Fighting the good fight

The latest skirmish in the Insurance Wars… a conversation with a customer service rep.**

You said you paid that bill.

“We did but we changed our minds.”

Come again?

“We paid it but we took our money back.”

I realize your reasons seem self-evident to you, but could you give me a clue?

“We sent you a letter in the beginning of the year which clearly states this procedure will now require pre-authorization. You did not get pre-authorization.”

But you paid at first…

“… a mistake we corrected.”

Finishing my thought… after the procedure was done LAST YEAR.

“Oh, well we must have thought the procedure was done this year.”

You mean two weeks from now?!?

“I don’t understand.”

It must be going around.


The date of service was November 28th, 2011. If you change the year to 2012 it hasn’t happened yet. In fact, why don’t you keep it the way it is, consider this claim as a request for pre-authorization, and pay my doctor next month?

“I’m afraid it doesn’t work that way.”

I’m afraid it doesn’t work at all.

“Your attitude isn’t helping.”

I’ve got a long list suggesting it won’t hurt.


I’m sorry. Will you please just pay the claim? I’m not above begging.

“We’ll need your doctor to resubmit the claim.”


“Sir? Are you there?”

Sorry, I was trying to think of something nice to say.

**While the information presented is accurate, I’ve embellished the dialog a little to burn off a little frustration after the fact.


Bad timing

I don’t have much to say. I’m having trouble wrapping my mind around it all. It’s probably more an unwillingness that an inability.

Let’s just say our new Governor picked the wrong week to propose drastic cuts to state employees’ health benefits.

Well, for me anyway.


Love, your health insurance company

I like getting love letters from my health insurance company. They catch me off guard, but it’s nice to know someone is looking out for me.

A few weeks ago I got a letter asking about all of my other insurance carriers after I made a rather large claim. They said they wanted to make sure I could “maximize my coverage.” As they said, “We’re constantly looking for ways to deliver high quality, affordable care to our valued customers.”

Now isn’t that sweet? I could just reach out and give ’em a great big hug. I just can’t figure out how you give a corporation a hug, but if I figure it out I’ll be sure to let you know. I’m sure it’s eating you up inside too.

Then it dawned on me. They paid one hundred percent of the cost for this particular procedure. I’m not sure how you could maximize it any more from my perspective without sending me a check. Not that I’m against the whole check idea, I just don’t think it’s very likely – about as likely as you sending me a check.

You weren’t planning to send me a check, were you?

So I got to thinking. Now, I know what you’re thinking. That sounds unlikely, but it’s true I swear.

Does this mean it wasn’t a love letter?Was something more sinister was going on? Was this really a “cover our financial ass” letter, dressed up as “we’re looking out for you?”

Would a wrong answer turn the sweet nothings whispered in my ear into the grand piss-off?

“Tough shit kid, you’re on your own. Go talk to your x insurance. They’re the ones who really ought to be paying.”

Does this mean they don’t really love me, that they never really loved me?


My Medical Riff

Sit back and enjoy a good old fashioned rant, boys and girls. Don’t sit too close though. There could be some spittle involved – unintentional, of course.

I’m not going to review my medical history with you now. You’ve either been reading along and know it already, or you haven’t. Maybe you’ll get the basic idea – or not. I’m really not sorry.

The other day I hit a wall. I wasn’t walking or driving so no physical harm done, though after paragraph two maybe you figure I got it coming. It was the metaphorical wall, the one you hit when you’re beyond the normal kind of tired.

It’s when your body cries, “no mas!” even as your mind replies, “what the hell does that mean? We’re a dumb American, uni-lingual you fool!”

Whew! Look at all the hostility fly off the screen. I told you this could be a hum-dinger.

It was 11:00 am on Wednesday after the long Memorial Day weekend – a weekend I had just gotten a LOT of sleep. Cheryl and the kids had left the previous Thursday for the long weekend in Orlando, and I was supposed to meet them Saturday morning. I never made it. A combination of a cold and fatigue kept me in bed.

So resting most of a quiet, long weekend, and working one routine day at work, I should be pretty fresh right? Nope, there was the encounter with the wall, remember? So my addled, exhausted mind tried to run down the possible causes. Thinking about it, I felt like I’d been feeling more drained over the last month or so, but I’d been associating it with my sleep disorder – though it hadn’t changed (to my knowledge).

So what had changed?

Besides the cold, which could only explain one weekend, there was only one thing I could think of: the increased dose of meds my neurologist was giving me to manage headaches. Just for kicks I checked online to see its common side effects. Low and behold, there they were: fatigue, difficulty concentrating, and memory problems (though, all of which could be explained by fatigue).

I decided the wall wasn’t someplace I’d like to live full time, so I called my neurologist’s office to share my concerns. I called first thing in the morning and stuck it out for the legally mandated eight hour wait period for a call back. When I spoke to the nurse I laid it out for her much as I did for you – the last part anyway. I told her how I thought it might be this drug because it was the only thing I could think of that had changed in the last few months. We spoke a little longer. By we I mostly mean me. She had the classic, overworked, “I’m thinking about five other things right now,” dead silence thing going for her. I was interrupted by the occasional blurted question, which she’d have to repeat. The first half overlapped something I’d said.

We had a great rapport going.

Her last question almost did something I thought was impossible. It almost cured me of my fatigue. Almost.

“I see you’re taking a lot of medication, all of it I’m sure is necessary. But what makes you think THIS ONE is making you feel tired?”





Cheryl doesn’t like it when I swear on the blog. I don’t swear an awful lot in real life, but I do have a temper that’s rare but nasty. This is one of those times when I’d like to lay it down thick enough to make Richard Pryor blush. But I’m not. Well, not a whole lot anyway. Time has passed. I’ve cooled down a bit. Anyway, back to the post.

Contrary to what you might think, I didn’t want to jump through the phone, even if it was physically possible. I didn’t have the energy. Would I fall through the phone with a big assist from good ‘ole gravity? Absolutely. Maybe I was reading to much into it, but her question almost felt like a work of art, with so much condescension dismissiveness packed into so few words. I was stuck somewhere between awe and my brain blowing its cap and incinerating everything in its path.

“Um, you heard me when I said everything else has been the same, right? When I said that I meant for months. I’ve been taking all of those other medications for quite some time without any notable side effects. Again, the only difference I can think of is THIS medication.” And yes, nurse whoever the frack you are. Several of my specialists do seem to think I need to be taking the medication I’m taking. Are they perfect, or even necessarily correct? Maybe not. But how about you lay off the fucking judging until you get your medical license and read up on my full medical history, instead of this three minute multi-tasking act you’ve got going here?

“Well,” skeptically, “you could try reducing the dose again and see if it makes a difference.”

Fuck you very much. That’s what I thought anyway, I just wanted to make sure. “Thanks, I’ll give that a try.”

One fine whine

One of the advantages of US style health care is being able to obtain services without having to wait until the sun goes supernova (which could be a really long time, since our sun doesn’t have enough mass to go it alone).
– common wisdom in the US. When I say common wisdom (an oxymoron in the US) I’m refering to the part about waiting for healthcare, not the part about the sun. Most Americans probably don’t know the sun is a star just like the other pretty lights in the night sky.

My doctor wants me to see a neurologist about my headaches. Well, one of my doctors. I have several. In fact I’m seeing another one today, one I’ve known longer. She referred me to a practice in Tampa, the only one in the area specializing in headaches (so she says).

I held my breath as I checked with my insurance to see if this neurologist, the lone sentinel standing against the headache blight, was blessed by the managed care gods. She was, so with a renewed sense of faith and optimism I called to make an appointment.

They can squeeze me right in between Christmas and Thanksgiving – assuming they can get all of my medical records right away. Hah! Me and what army of copiers? Trees standing under the threatening eyes of pulp mills weep at the thought.

How do you spell “ouch?”

I’ve heard chronic headaches are pretty common in the US, though I haven’t taken the time to do the google for this post. That begs the question: where’s this free market everyone speaks so highly of? With all of this pent up demand, why isn’t there a headache clinic on every corner (next to Starbucks)?

Oh capitalism! Why has thou forsaken me?

Six months of billing futility, revisited

Something about that call isn’t sitting right with me. I finally got through to my insurance company, only to be told the problem: “we’re getting bills.”

Now, as some poor shmuck with little more than a family and a mailbox, this sounds like something perfectly resonable to say… if it was born of my lips. As my insurance company – whose sole purpose in the universe is to disburse healthcare dollars for – drum roll please – healthcare, this sounded fishy.

Hold onto your skull caps frends, I’m not done yet. You see, I wasn’t exactly speaking to my health insurance company. I was speaking to the company with a subcontract for the work with a certain medical specialty. No, this wasn’t an error on my part – we were both on the same medical specialty page. The problem was, the subcontractor didn’t handle claims/billing/money.

If I had it to do all over, I would have asked a few probing questions – with a pinch of sarcasm for flavor.

So what do you do when you get a bill? Do you forward it to the correct recipient? Do you notify the Doctor’s office about the error? Do you do both? Do you just ignore it, hoping it will go away? If you don’t process claims, what the hell do you do? What value do you add to my healthcare?

Alas, I felt cowed, and for no good reason. Maybe it was a case of learned helplessness. Either way, I just said thanks and called my Doctor’s office to let them know what I learned. Of course, I had to leave a message with their billing department. They were on the phone assisting other patients.

They were assisting with other insurance problems, no doubt.


It’s the little surprises that make all the difference

“Ah… Mr Kauffman? Your insurance company hasn’t paid us since your August visit. You might want to call them.” That was the office staff at one of my many doctors’ offices. We’re pretty tight, seeing as how I’ve been there a lot since August.

I might want to call them? Does this imply I might not want to call them… that I might just want to pay the bill myself and not go through the hassle? Or is it possible they might want me to just pay the bill, so they won’t have to go through the hassle?

If you guessed all of the above, you win… a warm feeling in your heart, knowing you’re at least as smart as me. Well, maybe not warm, exactly. Room temperature?

I’m not sure what this says more about: my doctor’s office or my insurance company. Is health insurance so poorly run in this country that it’s routine to wait six months for payment? Or is the office manager at my doctor’s office REALLY lax with the ‘ole follow-up?

If this is business as usual, would it really hurt anyone if it was run more like a government?


Fickle Facebook friends

Note: I wrote this months ago, so the time references are way off (like someone’s concerned about timeliness… here of all places).

I was a social networking snob. At one time I had a blog, a web site, and all of it ran on a web server under my desk. I had Internet cred, and Facebook was beneath me.

Like everyone else, I didn’t get Twitter.

About a year ago I was talked into Facebook at an Obama event in Dunedin. “We’ll post all of our pictures there,” they said. “Facebook is cool. You’ll be hooked.” So I signed up.

A few days later I got my first friend request – someone who allegedly went to high school with me.

“Cheryl, do you remember a — —- from high school?”

“Um, yeah. I think she was a cheerleader and our class vice president.”

“Why on earth do you think she’d want to be my friend on Facebook?”

“Wait. Back up. Why would YOU want to join Facebook? When did this happen?”

Apparently I wasn’t the only snob in the house.

“I give. I’m weak. I gave in to peer pressure – and they weren’t even really peers – just a bunch of people I met at the Obama thing. Well, I suppose they were dictionary peers, but not my idea of peers. You know what I mean?”

“No John, I really don’t.”

Long story not too long, my prospective Facebook friend was helping plan our 20th high school reunion. I was new to the Facebook scene, and a little vulnerable, so I accepted. (Alright, I was vulnerable long before Facebook. Sue me.) I didn’t think we’d ever spoken to each other, and I knew we weren’t pen palls. I didn’t remeber her from any of my classes, though I’ve repressed most of those memories. Yet, through the miracle of social networking, we were Facebook friends.

Time passed. I voted for Obama. She almost certainly didn’t (more on that later). I had no intention of reliving my adolecent nightmares at a reunion. She posted lots of pictures with spirited captions. She’d been a popular kid. I was something, but it wasn’t popular. Dear Lord, who was this person? Shortly afterwards I ignored Facebook altogether (for a time). The hook hadn’t set.

Two people. Never met (I think). Never exchanged words (spoken or typed). Seemingly nothing in common but a brief bout of geography.

Facebook friends.

A few weeks ago depression eased off a bit and I caught up on the news. I left the house for something other than work. I checked Facebook to see what my friends were up to.

With a little curiosity, plus a pinch of boredom, I looked up that first Facebook friend. What I found was a wall full of political cartoons, jokes, and a pinch of right-wingnut hysteria; all railing against one of my passions: universal health care.

I was feeling frisky. My dander was tingling. The social courage I felt during the election returned. I was ready for a debate, even if I stood little chance of changing anyone’s mind. I had to comment, my fragile ego be damned. I picked the entry with the biggest choir and made my move.

I don’t know if I succeeded, but I tried to be civil. I thought I was arguing with reason and logic, facts and statistics. I made innocent/benign analogies. I made what I thought were reasonable points. They rallied – but not around me. Honestly, I don’t know if I drew first blood, but someone made it personal. One person called poor form. Another questioned my integrity, extolled the virtues of individualism, self-reliance and the boot-strap, implied collectivism in any form was the work of Satan, and suggested if I thought universal health care was so great, I should just move and leave everyone else alone.

I took exception to the moving bit, and said so. Still, I thought I was calm – reasonable. But maybe I wasn’t. Everyone got mad. I was told the move/leave comment was an honest suggestion, not an attack, I was essentially an idiot for thinking it was… and I took exception with THAT too.

Go figure. I’m odd that way.

Am I the only one who finds this kind of “suggestion” offensive? Am I the only one who finds an implicit “love it or leave it” message between the lines, implying I don’t love it? Am I the only one who finds it dismissive? Am I imagining an undertone of “we don’t want your kind here?”

And poor form? Can a guy get a collective: huh? Is it poor form to suggest social change conceived honestly, charitably, without malice, and dog gone it – just the right thing to do? I may not be right, and I gladly debate that point – but poor form?

Some of what follows is very similar to a post one of my favorite bloggers put up recently, only his was much better.

I felt like I wasn’t in it deep enough, so I set out to set mouths a foaming. I told them they were all collectivists. I don’t recall if I used these exact words, but I said something like this: “If not, then I expect you’d never drive on public roads, use public utilities, eat anything made out of corn, fly on planes that rely on the FAA to direct them, call 911 when you’re in trouble, engage in risk sharing via private insurance, support any intervention, under any circumstances, by a publicly funded military, use public libraries, beaches, or parks, or rely on others to monitor your water/air supply to make sure no one’s poluting it or poisoning you.”

I’ll say it again (because it makes me feel smart to use big words): everyone living in this country is a collectivist, to some degree.

At one point I had been accused of unfairly assuming one of the commenters was a Republican – though I don’t recall even using the word, let alone resorting to name calling. I got a little mushy and continued: “If I’ve made inaccurate assumptions, I appologize. I meant no offense. But when you’re trading short messages, with people you don’t know, it’s hard not to make certain assumptions based on what you say. I haven’t come out and said I’m a Democrat, but I’ll wager you’ve assumed I am one based on my stated beliefs.”

I might as well have set myself on fire and saved everyone the trouble. The next morning I was notified by email that another person had commented, once again acusing me unfounded/unfair/insulting assumptions, and self-evident deficiencies in logic conveniently wrapped in a single word rebuttal: socialist. I went online to read it again, to see where I’d gone so wrong, only to find I couldn’t. I’d been de-friended. I was in fact no longer welcome.

In an odd way, I hope I was an insufferable ass. Not because it gives me some sense of retaliation after the fact, but because I don’t want to believe the alternative: people are so closed to opposing viewpoints they huddle in little shelters, protected by a cocoon of agreement. I don’t want to believe we’re a society addicted to ideological insulation.

As for myself, I’m a little too comfortable in the cozy confines of my cocoon of naiveté. So make my day. Tell me I’m a stupid prick.

Oh, I know. There are other, less cynical possibilities. Maybe I broke a generally understood rule of social networking (by everyone but socially awkward me): thou shalt not argue on Facebook. Or I might not be right on this one, let alone persuasive. And then there’s the obvious: people don’t agree on everything. It’d be pretty dull if we did.

Then again, she did put all that political stuff up. You gotta expect a little dust-up when you talk political smack, right?

I know it’s not true for everyone, but I sense a pattern: folks get more cynical with age. I worry there’s good reason for it. Reading the news the last few months – about angry healthcare town hall mobs highjacking civil discourse, roving bands of bloodthirsty liberals hell bent on lowering the median age in this country, and the creeping influence of Satan in government (a place where I work) – hasn’t helped.

I don’t think I’m a pawn of Satan. Maybe I should re-read my position description and contract.

Bedtime thoughts

Do you trust the health insurance industry more than your government?


The right spent the last thirty years (at least) selling the idea that government is the root of all problems, and they’ve made a killing. But ask yourself, has your government let you down that much? If so, have you ever called your representative in Congress or Senator to let them know? Have you ever written them a letter? Do you know who your representative is? Did you vote in the last election? Did you vote in the last election that didn’t involve the Presidency? Do you know who you voted for? Did you know who you were voting for at the time?

Maybe it’s let you down because you allow it to represent someone else by default.

Writing a letter takes a few minutes and costs less than a buck. Email is free. A phone call might take ten minutes of your time, and is likely free if you call their local office.

Do you spend more time complaining about it than doing something about it?

Some say you get the government you deserve.

What kind of government do you deserve?

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Getting Ted wrong

I was born in Massachusetts so I’m required to have a soft spot for the Kennedys. There was rarely more tension in my house growing up than when my mother would accuse my father of voting for Nixon or Reagan… herself a liberal Democrat in the Kennedy mold – and fan of Ted, the liberal lion of the Senate, in particular.

She named one of our cats Ted during the dark years of Reagan/Bush – allegedly for a little push-back against my father. (Having lived through the sequel they seem like the good old days now.)

I get my politics from my mother, and I morn the passing of one of the last unapologetic liberals in the Senate.

Like Joan Walsh, I’m a little irritated by the claims of conservatives that Ted would have made compromise on healthcare happen. Universal healthcare was a career-long goal of his, and the current proposals were already a compromise (irrational hysteria by the far right, the misinformed, or the just plain scary not withstanding).

Here’s video of Ted arguing for an increase in the minimum wage back in 2007 on the Senate floor (via TPM).

Say what you will about universal healthcare, “public options,” or the proper role of government. Do you see that guy compromising further on his lifelong passion? I don’t. I’ll tell you what I do see: more BS from the right on healthcare.

Sadly, his views on the subject are probably irrelevant now.