June 6, 2017
In January 2017, Kenneth Sarauer, a La Feria, Texas resident, walked into his local library distraught and depressed. Sarauer was suffering from stage 4 Lyme disease, gout, and high blood pressure, and had recently discovered that the nearest doctor in his new health insurance plan was 30 miles away—too far for someone battling serious medical conditions to drive. Sarauer made repeated calls to his insurance company, but that resulted in few answers and even more questions.
Luckily, a librarian directed him to a table that was staffed by Cognosante Enrollment Assistance Program (EAP) employees. The program, launched in 2013, is designed to reduce the number of uninsured people by providing free in-person health insurance education and enrollment assistance to consumers where they live, work, and play. EAP employees help inform uninsured consumers about all their insurance options, based on their individual needs, so that they can make an educated decision on their healthcare choices. Cognosante’s EAP is contracted by the Centers for Medicare & Medicaid Services to serve nine cities in seven states. During the three-month-long open enrollment drive November 1, 2016 to January 31, 2017, EAP staffers assisted more than 15,000 Texas consumers.
Sarauer was just one of those Texas residents who turned to Cognosante when he felt frustrated and lost. For him, it made all the difference.
“They really listened to me,” recalls Sarauer. “They could have told me that my problem wasn’t in their realm.”
Once Sarauer explained his health insurance challenge, EAP staffers got to work. They searched online to find nearby doctors that were in Sarauer’s health plan network, and then made a series of calls to his insurance provider to pin down the exact details of his coverage. Ultimately, EAP assisters were able to confirm that Sarauer’s primary care doctor was indeed in his insurance network, a detail he hadn’t been able to uncover himself despite frequent phone calls to his insurer.
“For the first time in a long time I saw light at the end of the tunnel,” Sarauer says. “(Cognosante EAP workers) not only resolved my problem, but also lifted my spirits.”
Rebecca Rubio, team leader for Cognosante’s EAP in McAllen, Texas, was one of the staffers who helped Sarauer.
“He was very distressed when he came in,” she recalls. “He felt like nobody wanted to help him and that no one was listening. When he left, he was very excited. He had a big smile on his face.”
A community partner
Many of those seeking assistance from the EAP are buying insurance for the first time or are having significant problems with the insurance they have. A central feature of the program is community outreach, which is taken on through grassroots relationships with local, regional, and national officials. More than 150 EAP assistants engage with consumers at community events and at locations such as public libraries and local business offices as well as local healthcare facilities.
Uninsured consumers can also visit brick-and-mortar EAP storefronts, known as “EAP Enrollment Centers,” which are available for walk-ins and scheduled appointments during the Open Enrollment period. Cognosante also has national partnerships with leading enrollment organizations, including Out2Enroll.
During open enrollment periods, EAP staffers often put in long hours, manning desks from 8 a.m. to as late as 9 p.m. But employees say the rewards are worth the long days.
“I really enjoy helping people,” says Gonzalo Gonzalez, site supervisor for Cognosante’s EAP center in McAllen. “You get a great feeling from walking someone through the insurance education and enrollment assistance process, because you know that they probably would not have been able to do it on their own. A lot of times, all it takes is having some empathy and listening to them, being able to hear them out without interrupting. And just seeing that look of gratitude on their face makes it worth it.”
Denise Blackman, director and project manager for the EAP, agrees.
“The work we do is something that touches people’s lives in ways we can’t even imagine,” she says. “What’s unique about this project is that face-to-face contact with people. You have the opportunity to look somebody in the eye and hold their hand as they tell their story. When you’re looking at someone who is pouring out their heart to you, it’s something you can’t walk away from.”
Sometimes, the work the EAP does is literally a matter of life and death. Manuel Avila, a construction worker in El Paso, Texas, came to the EAP seeking health insurance, not knowing how important it would turn out to be.
“In 2013, (Cognosante EAP staffers) worked very hard to convince me to enroll in health insurance,” Avila remembers. “I didn’t know that it would eventually save my life. The following year, I was diagnosed with colon cancer. Without health insurance, there was no way I would have been able to pay for my treatment.”
For EAP workers, it’s stories like Avila’s that make the job worthwhile.
“People come to us with their stories, and a lot of them have never had health insurance,” Rubio says. “For me, I end up feeling what they’re feeling. Doing this work, I feel like I’m really making a difference.”