This was supposed to be my first real day back to blogging, but unfortunately the entire morning was taken up tussling with the bureaucrats of the health insurance industry. I have been credited with having a keen sense of the ridiculous but that cannot be so, for if it were I would be amused by my adventures in the last few hours, whereas in truth the morning found me owning my Dark Side and Valorizing those character traits which are usually referred to by others, in hushed tones, as my Anger Management Issues.
What the detached rational part of my brain finds interesting here is the proliferation of separate companies necessary to process a claim. In the past you merely had to go 'round and 'round with Aetna, say, or Blue Cross/Blue Shield. You may have had to deal with being bumped around and fobbed off, or with chronic revelations that the agent you spoke to for three hours yesterday neglected to leave any record of having untangled your problem, and has left for an extended vacation in the Marquesas. But it was one-stop irritation. (The example of the eternally out-of-office rep leads me to note another related, fascinating issue: I have not been told as much directly, but, considering the reasons service reps give for the long periods of time necessary to relay information within their organizations, I've concluded that the various agents of the modern insurance industry have not been outfitted with computer networks or modern telephony. They appear to have this in common with certain internationally situated banks I have been associated with, which, judging from the time some checks took to clear, could only verify their worth by corresponding with the issuing institution via ocean-going vessels.)
And with the proliferation of agencies grows an inability to pinpoint their actual function in the great chain of claims processing. Though incorporated entities abound, none are technically answerable to any knowledge of, or responsibility concerning, for example, the rules of eligibility for treatment, the status of a practitioner, clinic, or hospital, or anything but the vaguest generalizatins about the coverage in one's policy. I'll grant that the entity that lists its function as "claims administration" does indeed own up to being responsible for cutting the check to one's health care professionals - but they are only put in motion through the agency of the more evasive entities upstream.
One calls, for example, one group in order to get authorization for surgery. They carry a disclaimer warning that authorization for surgery is in no way a guarantee that any claims for payment for said surgery will be honored. This leads one of course to wonder why this authorizing entity exists, if it bears no necessary relation to the actual Insurance Company. Perhaps it is merely the company to whom the Insurance Company has underwritten its surgery scrutinization function, and the disclaimer exists as a legal nicety. But considering that this morning's problem festers in a logically analogous swamp, I somehow doubt it. To wit, an associated business of the nebulous Insurance Company was, at the time of Monday Morning Phone War Round Four, refusing to certify the In-Network rate for physical therapy, despite my having, before treatment, verified that the therapist in question was indeed In-Network, and despite the fact that her office manager not only did the same but had a written "In-Network" authorization from the PPO entity, which is also not part of the Insurance Company. So in end, the PPO entity, contrary to its name, ostensible function, and earlier confident verifcation of In-Network-itutde, disavows any final expertise in the gnostic craft of distinguishing preferred providerhood. Thus I believe that Authorizing Surgeries, Inc. exists sui generis, isolated, inscrutable, unanswerable, to "Authorize Surgery" under some guild defintion of "authorize" - perhaps they light candles or say prayers for you, or something. Whatever the case, the people at the end of that particular telephone number evince no relation to any of the more worldly concomitants of purchasing a surgeon's services.
Likewise I had earlier discovered that the phone number listed for "Benefits Information" connects you to a company that, while you wait for the next customer service representative, entertains you not with insipid melodies but, yes, a disclaimer - essentially, "we don't know nothin' 'bout no benefits". Since I had called to clarify a question unanswered by the less-than-exhaustive policy manual, I was not heartened to be advised to check my policy for any specific questions.
The actual Insurance Company is like the Wizard of Oz with no Toto to pull aside the curtain. It's there, great and powerful, but it may not be seen. No, not quite. The analogy is inapt. The Insurance Company is more like YHWH, whose essence is unknowable and whose name may not be spoken. I could not actually tell you who my medical insurance company is. The mystery is not revealed on my little wallet insurance card, fertile with phone numbers, group and member IDs, and the logos of PPOs, pharmaceutical networks, and a multinational corporation and its wholly-owned subsidiary, nor anywhere in my policy. Any or none of these may be, or be the user interface for, the insurer. I do not know who they are, but wonder if they are of a kind with the companies that are purported to control waste management and certain construction operations in major metropolitan areas.
As the spouse puts it, I'm winding up to "go Klingon" on these guys. (The spouse describes me as "half-Vulcan and half-Klingon, and most of the time the Vulcan has the upper hand.") Perhaps I should feel chastened by a recent dust-up with the phone company, in which I was eventually shown to be in the wrong. I called to inquire about why a mysterious charge, never before charged, had shown up under "services added" on our bill. The er, unhelpful clerk more or less told me that I should just shut up because it was a standard charge in my area and I was damned lucky I'd gotten off scott free all these years. She categorically refused to ferret out why this allegedy standard, years-old charge had mysteriously appeared in the middle of this latest billing period, and her pursed-lip tone implied some essential, deliberate free-riding criminality on my part. Suffice it to say the exchange went downhill from there.
A bit later I decided to try the issue with another clerk, who turned out to be pleasant, intelligent, thorough, and extremely helpful. It transpired that I had indeed, wonder of wonders, been the beneficiary of the proverbial "computer glitch", and had indeed received this service without the usual charge. I still think charging this much for the service in question is a racket, but everybody else has after all been paying for it.
It took this young lady all of 90 seconds to dig up the info and explain the situation to my satisfaction. I regret not getting her name, so that I might commend her to her higher-ups. She probably ought to be promoted beyond, or at least paid more for, dealing with indignant psychobitch customers like me. I don't feel bad about mixing it up with the first clerk, though. Remember the secretary at Ferris Bueller's school, who, if I recall correctly, later went to work for that car rental company in Planes, Trains, and Automobiles? That's right, she works for Verizon now.
I feel for you, but surely you realize how many large organizations are FUBAR in the employee incentives department. The wonder is that numerous workers continue to be good-natured and helpful even as the few revert to customer-service savagery. You can use this situation to your advantage by hanging up and calling again if someone gives you a hard time. Odds are you'll do better the next time.
Posted by: Jonathan on August 14, 2002