When all the debates were going on about healthcare reform last fall, I noticed the insurance industry was getting increasingly defensive.
Like, why do you Americans hate us so much when we’re only trying to take care of you?
And, well, if it’s so bad being insured by us, why does everybody complain about not being insured?
And, why don’t you go live in some socialist country with government medicine if you hate us so much?
You know, things like that. I just sat in front of the TV sulking, since I was so sick and tired of hearing the sound and fury of tiny little minds invariably connected to large, braying mouths. It had been ages — months, I think — since I’d had any run-ins with my own insurance company or my father’s. I could forget about them and concentrate on the more obvious villains and imbeciles of the day called Republicans. It was, now that I recall it, a moment of relative zen.
No more, no mas. Just last week — a pretty bad week, to begin with, I should mention — I got a bill from our family practitioner. On top of the co-pay I’d already ponied up for while in the office, I owed a low three-figure sum for the remainder of my regular physical exam. According to my insurance company’s refusal, I’d already had a routine physical exam earlier in the year.
Oh, yes. I got it. They must have been referring to my rather unpleasant experience with a New York doctor, when I was billed an exorbitant amount and told, too late, they didn’t take the kind of insurance I had and would I please produce the magical sum of $1,019? Oh, yeah, how could I forget? I’d almost had a nervous breakdown on the Upper East Side.
All of this led to a small round of magical thinking, which happens now and then, even when you’re as hardboiled and uber-realistic as I like to think I am. Out of sad desperation, I’d sent the bill to my insurance company, hoping I’d at least get some kind of smarmy sympathy card. I’d heard nothing back, not even, Tough luck, Toots.
But here was proof! My insurance company had heard from me, they’d felt my pain, they’d reimbursed the bill! I should be getting a check soon — it was just a matter of how much!
So, I called the toll-free number for my insurance company and ended up talking to Amy, who I’m sure was probably old enough to vote, but you couldn’t tell it by her voice. Amy had to get off the line to check to see how much of the bill had been reimbursed, then got back on the line with the good news it was $264.
“You sent $264 to the doctor in New York?” I asked, quickly moving into my default, well, it’s better than nothing mode (a well-worn place where I spend much of my life).
“Oh, no!” Amy chirped. “We didn’t pay. We just applied it to your $2,500 deductible for out-of-network coverage.”
“Well, that’s kind of funny,” I said. “You didn’t pay the New York doctor anything, so the insurance company isn’t out any money, right?”
Right, Amy said. She still sounded quite happy. That’s what happens when you work in one of the “helping” professions, I’ve heard.
“So, if you’re not out any money, why aren’t you paying for my physical in Austin?” I asked.
“Because you’ve already had one this year,” Amy said.
We talked and we talked. I tried to call Amy’s attention to the fact that my GOOD FAITH NOTIFICATION to the insurance company had ended up costing me. “And all the time, we keep paying our monthly premiums,” I pointed out. “And got no benefit.”
Amy said well, it was too bad I looked at it that way, but it was company policy. Then we both fell silent — something I’m terrible at, unless extremely provoked, but I was going to be damned if some teenager was going to out-silence me. So, the silence wore on and the line crackled and finally, Amy broke and said it had been nice speaking to me and she hoped I’d get in touch the next time I needed to.
I said that — in case she hadn’t noticed — getting in touch with the insurance company IN GOOD FAITH seemed to be costing me money, so I probably wouldn’t be calling again. Amy wished me a good day and I kind of hung up on her.
Hung up on her, the little twit, and thought for the first time in my life that I’d rather be watching preening Republicans yammering on TV than trying to communicate with some lightweight who probably hadn’t made it through puberty yet, but was part of the black hole industry that is bankrupting this country.
“You know, this is exactly why people hate insurance companies,” I’d thought about saying to Amy.
But then, really, why bother?
(Copyright 2010 by Ruth Pennebaker)
We care SO much about your health, but GOD FORBID you need more than one exam a year. My blood is boiling on your behalf.
Oh, how I hate health insurance. This was ridiculous! I don’t understand why they didn’t apply the entire amount you paid to the out of network deductible? That makes no sense.
I do not believe health insurance should be tied to employment. Why should my husband’s employer get to decide what kind of coverage I have? I really think health coverage is a matter of basic human rights and ought to be Medicare for all.
I have had conversations like this with insurance reps. They always are right, aren’t they? You wrote about this smug agent so well. They are happy because their industry is raking in the dough. It makes no sense to me, really. My insurance, as a self-employed person, has risen $95 per month, per year, for half a dozen years or so. At this rate, next year I will be paying $1000/month. Then, six months later, I can go on Medicare. The money I have to shell out will fall to $100 per month. Tell me, does this make any sense at all?
Ah insurance companies. I’ve often envisioned the training sessions for call people at insurance companies–they must prep them so that no matter what you say they remain cheerful. And then there’s that helpful reminder at the beginning of the call that they’re “recording it for training purposes.”
I think you can ask for some sort of arbitration with your insurance company, but it’s probably more trouble than it’s worth. I decided recently that no one likes:
1. Any health insurance companies
2. Any airlines
3. A single bank or lending institution
4. QuickBooks online and most of it’s software if not all of it
Yet these places stay in business and I just cant figure out how capitalism works like that.
That “recording it” deal can truly be a great thing. It got a $7,000.00 helicopter med-flight cost (above what insurance paid) written off because one of their collection representatives badgered me into crying as I tried to explain how upset I was after losing my husband. What a bunch of morons. Here’s a tip: contact the CEO, whatever it takes. An eloquent, evocative letter usually works.
Now I’m aggravated – this story brings me back to all the times I had to fight with my insurance company. It’s so maddening, isn’t it? And the people on the other end…they don’t give a hoot. They just keep repeating and repeating, over and over, the same damn thing.
I agree with Cara. “Amy” may not be empowered to help you, but their logic *defies* logic, so if you called and asked to speak to a supervisor or sent a strongly worded letter, you might have better results. That is positively maddening!!!
This strikes a chord. We just entered a new “age range” so our premiums shot up by $200 – after rate hikes not associated with age. It’s troubling since the people who make policy are kind of parasitically shacked up with the people who set the insurance rates, and the other way around. And that doesn’t even count the legitimate costs of an innovative test or piece of medical equipment, or the price to do research. It’s hard to take the big policy makers seriously when, well, we know most (all?) have amazing insurance, and will have it for the rest of their lives without a worry.
It’s all maddening and confirms my belief that a person can’t get by in this world without being an a**hole when necessary.
I’ve always thought there’s a huge opportunity for someone to create a business called “Hire an A**hole.” I’ve gotten better at being one, out of necessity, but would prefer not to be and just hire it out.
Really, how did we ever get to this point?
I agree with Cara. When running into this sort of thing, I just keep my cool, be persistant and go to the top of the food chain. It works a majority of the time for me, and when it doesn’t I’ve learned another lesson.
Oh My God, I so want to be a staff member of Jane’s “Hire an A**hole”…
I noticed during all the health care debates that never once was the costs of anything, from office visits to high-tech procedures to medications, called into question. I’ve also taken into note the plethora of ads hawking training for jobs in the health care industry– Seek a job in the Health Care Industry and Make GOOD MONEY! I remember when my doctor made house calls, a 30-day supply of medication did not cost the same as a semester’s tuition at university, etc. Things were OK before the cost of running a doctor’s office went skyward due to the addition of mal-practice insurance. Added because lawyers decided that clinging to life was valued at millions of dollars and went to court demanding enormous settlements. That scenario brought about the out-of-control rolling snowball of price increases for every kind of medical treatment. Any other industry would have priced itself out of existence. But health care is viewed as some kind of inalienable right. But we are given no low-cost options. I would like the option of Euthanasia Providers. I, personally, don’t want to survive a catastrophic health dilemma only to find myself living under a crushing debt of hundreds of thousands of dollars. These days I view modern high-tech medical care as an option for only very well-heeled citizens, but not for the remainder of us. What low-cost option is open to us? None. Just live with the fate a roll of the dice doles out to us until we perish. There is no compassion for the sick one whose wallet is thin. Want to take a world tour but can’t afford it? No problem. Instead take a 100 mile road trip and visit local points of interest instead. Where is my 100 mile road trip option within the Almighty Health Care Industry?
But the biggest trouble is that these companies simply wear you down. There’s no way it’s cost effective for me to keep writing and turning up the heat about being denied $200 or so. And that’s simply focusing on the money; the psychic drain would be tremendous. Yes, I want to hire an asshole, Jane. I lack the energy to be one as often as I need to be.
Yes – VERY draining, and it carries over into just about every aspect of our lives. I’ve been snarled up in the Bank of America remodification program for more than a year. Yes, I started the process in summer of 2009, and got nowhere with the phone banks. And I only wanted a forbearance for a month or two during my husband’s surgery, but they didn’t go for that and said “Why don’t you try the remod program – it can’t hurt.” Really? Well, it did.
Basically, they had me send in the same info a half dozen times (tax returns, yada yada), which immediately went into the BoA ether. Meanwhile, I was paying a “trial payment” (they named the amount) which kept getting me further and further behind until I was facing foreclosure and they were still dragging their ass.
I had to go into serious asshole mode, call our state senator and representative, get a local mortgage counselor (free through a non-profit agency), and open a file with the Michigan Office of Banking and Insurance, all of which took tons of time and psychic energy.
The result is that I got booted up to the BoA CEO’s office (right – whatever), and now when I call there, the guy I want to talk to answers his own phone. And I just signed for a loan refi with low interest rates, etc. – I’m not even in the original Making Homes Affordable program BoA wanted me to be in – I’m in some “other” program.
Anyway, way off track here from the original insurance discussion (thx for letting me vent here, Ruth!), but same thing dealing with crap. Yes, Hire an Asshole would be a major hit in today’s world.
I’m starting to hyperventilate just thinking about this, Jane. The insurance companies *count* on being able to wear us down — and snicker all the way to the bank. If I don’t fight it, I’m adding to their profits and reinforcing their cynical views. The more I think about it, Hire an Asshole is either a great blog or a book, as well as a booming business.
Hand up over here as someone else who has had more than her share of haggles with health insurance stuff this year.
And, you’re right, Ruth, it’s so draining — especially when you really need to focus on staying well, not fighting over medical bills.
It’s so infuriating how the insurance companies mistreat us, routinely denying claims because some of us feel too exhausted to fight them. It makes my blood boil as well. They DO wear us down sometimes, which is why they continue to use such unethical tactics. Argh.
Jennifer @ Mothering Outside the Lines
Oh, yes! Sign me up to be a Triple A Rated A-Hole. That would definitely be a booming business. Fighting with insurance companies is probably where I first learned the fine art of how to scream at strangers. I was raised to be “nice and polite” in public or on the phone. You know…that insane Southern thing. But years of dealing with insurance companies taught me how to scream obscenities at strangers.
Then we finally got the most amazing doctor in the world. She helped me scream. Oh, how I love and admire that woman. It all worked out. Still, nobody should have to cuss and foam at the mouth to get results.
It’s awful to worry about whether a loved one will live or die…go to work…raise a family…and have to deal with an idiotic insurance “code error” on top of all the other worries. It is draining. And yes, the prices hospitals charge are unbelievable. I once spent three hours on the phone fighting a seventy five dollar charge for one dose of an over the counter sinus medication. Insert cuss words here…
You are an intelligent, competent, reasonable woman. Imagine being the surviving spouse at 85 years old trying to handle these things, not savvy, and not assertive. They are overwhelmed, confused and in over their heads.
These companies count on people to not challenge them, to just meekly accept the “wonderful” policies that they have put in place in order to avoid paying us anything in return for all of the money we pay them each month. In our state, we have senior ombudsmen, legal aid has some senior law attorneys, and a state attorney general’s office who have taken on some of the worst offenders. Complain, complain, complain, make it public and complain some more.
Public healthcare in New Zealand where I live is far from perfect, but it is VASTLY better than what I dealt with when I was living in the States. You should not have to stay in a job or relationship to have medical coverage. It’s just shocking.
I get so caught up in crap like this. I will waste away on the phone, hour after hour, standing on principle. I’m a fight to the death kinda girl, and the fighter in me often misplaces my attack. But sometimes it’s so, so necessary. I would have stuffed my foot right up Amy’s ass, and then made sure that every person higher than her in the chain of command was sitting a little uncomfortably for the next few weeks.
And… this is why the tell me my health problems are stress related.