Best Intentions?

Since Humana’s latest denial of care, I have been on the phone at least 6 times with various representatives. I think it is more like 10 but I haven’t been keeping such hot logs of late. The first few calls were ostensibly intended to initiate an appeal to their grievances department. I had to go through customer service in order to do this which seemed a little stand-offish since they already know me over in G&A (that’s Grievances and Appeals to you). During three calls over the course of 9 days, a representative took my information down twice and each time said that someone from G&A would call me within 24 hours. Finally, on the 9th day, when I called and found that the rep who had been working with me was out sick I asked to speak to a supervisor. The supervisor took down all of my information again, reviewed the extensive logs of many of my previous calls going back about three months and then said that there were a few other people she wanted to speak with to fully research my case. She promised to call back later that day. Amazingly enough she did. I truth, I was impressed by her candor. She stated that the people I had spoken with had actually not been “building a case” to submit to G&A but were in fact re-presenting my information to the Access to Care Team, the group who had just told me to go all the way back to square one and get a referral from my primary care provider. However, she promised to help me “build a case” so that I could get a definitive answer as to whether my dentist Dr. Reisberg could go ahead with surgery.

The supervisor with whom I spoke struck me as concerned, organized, empathic, and determined. I have no doubt that she will do her best to try to help me. However, in my dealings with Humana I have encountered several people who exuded such quality, and each time I had to wade through a swamp of other folks with more limited powers and levels of motivation in order to get to them. Sometimes these seasoned helpers are able to provide a real service, a breakthrough even, but their aid is always temporary. It comes with an expiration date. The over-arching system which, just as in The Rainmaker seems structured to withhold service, will eventually overwhelm their efforts.

Such is our level of acceptance of the health insurance industry that no one seems particularly surprised by my story. Often, when I tell my tale, I get one-upped by an even worse encounter. When we pick up the phone to call our insurer, we brace for struggle. Just today the Institute of Medicine released a report indicating that the US healthcare system wastes $750 billion (with a B) per year. Sources of waste include inefficient delivery of care ($130 billion) and excess administrative costs ($190  billion). I have often wondered, while listening to muzak playing between call transfers, how much is all of this costing? All of these calls, all of the person-hours devoted to listening to my story over and over again, what is this costing Humana–and me? Though I have kept a record of many of the calls, I have not timed them. And though, if I wanted to, I might be able to estimate the total time spent on the phone and perhaps assign a dollar value, I have no way of knowing how much more time and effort were applied between calls. And, in the end, will it have been worth it to them? Not if I keep at it, I suppose.

I apologize for the rant. More inspiring stuff coming soon.


Addendum, a day later: suddenly, after my last barrage of calls I am getting return calls with updates from various levels of customer service. Literally, within a half hour span I got three calls (one from the supervisor, another from a woman working with the supervisor, and a third from the person who referred me back to my primary care physician a week ago) all to update me on their efforts and to reassure me that they should have some sort of answer next week, provided that Dr. Reisberg, whom they have been reaching out to, gets back in touch with them, The empathic supervisor even said that in the (seemingly likely) event that Humana denies this latest request, she would be there to help me to craft my appeal to Grievances. Apparently the part of the company that helps people is often at odds with the part of the company that makes decisions. Sort of like opposing sides of the legal system. While I am very grateful for her assistance, I can’t help but feel like a “perp” getting the good cop-bad cop business: “Don’t let that mean old bully scare you. I’m here to help.” All the while time it ticking by.

It is also quite possible that the reason I am now getting so much attention from Humana is because of you, good readers. When I first spoke with the supervisor, I gave her the link to Counting My Teeth, which is now up to about 3500 hits! Maybe, once again, you are helping to turn the tide. Thanks for your support! Please keep checking in.


About jkasbury

A guy with busted teeth fed up with his HMO.
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One Response to Best Intentions?

  1. I can’t help but agree with the good cop bad cop idea. While I truly hope the compassionate representative has your best interests at heart, I wonder if it is all a pantomime. This is what we pay hundreds to thousands per month for: to be deceived and cheated. Sorry, I am feeling particularly cynical right now. Humana sounds like the worst of the worst, honestly.

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