Diners at eight Gator's Dockside casual eateries are finding a 1% Affordable Care Act surcharge on their tabs, which comes to 15 cents on a typical $15 lunch tab. Signs on the door and at tables alert diners to the fee, which is also listed separately on the bill.
ANNAPOLIS, Md. (AP) -- For those trying to enroll through online health exchanges, help has long been advertised as just a phone call away.
Yet the challenge in some states has been trying to get a call through at all, never mind the multiple transfers once contact has been made.
Long wait times of an hour or more have been commonplace in some states, primarily those running their own health care exchanges. California, Maryland, Minnesota, Nevada and Washington are among the states in which consumers and insurance agents have complained. One consequence is that people just give up because they are unable to wait indefinitely.
"If I had to use one word, I'd use `frustrating,"' said Jacki Manley, a stay-at-home mom in the western Maryland town of Keedysville, who has been trying since mid-December to enroll in a health plan through that state's health exchange.
With a child who is almost 3 and another who is 5 months, the 20 minutes she can spare on hold often have not been enough. She estimates she has reached someone at the Maryland call center three out of about a dozen times she has called, but then she gets passed between different people and cannot get definitive answers to her questions.
"It just seems like all the right connections aren't being made," Manley said, adding that she believes she has successfully enrolled her children but is unsure whether she and her husband have been enrolled after more than two months of trying.
Manley said she has given up calling. Now, she uses Facebook to try to get the help she needs.
The telephone frustration is just one more obstacle consumers are facing as the March 31 deadline for open enrollment approaches. Technical glitches and software meltdowns on the federal and some state-run exchanges deterred many people from signing up after enrollments under the federal Affordable Care Act began in October.
With many of those technical problems solved, enrollments across the country have been brisk since the start of the year. Yet even with 4 million signed up for policies through the exchanges, the Obama administration will be challenged to meet its own projection of 7 million enrollees by the deadline.
Long wait times for consumer won't help.
In California, an operational review of the state-run exchange's first three months showed consumers waiting 45 minutes to an hour for an employee to answer, and insurance agents have said they have waited hours to make human contact. The exchange's goal was to answer 80 percent of the calls within 30 seconds.
"We did not meet our standards," said Yolanda Richardson, Covered California's chief deputy executive director.
The most recent statistics, from the first week of February, show the average wait time for those dialing in to a California call center at about 47 minutes.
Sherrie Larsen, a 49-year-old truck driver in Tacoma, Wash., said the first time she called the exchange, she was told after waiting an hour and 27 minutes that the computer system was down, and she would have to call back. She called the state insurance commissioner's office to complain, and said she didn't get a lot of help or understanding there. The next day, Larsen called the exchange again, and was told the wait time would be about 29 minutes. After more than an hour on the phone, she finally got the help she was seeking, but no apology or explanation.
"It's very, very, very frustrating," Larsen said.
In Nevada, Claudia Lamb complained publicly about spending more than 100 hours on the phone to a call center, then waiting by her phone for hours more for return calls that never came.
Lamb and her husband first tried to apply in early October when the system went live, but she only received confirmation they had been insured on Feb. 12. That was 129 days after she first applied.
"I once waited three hours and 40 minutes to get through to a manager who cycled the problem back through to his subordinate," Lamb testified about her experience with Nevada Health Link, the state's exchange. "The subordinate's solution was to do another application."
Wait times for call centers on the federal marketplace that is running in 36 states have been much shorter to reach a customer service representative. The average wait time in October was just more than one minute, dropping to 38 seconds in November. It rose to about eight-and-a-half minutes in December, when more people were trying to get coverage for Jan. 1.
The federal call centers have about 14,000 employees.
Maryland's problems have been particularly embarrassing because officials there were quick to support President Barack Obama's health care overhaul.
Gov. Martin O'Malley, a term-limited Democrat who is weighing a White House bid, and Lt. Gov. Anthony Brown, who is running to succeed him, had hoped to make Maryland a national model for health care implementation. Instead, the state has had one of the rockiest rollouts of the 14 states operating their own exchanges, with the call center problems coming on top of constant problems with the online enrollment portal.
For example, some Maryland residents early on were prompted erroneously on the exchange website to seek help by calling a telephone number that led callers to the owner of a pottery shop in Seattle.
The disastrous rollout forced the previous director of the Maryland exchange to resign.
Officials in some states, including Maryland, Nevada and California, have taken steps to address the long wait times.
Nevada has boosted its call center staff from 50 to nearly 250, and wait times reportedly have been reduced significantly. California is adding 350 to 400 more call center employees by the end of March, while Maryland has tripled the number of call center employees from 120 to about 360 at the state's call center in Baltimore, said Carolyn Quattrocki, the interim director of Maryland's health exchange.
Quattrocki said she is optimistic the boost in staff at Maryland's call center, expected to cost about $6 million, will be enough to handle the expected increase in activity as the enrollment deadline nears. She said wait times and abandonment rates have gone down since the middle of January.
Covered California also created a dedicated phone line for insurance agents and counselors, increased the number of bilingual staffers and added an online chat feature to help take pressure off the phone lines. Exchange officials there said they were somewhat surprised by consumer behavior that exacerbated the long wait times.
They designed the exchange so people could shop, compare, select a plan and be done with the process in one stop. Instead, they found that people often had questions after visiting the website and wanted to speak to someone by phone. They often called back two or three times before selecting an insurance plan, adding to the volume of calls coming into the service centers.
Still, Covered California Executive Director Peter Lee said the exchange is not making excuses and is working hard to reduce wait times.
"We've heard their concerns," Lee said. "We've stepped up to say we're going to make it right."