortable environment. Secret shoppers are common in many large and small companies who place a high value on service. I’m unaware of the state of Kentucky hiring secret shoppers, but my tax dollars help pay for state government and I want to make sure they are providing quality service to their customers.

The state’s transition to Medicaid managed care over the past year has been a debacle. More changes are coming January 1 with four companies operating in what has been the solely-run 16 county Passport region for 15 years. With all of these changes, we want to ensure Medicaid members have access to people who can answer their questions, clarify confusions, and switch them to another company if they wish. The state Department for Medicaid Services operates a Medicaid hotline which is a toll-free number for Medicaid members to call with questions, concerns and requests about their Medicaid coverage. Kentucky Youth Advocates is concerned that the Medicaid hotline is only open Monday-Friday 8am-5pm EST. While some people may work at jobs with flexible hours, many jobs do not provide flexibility during the day leaving families with Medicaid little time and accessibility to call the hotline.

But given the current hours, I wanted to know what kind of service the state provides to Medicaid members when they call. So on November 5, 2012, I decided to become a self-appointed secret shopper of the state. At 12:13pm, I called the Medicaid line which was initially answered by a recorded operator who stated that Medicaid was currently under open enrollment until October 19. That was my first clue that there was a problem since it was already November. I was then told by the recorded voice that due to open enrollment, they were experiencing a high call volume and I could either hold or call back at another time. That was also a problem since the state was blaming high call volume on open enrollment which had already ended. So I sat there, listening to the hold music for a while, waiting for my call to be answered. Every so often, a recording would come on and tell me that all representatives were helping other callers and open enrollment was through October 19. Finally, after 13 minutes and 23 seconds a real person answered.

A few highlights stood out on this experience. First, it was not open enrollment so if November 5 was a high call volume day, I can’t even imagine how long I would have waited had I called on October 15 when it was actually open enrollment. In addition, 13 minutes and 23 seconds is a lot of time to wait. Parents may have to get their kids off to school without much time in the morning to sit and wait for someone to answer. They may only get 10 minute breaks during work (as I did at a previous job), or they may not be able to call after 5pm in which case the hotline would not be open at all. This experience concerns me greatly about the quality of service Medicaid members receive in the state.

Medicaid provides health coverage to thousands of children in the state of Kentucky. This coverage allows children to receive preventive care and health care services which keeps them from developing chronic health conditions. But this coverage is only good if parents have easy access to the state Department for Medicaid Services when they have questions and concerns. We want parents to take responsibility for getting their child on the right managed care plan, but how can they do this if they don’t have the flexibility to call between 8am-5pm Monday through Friday? We want managed care to work in Kentucky but that starts with the state providing quality customer service to help members navigate the new system. And we want the state to receive an A on secret shopper calls, we really do. But for now, as a self-appointed secret shopper, I give the state a C- with plenty of room for improvement.

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