Category Archives: insurance

The Unhealthy Health Care Debate

I just don’t understand it.

All this talk about rationing health care under “Obamacare”. We already ration health care. from patients bounced from insurance coverage for unrelated pre-existing conditions to serves denied until patients actually die. WE RATION health care. Perhaps that’s even necessary in a world of finite resources, but to dump it on the current plan(s) is most disingenuous.

Rationing. Why else does Remote Area MedicalĀ®, founded by Stan Brock in 1985, provide “free health care, dental care, eye care, veterinary services and technical and educational assistance to people in remote areas of the U.S. and the world”? The “remote” area of the United States this week? Los Angeles, California. For his efforts, Brock was picked as ABC News’ Person of the Week.

I know, from personal experience, that people without insurance wait as long as they can before seeking medical assistance. I know that, until I got dental insurance, my trips to the dentist were few and far between, going only when I was in extreme pain, instead of going regularly to maintain my dental health.

I may have told this story before but can’t find it. Two days before I was going to college in 1979, I was at a friend’s house and somehow got an infection under my toenail. It hurt mightily but I had no insurance. But I WOULD have insurance in a couple days. So I hobbled through college registration; if I had had a walker or wheelchair, I would have used it. Then I went to the infirmary. By this point, the infection was going up my leg; if it had reached my heart, I most likely would have DIED. As it was, I spent the next six days – the first six days of the semester – in bed.

Yes, I believe in universal coverage. Heck, I believe in “socialized medicine”, though I know THAT’S not gonna happen. But why can’t we just debate the reasonable differences, such as its effect on the deficit, a legit question.

Take Sarah Palin, who is repeating her “death panel” claims. Someone please explain why she would say this, yet again. If there is a third option, PLEASE let me know, but I have to think that the only reasons would be that 1) she is stupid or 2) she is lying. I tend to think she’s not stupid, but I could be wrong about that. Of course, the White House’s reality check page won’t be believed, or listened to, by those who’ve been listening to the Sarah Palins.

Joe Baker, President of the Medicare Rights Center, was recently on the Newshour with Jim Lehrer on PBS to discuss some aspects of Medicare in national health reform. The specific topics related to Medicare discussed during the segment include the much-discussed reimbursement for end-of-life counseling, as well as other provider reimbursement rates. Here is a link to the transcript and video of the segment. It seems that a good libertarian position would be for individuals to control their own end=-of-life decisions, rather than have others do it for them. Expect that this provision NOT to show up in the final bill.

The cost of health care reform is $1 trillion over 10 years; that’s real money. But what is the cost of NOT doing reform? Current estimates based on the recent rise health care costs is $70 trillion or more in ten years.

Did you happen to see Jon Stewart this week when FOX News was “monitoring” some town hall debate and promised to go to the event if it got heated? Evidently, people screaming at elected officials is some sort of infotainment, but a reasoned conversation must be too boring to cover.

Finally, I HATE the phrasing of current poll questions about health care, one of those “How’s he doing?” things. More people think he’s not doing well than think he is. But saturated by coverage of the screamers, one could conclude that all the objectors think the plan’s too radical. In fact, there are some people, and I number myself in their ranks, who would answer the question negatively as well because I don’t think the plan’s “radical” enough. Amazingly sloppy poll questions, which, I guarantee will be cited by the host of at least one Sunday morning talking heads program; David Gregory of NBC’s Meet the Press is almost a lock.


Roger (Finally) Answers Your Questions, Scott

Scott from the Scooter Chronicles – GIVE THIS MAN A JOB! – wrote several questions:

Since obtaining your current job, have you ever thought of switching careers?

What, and leave show business? Seriously, not really. I learn something new (and sometimes interesting) every day. I work with smart people, and I provide a valuable service, if I do say so.

Besides which, I came to it so late (library school at 37, librarian at 39), I feel behind the curve compared with people who are my contemporaries agewise but have twice as much experience in the field.

Do you think the Obama administration will be able to make changes to the current health care systems? If so, do you think it will truly change for the better?

It’ll be incremental change, and it’ll be marginally for the better. But it won’t be the sweeping changes you righteously ranted about a few months ago. I knew trouble was brewing when single-payer wasn’t even on the table. I blame Sen. Max Baucus for that. Then the single-payer people were at the table but could not speak. Do not underestimate the power of the insurance lobbies.

Who do you think will be in the World Series, and who will win it?

At the beginning of the season, I picked Mets over Red Sox. Still feel the BoSox will be there. I could/should jump on the Dodgers/Cards/Phillies bandwagon, but heck with it, I’ll stick with the Metropolitans.

Oh, there was an interesting article in the Wall Street Journal about “high-leverage” situation hitting versus the two-run homer in the fifth inning when you’re already ahead 11-1.
These are the best and worst, through June 13.
Giants .299/.254
Phillies .288/.247
Marlins .263/.231

Nationals .236/.284
Mariners .252/.279
Rays .257/.276

When growing up, did you play in any organized baseball leagues?

No. Tried out for Little League once. I was a middling to poor fielder, but what really made me give up was being at bat. This kid threw a 3-2 pitch for a strike and I never even saw it.

Is so, what position(s) did you play? (If you didn’t, what position would you have liked to play?)

I played a lot of unorganized baseball. I tended to play the right side of the infield, though I’m right-handed, because my arm wasn’t great. I could throw relatively accurately from second to first, but not from shortstop or third base. Also played first, since I was a large target. Actually got better getting throws in the dirt, but not throws that were too wide or too high.

I also caught some games. Didn’t much enjoy it, but I could block the ball if I didn’t catch it.

Who was your favorite baseball player while growing up?

Clearly, Willie Mays. He could hit for average and power, he could run and he could field well. That said, I always had an affection for National League outfielders such as Vada Pinson (Reds), Lou Brock (Cards), Billy Williams (Cubs), Hank Aaron (Braves), the Alou Brothers (Giants), Frank Robinson (Reds/Orioles), and Roberto Clemente (Pirates); I had a Clemente card that referred to him as “Bob”, but he was no “Bob”.

Do you have a favorite baseball player now? If so, who and why?

Albert Pujois (Cards). Seems like a decent guy and he’s very good.

Any big travel plans for the summer months?

At this very moment, we were supposed to be in Williamsburg, VA with my parents-in-law, my two brothers-in-law, their wives and collectively, their three daughters. But my wife Carol has so much school work to do in preparation for going away to college for 17 days in a row later this summer that we bailed. During that 17-day run, I’ll be doing the solo parenting thing. Having my wife back will be like a vacation; we did this last summer as well, so I know of what I speak.

There’s talk about going somewhere in August, but so far, I’m not feeling it. I don’t know about your experiences with Nigel, but my experience with Lydia is that vacation away from home is more taxing than just staying in the routine. I AM basing that on our vacation when she was three, and she’s more self-sufficient now.


Insurance Blues

A couple weeks ago, I was telling someone about the movie Sicko, and I’m relating it to my tenure in 1989-1990 as a customer service representative for an insurance company. I get animated, and, apparently, loud, so much so that I was asked whether I have high blood pressure. (No, my bp, when it was checked five weeks ago was 124/78, thank you very much.)

What it does mean, though, is, to paraphrase Paul Simon, that I am Still Ticked Off After All These Years. And it wasn’t until this recent iteration of the story that I realized that it wasn’t just that I felt I (and others) who worked there were treated badly; I recognized, more fully than ever before, just how poorly their customers were treated as well.

This was the job I took after FantaCo. There were perhaps 16 of us in the training class, learning about medical prefixes and suffixes for eight weeks, which was actually cool. Then we got on the floor, already diminished by four, but adding to the five people already on the job. Soon, the 12 became eight as the tedium and/or the low pay – I was making $5000 less than I did at FantaCo – wore on people.

Yes, it was 1989, but how could it be that EVERY single claim for the use of an MRI was initially rejected as “medically unnecessary?

There is a condition called TMJ disorder, which involves the jaw. Routinely, people with medical coverage were rejected, saying it was a dental issue. People with dental coverage were rejected, saying it was a medical issue. EVENTUALLY, people with both coverages would get their claims paid, but it was, I realize now, a stall tactic.

When I started, we had what seemed to be a perfectly good dental claims customer service interface on our computers. It was changed during my tenure to some illogical, incomprehensible product, which, as it turned out, was ordered because someone’s brother or cousin developed it. Grrrr.

There were huge layoffs right before Christmas. The organization WAS middle-management heavy, and several of those folks went. But so did the clerks, who were runners to find files for the customer service reps on the phones. Never have I been more disappointed than when I WASN’T laid off.

What they say: You are now empowered to take care of these problems.
What they mean: We have systemic problems, and when they inevitably happen, you’ll be the fall guy.

The single most egregiously stupid decision made by this insurance company was the timing of the changeover from one medical claims billing processing system to another. The actual change in product was fine, but the time frame was ridiculous. The old system went down around Christmas. The new system was supposed to be up in two weeks; it took six.

If it were up to the customer service representatives, the switch would have taken place after the third or fourth week in January. People really cared about their 1989 claims for income tax purposes; less so about their 1990 claims. They could/should have announced that the 1989 claims were received by date certain in early 1990 would be processed on the old system and all others on the new. But no.

During this period in early 1990, some people wanted to know, not when the claims would be paid, but if it had even been received. Since the new system was batch processing, nothing was being entered at all. While I wasn’t supposed to tell the customers, we were told there were 40,000 claims in the basement, so I literally couldn’t find out the answer to their question. The official answer to the query, “Should I just send it in again?”, was “no.” But I’m told some at least a couple of the more irate customers “all right; if it’s duplicate, the system will kick it out.” This was true. But you know how some phone calls “may be monitored for quality assurance”? Got raked over the coals a couple times over that.

FINALLY, the new system was up. Claims were being processed, and far more quickly than before. But wait! Many of the policies had deductibles. The AMOUNT of the deductibles (e.g., $50 before a claim would be paid) were programmed into the new system, but the amount of the deductible ALREADY MET so far for those 1989 claims was not. So, customers who had met their deductible were getting letters saying “The claim was applied to your deductible.”

These people were now FURIOUS. And rightly so. The insurance company had a policy that the third call on the same claim would be a supervisor callback. By this point, EVERY OTHER CALL was a supervisor call. And here’s the source of my 2007 rage; for years, I had attributed this situation to an incompetent management of ignorant rubes. I now firmly believe, after seeing the movie Sicko, that not putting in the 1989 deductibles that were met into the new computer system was a deliberate attempt by the company to save money, hoping that the customers didn’t notice. And I’m sure that there were customers who DIDN’T notice, especially those who had separate deductibles for each member of the family. I’m now convinced the company put profits in front of the well-being of their customers and their beleaguered employees.

The last straw: we were scheduled to move into a new building in Corporate Woods. Two weeks before the move, I notice an ambulance at the new building. Then another. Then another. Then a school bus. It turned out that thirteen people went to the hospital because of something in the air ducts, a problem which, we were assured, was “rectified”. A fortnight later, we moved in, and at the end of that week, I gave my two-week notice.

I didn’t have another job. I didn’t have any savings. Since my last day was March 1, 1990, I did have health insurance through April 30; if I had left the day before, it would have run out on March 31. I just didn’t want to be working there on my birthday. Looking around, of the 16 people in that training class, after I left, only three of them were left, one in a different location. Interestingly, the five customer service reps who were there when I started were STILL there; hearty folks.

After that, I worked on the census for five months, then, having nothing better to do, went to library school; that seems to have worked out.

Oh, the pictures of the turkeys: taken a couple days ago from the third floor on a cellphone, looking at just outside my building, which, like the insurance company, is in Corporate Woods. Representative of the turkeys I used to work for.