If the complaints of public school districts serve as any indication, MESSA does not care much about customer satisfaction. And if MESSA's apparent disregard for the fiscal welfare of its customer school districts is any indication, MESSA does not care how its business conduct negatively impacts public education. Why should MESSA care if there is no incentive to care? School districts do not use MESSA because of its cost effectiveness or its exceptional service; they purchase MESSA insurance because the MEA continually pressures them into using MESSA. True, MESSA health insurance is now less expensive than comparable Blue Cross/Blue Shield coverage, but that does not necessarily mean that MESSA is a better buy. It also fails to consider that other private sector insurance companies can provide acceptable service at a more reasonable cost. In fact, MESSA is a far cry from overall quality when considering the abundance of legitimate qualms that school districts have with MESSA.

At MESSA, the needs of members come before the needs of school districts which actually pay for MESSA insurance. Consequently, school districts have experienced several difficulties while transacting business with MESSA which require consideration. These difficulties have severely impaired school districts, because districts are forced to accept additional costs with no practical means of escape. Overall, the problems that school districts have with MESSA have produced an unfavorable business relationship, and MESSA's evident disregard for the situation has fueled discontent about MESSA and the MEA. The problems relate to the failure of MESSA to disclose essential information, to negotiate changes in benefit contracts, and to provide sufficient purchasing options for insurance. Furthermore, school districts have voiced concerns about MESSA's gift coverage program, its requirement of uniform coverage for MESSA PAK insurance, and its decision to eliminate "dual choice."