The woman wanted information about the new health insurance marketplace.
But on the phone, she also gave Lara Adedokun a piece of her mind: "'I know this is not your fault, but I just don't get why the government wants to tell us what to do,'" Adedokun recalled the woman saying.
Uninsured Oklahomans could face a financial penalty if they don't have health insurance as a part of the Affordable Care Act. One big exception: if the cheapest insurance plan costs more than 8 percent of household income, no penalty is enforced.
However, many others remaining uninsured would have to pay -- a minimum of $95 per adult in 2014, then $325 the next year, and $695 in year three.
Adedokun responded to the woman by offering up some positives for consumers.
"I talked about people that, right now, they're trying to get insurance but they already have a pre-existing condition and they cannot get on any plan. That's one of the things that this would eliminate," said Adedokun, quality improvement team leader for Community Health Connection, a system of two clinics at E. 3rd Street and S. Lewis Avenue and also on E. 21st Street near the Mingo Valley Expressway. The sites now double as information hubs for the new insurance marketplace.
Adedokun said she also offered the woman an analogy. "The same thing goes for like your auto insurance," Adedokun told the caller, referring to how motorists can get a ticket for not having insurance. "It's about the same thing."
Adedokun spoke just days before the insurance marketplace came online Oct. 1 at HealthCare.gov. The calls had already begun to come in daily, following a drumbeat of publicity in the form of news reports and even billboards.
Key questions, like exactly how much the plans will cost, remained unanswerable until the exchange officially came online and, early Oct. 1 the site failed to work properly. The federal government has touted the availability of subsidies for many lower-income Americans.
Some in the insurance industry question the quality of helpers now guiding people through this new process. But at least Tulsans have many options when seeking answers.
Anyone can call 2-1-1, the social service hotline, to receive assistance.
In addition, two of Tulsa's major clinic systems -- Morton and Community Health Connection (which will feature Spanish-speaking helpers) -- have hired people to help with the effort. These clinics have a large percentage of their patients walk in without insurance.
Helpers will also be visible in the community as they attend various events -- sometimes with a laptop and portable scanner for income-related documents -- to also provide outreach to non-patients.
Certified helpers known as navigators must complete 30 hours of online training offered by the federal government.
Other organizations may have staff train to be certified application counselors -- which will be plentiful within one hospital system, at least.
"St. John will have certified application counselors (CACs) onsite to assist St. John patients at many of our facilities," the health system's director of community and physician relations, Cheena Pazzo, said in a statement.
"Additional CACs will be available to help consumers with enrollment by phone or appointment. St. John will also provide training to front-line associates so they can address general questions about the exchanges."
OSU Medical Center is sending out letters to patients to let them know that certified application counselors will soon be available at the hospital for on-site enrollment.
Neither Saint Francis nor Hillcrest responded to repeated requests for comment. But the Tulsa City-County Health Department will also have counselors available to help.
Elsewhere, other professionals have been studying information provided by the Centers for Medicare and Medicaid Services, even though they are not certified helpers.
That's what Ruth Neal, a health librarian based on site at the University of Oklahoma's Schusterman clinic, has done, along with others on staff.
"We're not officially navigators, but we've all been looking at the online training that's available through the CMS website and trying to prepare for the people who need help," Neal said.
Not everyone is a fan of the marketplace rollout.
Dan Ramsey, president and chief executive officer of the organization Independent Insurance Agents of Oklahoma, expressed doubt about the helpers for the new system.
"They're not licensed, they're not regulated, they're not accountable legally. We have great concerns about the navigator program," Ramsey said.
In Oklahoma, consumers can look-up insurance agents by name and check their credentials. But no such look-up is available for the certified patient navigators or certified application counselors.
Cathy Vu and Owen Cowdery at Community Health Connection are two such navigators.
The training explained "what our actual role is what were supposed to do, what were not supposed to do," Cowdery said. "We're not supposed to tell the consumer you need to pick this plan over this plan, or this company over this company. We're just supposed to present the information to the consumer and let them make their own decisions."
The training included information on privacy, they said. The questions "weren't simple," Cowdery said. "They make you think. They give you a scenario, and then you're supposed to pick two or three answers, which of these answers applies to the situation."
He said he knew "next to nothing" about the new marketplace before being hired about a month ago as a marketing and public relations specialist.
"After taking the training I know way more than I did, but I still feel I still need to learn stuff," he said. "It's a lot of information."
A daylong training event took place in September in Tulsa, where Vu and Cowdery estimated that more than 50 professionals listened to government presenters explain the new marketplace. However, a plan to demonstrate the new website failed because of connectivity problems.
Community Health Connection received federal funding for its navigators, and the government set a goal for them to have contact with about 8,000 people in the community and enroll 3,000.
Patients coming in for care will be asked if they've heard about the insurance marketplace. From there, a brief consultation may take place with a navigator. Then, an appointment would be set up for later, with clinic computer stations devoted to enrollment.
Vu, who speaks Vietnamese, serves as outreach and enrollment coordinator. "We have a lot of events coming up," she said.
The benefits of insurance -- being able to choose from multiple providers, having coverage for specialty care, and also receiving preventive check-ups -- must be communicated to people who may have never been able to afford insurance previously, the clinic staffers said.
"It's just a matter of people getting more comfortable with it and getting more information and not seeing it as somebody forcing it down their throat," Adedokun said.
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