|
Imagine! Today I was just thinking about starting a health insurance thread. I was trying to settle on a variety of titles:
Blowing the whistle before I blow my stack
How I became a cog in a robot that went evil
Bottomless pit: insurance in canon and fugue
But now I don’t have to use any of those. Because you so kindly started the thread for me.
Anyway, I work in insurance. I don’t work for one of those big Fatcat companies. My company does. I won’t tell you which one (or my last name, and doom to all who post it here—and no, I don’t ever post from work.) because as much as I’d really rather dispose of my job, I’m stuck in it if I want to make rent. And I do. I do want to make rent. But not this way.
I was able to hold my head up once. When I hired into my company, I could proudly say that I was improving the world and making life better for the people with whom we dealt. We’re a negotiation firm. This means that when a patient chooses to see a doctor that isn’t in cahoots with Fatcat, we take their claim back to the doctor and say “you’re overcharging by yea much, and if you’ll agree to bring your price down a bit, none of us will have to charge the patient extra money.” And doctors like that, because most of the time, they don’t want the patient stop coming to see them. And patients like that because who wants to pay extra money for their angina? And Fatcat likes it because, hey, they get to pay less money to everybody.
When I arrived back from vacation on Tuesday, I was greeted with an interesting memo. Over the weekend, Fatcat had decided not to use my company’s full services anymore. Instead of negotiating the claims, they now want only to find out what the “reasonable” amount is. And they’re only going to pay that. And the patient gets to pay the rest.
This might be a good thing if a patient is choosing a doctor who’s committing fraud. But what about when a woman has a knife wound in her stomach, and if she doesn’t get to the nearest possible hospital she’ll die? That’s right, friends, if that hospital isn’t in league with Fatcat, Ms. Knifewound McWoulda-Died gets to pay the remainder of whatever Fatcat says is reasonable. And let me tell you: what Fatcat says is reasonable ain’t a lot.
Overnight I turned from Helper of Humanity to Hand of the Devil. Thank you, so much, bossman Fatcat.
Of course, working indirectly for Fatcat, I get to see firsthand what kind of Shi’ite goes down. And not in the good way.
For instance, I was assigned a new project that helped handle claims that were being negotiated before the patient goes in for services. This is usually for patients with serious trauma or chronic or terminal diseases. People who really need our help. And I was the only one in charge of making sure these claims were actually coming in and being handled correctly.
So in the first month I noticed that a bunch of them weren’t being paid correctly. So I told somebody up the ladder. They brushed it off, “fix that claim, I’m sure it’s just an isolated incident.”
So I fixed that claim. And the next month there were even more. So I said again, to the next dude up the ladder “there’s something wrong with the system.” And they put me off again. “Get the handful of claims fixed, and it’s probably not really a problem.”
Except that every month it got worse, and every month I yelled “help!” until my company believed me. But then Fatcat didn’t believe me. “It’s your company’s problem, they’re doing it wrong.” It took me weeks of making reports and connections to prove to them there was, in fact, a system error. And just today, as we’re finally getting the 100+ claims fixed, we’re getting new messages. “Why does this have to be done? What is this?”
AUGH. If I, in the infinitesimal portion of claims I handle, am seeing this much error and this much passing the buck, what for the rest of the people? What for the other Fatcats? What for our poor, poor country as health problems soar and health insurance says, for the umpteenth time, “What? It’s not my problem.”
|