Health Care Crisis

Who will help Teddy?

Americans have access to the best health care system on earth. The various parts within this system work together seamlessly: the doctors diagnose diseases; the pharmacies dispense health-restoring medicines; and the medical insurance companies complete the circle by making you sick. This last role is essential, since a nation of healthy, vibrant people could plunge the health care community into utter chaos, culminating in doctors opting to play golf in their spare time.

This was made clear when I recently tried to apply for new health care coverage. I researched the various insurance providers in my state, including Blue Cross, Blue Shield, and the other Tools of the Blue Crusaders affiliated organizations. Finally, I selected a provider whom, in order to protect their privacy and to keep from getting royally sued, I will refer to only by their level of service. The application process at Zero Health was relatively painless, and I was even able to avoid the normal lung-lobe submission process.

A few days later, anxious to begin a long and satisfying relationship with Zero Health, I accessed their web page to check the status of my application, only to see the following familiar yet negative result:

HTTP 404 – WEB PAGE NOT FOUND

Eventually, I reached the status page, and this time it said “Declined.” Declined? How can they turn me down? What about my rights as a patient? As a citizen? What about HIPPA? Or is it HIIPA, or HIPAA, or HIPPO, or OPRAH? I was mad enough to sweat bullets, a medical condition that might have been the reason I was rejected. Fortunately, I was able to calm down during the three-day handgun waiting period.

It was at this point that the sickness began, which shows just how effective health insurance companies are. I had not yet sent in a single premium, and I was already receiving the service I expected. I was anxious to discover the nature of the rejection, but I knew that to find out, I would first have to brave the Friendly Customer Service Representative, often abbreviated CSR or HIPPA.

Getting to a representative can be difficult, since you must first follow the phone system prompts to identify the precise department that will be able to handle your call efficiently. Of course, there is only a single bank of representatives that answer the phone no matter which phone system selections you make. But you must still make the minimum selection because your coverage is based, primarily, on how long you wait to press “0” and reach a human. The exact phone-to-coverage formula is an industry secret, but those who are truly serious about their health coverage will hire specialists to navigate the phone system for at least an hour.

Eventually you will reach Valerie in Customer Service. Even if your question is of a general nature—such as asking whether your heart is on the left or right side of your body—you must completely and accurately answer each and every Patient Verification Question.

Eventually, you are allowed to ask one question. Unfortunately, I wasted my one question by asking, “Who do I talk with about this?” Valerie didn’t know the answer, and wouldn’t give me another question, so I was transferred to her supervisor, Karen. Karen did know the answer to my question: nobody. There was nobody I could talk to about being declined. But she also knew why I was declined. Five years ago, I had gotten sick and had to stay overnight in a hospital. Although I fully recovered, and the doctors assured me that the illness was a once-in-a-lifetime event, the insurance company’s underwriting department wisely called me a liar. This is natural, because it is always better to believe an actuary reading from a set of statistical guidelines then to talk to a doctor about a specific patient diagnosis. That’s how health care works.

Karen said that I could appeal, but it would be a tough road because, as she made very clear, I had been sick, and I might get sick again. Heaven forbid that I should get sick and ask my insurance company to pay for it. Why even apply if I might get sick someday? That was Karen’s general advice.

By this time, I was thoroughly ill. Fortunately, as a smart medical consumer, I had pre-scheduled an appointment with my physician for that same afternoon. Of course it won’t be a covered visit—it never is. But with some efficient bedside manner, and a brown bottle of generic prescription medicine, I’ll be back in tip-top shape in no time. I think I have everything I need: my subscriber ID, my SSN, my birth date..hey, where are my toes on my left foot?