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Friday, September 14, 2007

Insurance Blues


A couple weeks ago, I was telling someone about the movie Sicko, and I'm relating it to my tenure in 1989-1990 as a customer service representative for an insurance company. I get animated, and, apparently, loud, so much so that I was asked whether I have high blood pressure. (No, my bp, when it was checked five weeks ago was 124/78, thank you very much.)

What it does mean, though, is, to paraphrase Paul Simon, that I am Still Ticked Off After All These Years. And it wasn't until this recent iteration of the story that I realized that it wasn't just that I felt I (and others) who worked there were treated badly; I recognized, more fully than ever before, just how poorly their customers were treated as well.

This was the job I took after FantaCo. There were perhaps 16 of us in the training class, learning about medical prefixes and suffixes for eight weeks, which was actually cool. Then we got on the floor, already diminished by four, but adding to the five people already on the job. Soon, the 12 became eight as the tedium and/or the low pay - I was making $5000 less than I did at FantaCo - wore on people.

Yes, it was 1989, but how could it be that EVERY single claim for the use of an MRI was initially rejected as "medically unnecessary?

There is a condition called TMJ disorder, which involves the jaw. Routinely, people with medical coverage were rejected, saying it was a dental issue. People with dental coverage were rejected, saying it was a medical issue. EVENTUALLY, people with both coverages would get their claims paid, but it was, I realize now, a stall tactic.

When I started, we had what seemed to be a perfectly good dental claims customer service interface on our computers. It was changed during my tenure to some illogical, incomprehensible product, which, as it turned out, was ordered because someone's brother or cousin developed it. Grrrr.

There were huge layoffs right before Christmas. The organization WAS middle-management heavy, and several of those folks went. But so did the clerks, who were runners to find files for the customer service reps on the phones. Never have I been more disappointed than when I WASN'T laid off.

What they say: You are now empowered to take care of these problems.
What they mean: We have systemic problems, and when they inevitably happen, you'll be the fall guy.

The single most egregiously stupid decision made by this insurance company was the timing of the changeover from one medical claims billing processing system to another. The actual change in product was fine, but the time frame was ridiculous. The old system went down around Christmas. The new system was supposed to be up in two weeks; it took six.

If it were up to the customer service representatives, the switch would have taken place after the third or fourth week in January. People really cared about their 1989 claims for income tax purposes; less so about their 1990 claims. They could/should have announced that the 1989 claims were received by date certain in early 1990 would be processed on the old system and all others on the new. But no.

During this period in early 1990, some people wanted to know, not when the claims would be paid, but if it had even been received. Since the new system was batch processing, nothing was being entered at all. While I wasn't supposed to tell the customers, we were told there were 40,000 claims in the basement, so I literally couldn't find out the answer to their question. The official answer to the query, "Should I just send it in again?", was "no." But I'm told some at least a couple of the more irate customers "all right; if it's duplicate, the system will kick it out." This was true. But you know how some phone calls "may be monitored for quality assurance"? Got raked over the coals a couple times over that.

FINALLY, the new system was up. Claims were being processed, and far more quickly than before. But wait! Many of the policies had deductibles. The AMOUNT of the deductibles (e.g., $50 before a claim would be paid) were programmed into the new system, but the amount of the deductible ALREADY MET so far for those 1989 claims was not. So, customers who had met their deductible were getting letters saying "The claim was applied to your deductible."

These people were now FURIOUS. And rightly so. The insurance company had a policy that the third call on the same claim would be a supervisor callback. By this point, EVERY OTHER CALL was a supervisor call. And here's the source of my 2007 rage; for years, I had attributed this situation to an incompetent management of ignorant rubes. I now firmly believe, after seeing the movie Sicko, that not putting in the 1989 deductibles that were met into the new computer system was a deliberate attempt by the company to save money, hoping that the customers didn't notice. And I'm sure that there were customers who DIDN'T notice, especially those who had separate deductibles for each member of the family. I'm now convinced the company put profits in front of the well-being of their customers and their beleaguered employees.

The last straw: we were scheduled to move into a new building in Corporate Woods. Two weeks before the move, I notice an ambulance at the new building. Then another. Then another. Then a school bus. It turned out that thirteen people went to the hospital because of something in the air ducts, a problem which, we were assured, was "rectified". A fortnight later, we moved in, and at the end of that week, I gave my two-week notice.

I didn't have another job. I didn't have any savings. Since my last day was March 1, 1990, I did have health insurance through April 30; if I had left the day before, it would have run out on March 31. I just didn't want to be working there on my birthday. Looking around, of the 16 people in that training class, after I left, only three of them were left, one in a different location. Interestingly, the five customer service reps who were there when I started were STILL there; hearty folks.

After that, I worked on the census for five months, then, having nothing better to do, went to library school; that seems to have worked out.

Oh, the pictures of the turkeys: taken a couple days ago from the third floor on a cellphone, looking at just outside my building, which, like the insurance company, is in Corporate Woods. Representative of the turkeys I used to work for.


ROG

5 comments:

GayProf said...

Library school sounds a lot more serene.

I can't believe the state of health care in this nation.

Nik said...

The US health care system is so broken it's not even funny. Like everyone I have my share of horror stories (such as insurance denying the use of an ambulance for my emergency appendectomy several years back). Since we've been in NZ almost a year we've paid maybe $50 on medical stuff – and that's been for five or six doctors visits for Toddler Peter and a few prescriptions (who's been sick a lot since starting day care). And NO paperwork, NO denials of care, very little hassle. It isn't perfect - taxes are higher to compensate - but I'd gladly pay more to avoid the sheer lunatic uncertainty inherent in the corrupt US system. End of rant!

cd said...

Hmmm...I had one incident with an insurance company that I always suspected was intentional malfeasance. My COBRA insurance was set to run out at the end of October. So I scheduled as many appointments as I could for that month before it ran out: physical, gyno, allergist, whatever. What I failed to notice, however, was that the last bill never arrived in the mail. I paid all my bills that came in as they arrived, but didn't write a check for the one that didn't. All of those October appointments were denied because the last month of my insurance was deemed to be cancelled for lack of payment. I always wondered how many other final bills somehow got lost in the mail.

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Kiana said...

Well written article.