I moved last year. Three things happened next.
First, I was forced to give up my excellent health insurance, because it
was not available in Des Moines, Iowa - the insurance capital of the world. I
live in a downtown converted loft with an insurance company’s name carved in
stone at the entrance, so the irony is not lost on me.
Major invasive surgery without anesthesia is to Open Enrollment as
getting kissed is to getting hit in the face with a shovel. In the end I chose
a PPO plan based on two criteria: the relatively new non-statin cholesterol
drug was on their formulary; and no HMO was available. It seemed like a good
idea at the time.
Second, by leaving the coastal elite state where I retired for the
bleeding red heartland, I was downgraded to my pension plan’s category of
retirees about whom they give zero fucks, and my once excellent health benefits
were reduced to a $3,000 health retirement account. And it’s not just worth a
shadow of its former coverage; I now had to process my own claims and submit
proof I paid for each specific service. I had two dozen appointments in January
alone.
I cried when the benefits counselor told me he couldn’t be sure, but it
looked like my new drug might be expensive. In my defense, I had finished my
first double Manhattan by that point in our call. Is a spoiler alert warning
necessary? Do insurance costs increase exponentially annually? Do third party
contractors multiply like mold in a warm petri dish? It costs $375 for one month.
So far, I’m spending up to 8 hours a week on health insurance paperwork,
including an appeal for approval of that drug that’s already on their formulary,
plus another appeal of their denial to pay for a generic prescription I took
for 20 years, plus an appeal for reimbursement of a claim to correct their
mistaken denial, plus scanning in bills and receipts and filing claims, plus re-filing
claims wrongfully denied, and plus navigating purposefully clunky and
click-heavy websites that make an afternoon in voicemail hell seem like a walk
in the park. I admit that I also take some time to compose masterfully snarky Strongly Worded Letters.
You may not know this, but not only is there an insurance clerk/computer
algorithm between doctors and their patients. Those were the good old days. So far, and not counting >3 different online bill paying systems from the single network I have chosen, I have encountered the separate plan
administrator hired by the pension system, the plan administrator's third party Open Enrollment system, a separate third-party claims processor
responsible for issuing reimbursement payments (but not for approving payments,
but you have to figure this out) plus an after-completion survey company. I
have delved so deeply into this subcontractor hell that I tripped the survey
company’s third-party profanity filter and was politely asked by a robot to
clean up my shit and resubmit the survey.
My working theory is that all these people taking a slice of my
catastrophically reduced benefits have agreed to make a certain level of ongoing
low-grade problems for the patient-slash-customer that, regardless of the issue, the result is
denial of payments or services. I am convinced they have tuned their systems to assure a pre-determined profitable ROI in
dicking around until the patient gives up and goes away. Or, hopefully, dies.
The insurance industry must also be aware that a certain percentage of
patients have nothing better to do than fuck with them. My superpower, both by
nature and nurture, is bureaucracy. My Excel spreadsheets are meticulously
cross-referenced, color-coded, formula-embedded records of every appointment
tracking people, places, purposes, inconsistent reference numbers, costs,
payments, claims and reimbursement, both covered by medical insurance and not
covered but deductible for tax purposes. My mission is to cost them more than
I’m worth, not even counting the fact that my actual health care is more
expensive.
So, I knew.
