Friday, August 14, 2009

War Stories

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.
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.


  1. I think that is the biggest problem with the health care debate right now, people can't seem to fathom that people have different experiences with and without health care. If someone is lucky enough to have a good policy they don't seem to get that there is a problem out there. It really brings out the "Fuck you and your problems, I'm happy where I'm at" mentality that never makes anyone look good.

    And when I hear people complaining about not wanting to give up "control" of their health care I really ask myself, what "control" do any of us really have? I don't have health care and I am SO IN CONTROL.

    And the woman with the miscarriage? she sounds like she's SO IN CONTROL as well.

    It's a broken system with a large amount of the people in it bent on beating those in the water away from the lifeboats.

    all right. I'll shut up now.

  2. No need to shut up! I totally agree--people with good insurance can't fathom that there are people without, or, in my case, people with crappy insurance. Over the weekend, I got yet another medical bill, for another thing my $400/month insurance won't cover. I have grudgingly come to the decision to drop my health insurance, so I can have that money to pay my mounting medical bills. Tell me there's not something wrong with that.

    Things that society has made important for us to function--credit rating high among them, force our hands in many decisions. Also, the fact that being without health insurance for any amount of time creates a situation where an insurance company can say, "well, you didn't have coverage, so we can charge you more to start you on this policy, or give you only limited coverage for a certain amount of time..." So you HAVE to maintain coverage, even when it's financially damned painful to do so. And don't even start with pre-existing conditions...I don't happen to have any that I know of, but I'm sure that if I start having insurance again some time in the future, that insurance company will FIND one.

    And you are also right about the "control" issue. It is an ILLUSION to think that because you have health insurance, you have any kind of control--people, the ones holding the purse strings are the ones in control, not you. An insurance company puts MORE restrictions on what you can do than anybody else would, ever--doesn't matter what you and your doctor want, or think is necessary, no matter how prudent you are. I thought I was being prudent by choosing Urgent Care over waiting a couple of days and ending up hospitalized with a staph infection taking over my whole body, and missing a weeks worth of work (for which I would not be paid). Turns out, my insurance WOULD have paid for the hospitalization, but they don't pay for emergency or urgent care, even as a preventative.

    The most painful thing about the current health care situation is that you are forced to think dollars and sense when all you SHOULD be thinking about is saving your life, or feeling better, or fixing that broken bone--whatever. Now, I'm all about free enterprise, so I'm not one to immediately denounce insurance companies, but like I said in the post, they are capable of so much good--if they would just streamline, they would have tons of money without denying people coverage. Insurance companies, by and large, are HUGE, have numerous departments full of specialists who do ONE THING and one thing only, the communication between departments is incredibly BAD, and the people who have the most contact with actual customers (the customer service reps) are the LOWEST PAID individuals in the company. Customer service is an entry-level job, so the people who know the LEAST about it, are the ones who not only communicate with YOU, but also aid in your communication between the departments who barely talk to each other. If insurance companies actually had to COMPETE, they would not be run like this--they are fat and lazy. Shameful, really.

    In this country, EVERYBODY is just one bad accident away from bankruptcy, and, because we need our credit rating to survive anymore, you should ALL be very, very scared.

  3. It isn't just health insurance policies that people neglect to read or's all of their insurance policies. We recently switched to a High Deductible plan with and HSA tied to it - I feel a lot better about this plan than I had about the old one.
    On another note - Asking how to handle a delicate situation shows heart, maybe the client didn't see it, but it is good to hear. I know someone who suffered 10+ miscarriages; in the nightmare that was her medical issues she decided to change doctors along the way and when she called to ask for her records the nurse said
    "Oh, I remember you, you're the repeat aborter".

  4. Yay HSA! HAHA...I say that because I used to work in the HSA department at a different company, and I just loved the product--makes so much sense. I wish my employer offered that option. I could get one privately, and I believe I will--the $400 a month I have been paying for premiums, I could have been saving, interest-free, and that would have handily covered the current, huge bill.

    I cannot BELIEVE someone said that to her!!!!!!!! I hope that person gave her an earful. And then gave the doctor an earful, too...

    We have good people here, where I work, and not a one of them is ever cold to anyone on the phone--just so sad that they have to constantly dish out crappy news to everyone all the time.


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