bureaucratic insanity

I’ve taken over the phone for my mother, whose is once again on hold, as she has been for at least 20 hours since Aug 12, including 3 or 4 hours today.  She bought a “deluxe rider” to her health insurance to cover vision care (among other things).  The insurance provider assures her she has the insurance, but she does not “show up in the system” at the health care provider for the vision benefit.  There are three parties to the problem: her health insurance provider, the organization that handles most of their vision insurance, and her health care provider organization.  At all three organizations, you can never direct dial back to the specific person you spent several hours with the last time, you have to start over with a new person and retrace the same steps multiple times.  Many times she has been assured that the problem is resolved and she will show up in the system in 24 hours, 48 hours, or a week.  Apart from the first visit, where she was shocked by her lack of coverage and had to pay a larger-than-expected copay at her optometrist, she’s been told she’s good to go twice, only to be told no on site after she has paid her neighbor to drive her to the office to get the glasses.  She is exhausted and near often tears with frustration.  Many different interpretations have been offered as to why the problem exists and what needs to be done to resolve it.   This week, while I’ve been listening on the speakerphone,  the phone people have been humane and sympathetic and willing to do a lot to resolve the problem, but even humanity seems to have limits when running up against an insane system.  According to today’s people — including a very helpful Sharon in Wichita who with her supervisor spent several hours yesterday and personally faxed a document to organization #2 and who today spent several hours in a multi-way conference call with the health care provider (even insurance company representatives have to wait on hold when they call each other!) — the problem is that most of the insurer’s customers are assigned to company #2 for vision benefits but my mother is in the 10% who were assigned directly to her health care provider.  This is why all the attempts to get her in the system at company #2 did not work.  At this point, I just spoke to a person at the health care provider’s patient services who says that she has been assured by Sharon that the benefit exists and is assigned to them, that she personally will be calling someone else (!) to get the information entered into the system, and that we should get a call from her or the optical department when this is done.  She also gave me her direct line phone number so I can follow up with her.   Now we will see if it works.

Author: olderwoman

I'm a sociology professor but not only a sociology professor. I keep my name out of this blog because I don't want my name associated with it in a Google search. Although I never write anything in a public forum like a blog that I'd be ashamed to have associated with my name (and you shouldn't either), it is illegal for me to use my position as a public employee to advance my religious or political views, and the pseudonym helps to preserve the distinction between my public and private identities. The pseudonym also helps to protect the people I may write about in describing public or semi-public events I've been involved with. You can read about my academic work on my academic blog http://www.ssc.wisc.edu/soc/racepoliticsjustice/ --Pam Oliver

5 thoughts on “bureaucratic insanity”

  1. You have my sympathy! I have spent the better part of the last month on hold with insurance companies, trying to get them to fund speech therapy for my kid. There is a federal AND a state law that requires them to do so in a case of autism — in addition, my university specifically negotiated this with my carrier. They also recently lost a large lawsuit over this very same issue. Alas, they still turn me down and refuse to pay.

    I really do think that insurance companies do stuff like this on purpose because it is much cheaper to pay off a lawsuit or wear out the vast majority of people than to actually cover the things they are supposed to cover. I’ve been meaning to write a post on developmental delays, health care, and inequalities in attainment but it’s hard to write with your head permanently cocked to the left while listening to Muzak… I think I will buy a speaker phone tomorrow.

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  2. forget the speaker phone — call the lawyer who litigated the last case for the plaintiff(s) and ask him or her to take you on contingency with attorney’s fees and a portion of the punitive damages (which you should win easily if the company already has been told they have to cover this and still fails to follow the law.). This case will scream, “EASY MONEY!!” to that lawyer and should, in theory, require little more than a couple of phne calls that the insurance company wil have to pay for.

    Or, go to University General Counsel and ask them to represent you in informal discussions with the insurer (which they should want to do as a party paying a ton of money to the insurer — they should be demanding what is covered).

    And when they make you feel like an a-hole (which they will), remember that the more you cost them, the more they are going to ensure that the next person is protected. And that person might be a janitor at your University trying to get speech therapy for their kid.

    The repeat player — be it the university’s lawyer or the other plaintiff’s lawyer — is going to get the insurance company to pay attention faster and with seriousness in a way that you cannot (sorry – it is structural).

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  3. nsp: yeah, speakerphones or headsets are the way to go. My mother has been able to lay down the phone and read while waiting, which helps somewhat. My phones are all speakerphones, and I also have a headset which I actually like better for walking around and doing chores while talking or waiting.

    I’m with LBN on the lawyer for you, which is a denial. My mom’s case isn’t a denial, they say she is covered: they just can’t seem to get the correct information to the right place.

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  4. Good advice and I’m on it (that soc of law training pays off even though I couldn’t tolerate law school!) — our insurer is now subject to a class action suit but I am trying to pursue it through the university legal people rather than joining the class.

    In any case, I expect to be reimbursed when Junior is 14 and no longer needs speech therapy. Should come in handy for the college fund :)

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  5. This has been the story of my life for the past several months–I became my mother’s guardian, and had to put my dissertation on hold while I spent hours and hours on the phone with Medicare, Humana, etc etc etc.

    If your mother needs a quick fix (or even a backup pair) while this situation is being resolved, check out http://glassyeyes.blogspot.com/ for reviews of Internet shops with Very Cheap Eyeglasses. I plan to order some for myself whenever I can get my husband to help me measure my pupil distance.

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