The health insurance industry is a complicated monster. The simple act of looking up someone's account requires a security clearance, and, once you have the information up on the screen, well-honed interpretive skills, to decipher all of the gobble-dee-gook that you see there. You have to learn a completely different language in order to work in it, and there are a lot of rules and guidelines--the complexities can be exhausting. Most people who go to work for an insurance company go through a lot of training, because it doesn't matter much if you've worked in an office, or a were a playground monitor, or wrestled lions for a living--little than you learned in those endeavors relates to the things you will need to know to work in the health insurance industry. There are days in which you do nothing all day but give people bad news, peppered just lightly with side projects in which you feel like you're truly helping someone.
The other day, somebody in my office had to explain to someone that we would not cover a lot of the expenses associated with the policy-holder's miscarriage, because she hadn't been insured with us long enough at the time that it happened, even though she wasn't pregnant when she got the policy. The rep leaned over to a co-worker and asked what was the most delicate way to explain this to the woman, since, that co-worker had to break that same news to other women on several different occasions. The other rep explained her preferred method.
We are so well practiced in the business of adding insult to injury that it breaks my heart. In fact, we become numb to it, after a while, and I suppose it is much the way a soldier tries not to think about who lived in that building they just blew up. What could be more heartbreaking than someone losing a baby? Someone losing a baby and then having to be reminded of it when the mail comes, month after month, while they pay off the bill.
The days when this job is hard, when I really wonder what the hell I'm doing here, are the days in which I catch my co-workers acting as if the policy-holders should know this stuff--like, before anything happens, before they get sick, they should understand every nuance of their insurance policy just like we do--as in, Don't think about a new baby, just, think about your insurance.
After all, that's all we do all day...
But we don't know this stuff, we consumers. I mean, even though I am an intelligent person, I didn't know that my health insurance policy doesn't cover Emergency Sick. Oh, it covers Emergency Maimed, but not Emergency Sick. And only Emergency Maimed if you drive yourself to the Emergency Room--no ambulance. It never occurred to me that I could not follow a doctor's explicit orders and expect a little help from my insurance company. I found out the hard way, of course, when the bills started coming.
The ever-present attitude around this business, and, it's not at all malevolent, it just is, is that we know this stuff about your policy, why don't you?
When people who work in insurance tell their stories--the "war stories" about interactions with customers, they usually have that tone to them--"duh, their policy doesn't cover this--I don't know why they are getting angry with ME..."
We forget that the people reaching out to us might just be stunned that their insurance isn't paying--their doctor told them they needed it, so, they did it, thinking that their health insurance would certainly consider it a valid use of funds...and, yes, they are angry. I'm angry because I pay $400 a month for health insurance for my children and myself, and you know what? I've already paid more in premiums than what my medical bills add up to, but, that money can't be used to pay those bills--that money is just gone. My shoulda-woulda-coulda brain is now thinking, "Gee, if I had only put that money into a savings account, instead of paying for health insurance, I could have paid this bill, no problem--instead, I get to pay for this, AND that. What a complete WASTE of money that was! How STUPID" And I'm utterly embarrassed that I was so "stupid" to not read the fine print--$400 is a lot of damn money to a single mother--it is a significant percentage of my income. I mean, my car payment is less than that, and so is my monthly grocery budget--and at least with those things, I get something tangible.
As we enter into this time in which all of what we do is being called into question, I hope we all remember, and I hope it's as harsh in our heads and hearts as it sounds right here in black and white. I've seen what this industry is capable off, "good" and "bad"--so much CAN happen as long as we keep ourselves from being numb to the realities of what people are actually going through, case by case.