Healthcare Systems Keepin Us in Check

Here is something i wrote a few years ago after some awful experiences with insurance companies and figure id share now. Enjoy.

I spent the better part of yesterday back and forth between my insurance company and the doctors office absolutely bewildered at the state of healthcare in America. My foot propped up on a pillow; I remembered why I had put off calling the doctor for three weeks, because I was already overwhelmed with what lay ahead. The inefficiencies of our nations insurance companies are mind-boggling. Some might think that they fail at their goal; they don’t provide what they offer. But this is untrue; the insurance company achieves its ultimate goal. This is because its goal is to fail. Its not supposed to provide health coverage to its members. Instead the corporations essentially offer false hope and as a result disillusionment that leaves more Americans in their current social and economic state.
I called Anthem Blue Cross Blue Shield and was immediately greeted by an automated service. The computerized voice offered me a few options that were none of the options that I was searching for. After about five options I pressed zero thinking I knew the little secret that many others didn’t, the golden number to a live operator. I’ve always been quite proud when I would tell others about my secret, the way that I would skip the line and get right to a live person by pressing the golden “0”. Alas apparently I have told to many people because this was no longer an option. Instead Max Headrome returned and went through the aforementioned options. I pressed “1” and then had to choose between English and Spanish which would be the easiest part of my journey. Of course once I selected a language I had to wait for a few minutes listening to horrible elevator music although I was actually in an elevator. I cursed myself for not finding a landline to make the call thinking about how sprint had to be in on this too as my daytime minutes slipped away.
Finally I heard a pause in the music. My heart raced as I sat silent for a second only to realize it was my connection that was suspect, the elevator music resumed. But alas after a few more moments, while watching Oprah belittle some author I was greeted with a friendly voice.

“Thank you for calling Anthem Blue Cross Blue Shield, how many I help you?”
“Hi, I don’t know if you are the right person to call, but um, um, I am looking for the out of state, away from home care, do you need my membership number first”
“That would be great”

Why didn’t she ask me this to begin with? It would seem like the logical thing to do considering at one point or another she would need this information. We spent the next few minutes discussing the different intonations of “M” versus “N’ and “V” versus “B” or “C”. For some reason I never think of easy words to offer such as “B as in Benjamin”. Instead I always think of curse words or nothing at all, “B as in bitch” and I giggle to myself in my head. Finally we confirm that I am indeed me, which I always find is a relief. Infact I urge any of us who are having any type of identity problems to immediately call their insurance company. They will certainly give you confirmation and you can go about your existence again. After all this she finally says,

“So how may I help you?”
“I need to find doctors in Philadelphia.”
“Any type of doctors?”
“Oh wow, I didn’t think of that, well yea a foot doctor, a podiatrist, I injured myself playing basketball” (She didn’t give much attention to this information) But you should know I’m out of state, my coverage is in Connecticut.”
“I see”

The dreaded “I see”. Its arguably one of the worst expressions one can hear. Right up there with “Sorry hunny, I've been cheating on you with Hitler or your best friend” and “Hi, this is Tina, that girl from the bar last month, you know McFaddens, yea well I'm pregnant”. Blasted McFadden’s!

“Well sure ill have to connect you with the out of state operator, she will take care of you.”
“Oh, okay then, thank you.”

Why didn’t she do this in the beginning! Why did I spend the last five daytime minutes on the phone with someone who could not help me? It makes no sense, its almost as if she was just teasing me. Like youre 17 in the back of your car with the prom queen, you feel like a million bucks. But then she gets out of the car after two minutes of kissing right when you were beginning to maneuver your hand up her shirt! God Damnit! Stifled again! I feel like a blue-balled teenager.
More time goes by and finally I’m in the right place. This voice sounds much like the previous one and makes me think that I’m the butt of a big joke. Like the guys from Crank Yankers are on the other end having a big laugh. And the first question she asks,

“Hello sir, may I please have your membership identification number?”

Are you fucking kidding me? Seriously? Now I know I’m the target of some vast conspiracy. Didn’t I just give this information to the last operator? Shouldn’t you already have this information? Now I feel like a foreigner speaking to someone in French. (I chose the French here because they are the only people who have as much disdain for me as insurance customer service operators). You know those times when you just repeat the same thing over and over again as if they will all of a sudden learn English through repetitive listening.
I give up my information all the time praying that she wont ask why I’m out of state, in Philadelphia considering I have a few doctors visits in the area and none in my “home state”. I will refrain from giving up any more information for fear of the obvious, they are watching. After five more minutes she has found three doctors in my network. Hallelujah. My blood rushes, my heart pounds. I see light at the end of the tunnel until I ask the next question.

“So do I have to do anything else? Once I make the appointment do I have to do anything else?”
“I don’t know sir, I only am a locator. You will have to call membership services.”
“Oh ok, can you please connect me to them.”
“I’m sorry, I don’t have the directory here so you’ll just have to call the customer service line, it should be on the back of your card.”

No shit, I used it to call you. I hang up. I look at the clock and see that I have twenty minutes to Around the Horn on Espn and would like to have all this finished up so I can hear five people’s ramblings on the significance of Kobe Bryant dropping 81 in an NBA game. Upon occasion I marvel at the fact that people are paid to just give their opinions and report events. It seems like such an easy job, I should be paid to do that. I do it ever day, “That hot ass chick just bought a chicken parm sandwich, damn she is hot, I should get her number.” Seems easy enough. I take a deep breath and call back. Brimming with confidence knowing that it didn’t take me too long last time to find an operator. At least after a few miscues. But this time takes much longer. For some reason all the options that were available the last time I called seem different. I can never remember what option I chose in my Choose Your Adventure story.
You might ask why don’t I just make the appointment? Well rewind a few years when I had a knee injury and was attending college in Washington DC. After finding a doctor in the network I made an appointment and went in for knee rehabilitation. Confident that I was completely covered I went a few times. The doctor’s office never gave notice that anything was wrong. After 9 visits totaling at $900 I find that the insurance company wont cover it because I never alerted them for authorization. I thought I had considering I talked to an operator. But alas this was not enough and I was stuck with a $900 tab. Insurance companies are the devils.
So this day I growing increasingly frustrated. I had just hung up for the third time, not finding my pot of gold through the winding automated maze. I decided to give it one more go before giving up on the day. Somehow, through divine intervention I found the person I need to talk to. Three daytime phone calls and 20 minutes to find one person to offer me this after I gave her my membership number again,

“Yes sir, call and make an appointment then call us again here at the out of state care to alert us to the doctor, date, time and address so we can put through an authorization code for that day.”

Once I had to reschedule an appointment after putting the authorization call in. I forgot to call in a second time to alert the change in date and was denied coverage once again. I figure they would be smart enough to know that it was the same patient and doctor. Apparently it was I who was not smart enough. So I ask this lovely lady for some information as well,

“May I have your name and extension so I can just call you back?”
“Yes my name is Monique and I don’t have an extension, but you can just ask for me. Also make sure you ask the doctor if they are still in the network.”

That’s essentially the same thing as the “how about I take your number instead?” Then you walk yourself home late at night telling yourself she will indeed call. After a few days you start looking her up on yahoo, google, friendster, myspace to no avail and convince yourself that she must have lost your number because why would she have asked for your number in the first place if she didn’t want to call you. Wait did she really ask for my number? Hmmm.
I google the three doctors whose names I received through the locator operator who has nothing to do with the out of state operator. Only one of them has any information online and two of the others have names that sound like id meet them in the back of a dark alley in Bangkok during monsoon season. I call the listed doctor and leave a message on a shotty old school sounding answering machine.
Two days later I get a call back and make an appointment. I ask the secretary if they are still in the network.

“I don’t know, how would I know? If they listed us we must be. That’s all on the insurance company, that has nothing to do with us. How about this, you just come in and if they approve it they approve it. If they don’t then you can deal with it later.”

Exhausted, mentally and emotionally I say “whatever” and hang up. I now get ready to call back Anthem Blue Cross and Blue Shield. Ill skip past the Choose Your Adventure phase this time but be assured that it definitely occurred. I find an operator and ask to speak to Monique only to find that Monique doesn’t exist. She was like a dream, or a nightmare. Eventually I am reconnected to out of state coverage. This woman was nothing like Monique. Not that Monique was a saint but she was helpful in her role. This woman though was immediately suspect of my out of state care and the reasons behind me not being in Connecticut. After much convincing she accepts my lame duck story and puts through the authorization. I wet my pants in excitement and down a shot of Jamesons by myself. I ask her for her name before I hang up,

“My name is Monique sir, anything else I can help you with?”
“A rope and a high chair?”

She doesn’t get it.

I have yet to visit the doctor. They didn’t have an opening for ten days so I have to sit here with my injured foot awaiting news that I already know. “You should rest it for a while, a few weeks, maybe we should take some x rays.” At which point ill have to get the insurance company to cover the X-ray somehow. Which means ill have to go through the whole process again.
I sit here now completely jaded by the whole bureaucracy. I think to myself that there is such an easier way. That the system does not make any sense. Its not efficient and it doesn’t do what its designed to do. But infact it does. Insurance companies aren’t designed to provide affordable quality healthcare to their members. They are designed to earn money and its what they do best. That’s how the companies are constructed.
And all this money goes to one place, the higher ups, the bourgeoisie. The money goes right into the pocket of the ceo’s who are making deals with the prescription drug companies and to lobbyists who then pad the pockets of our civic representatives. It’s designed to keep the current social caste system. A system where the upper and lower class are being even further separated as the middle class disappears. There’s no mistake that every operator is named Monique (reference page 179 of Freakanomics, by Steven D Levitt Would a Roshanda by Any Other Name smell as Sweet). They find people from lower income brackets who they can train and offer full health benefits. To this individual it’s a great deal. They get a steady job; benefits and they can support their families. Meanwhile the corporation dangles the cheese in front of them, consistently creating a falsehood while promising these low-income workers opportunities to move up through the corporate ladder. It will never happen. Although the women’s movement has created more jobs for women there is still a large discrepancy when it comes to women in positions of corporate power. Even more so for African-American women who have lived hanging on the bottom rung since Americas inception. All Monique can do is follow protocol and report problems to her manager who is probably someone named Jim and earns just a little more then her and reports to someone who reports to someone who reports to someone who reports to someone who reports to someone who reports to someone who reports to the board of directors at Anthem Blue Cross Blue Shield.
The Insurance companies also keep each division separated. They don’t want their employees developing relations with their peers. Its not encouraged. Hence the reason we have to keep giving them our membership number over and over again. If each division were in constant contact with one another then it would promote discussion and debate. They would eventually find that Monique in the out of state office earns more then Monique at the locator office and would also discover that the another Monique has been working in membership services and hasn’t been given a raise or promotion in the 23 years she has been working with the company. Monique will never move up the ranks because those positions are reserved for those upper class individuals who attended the nations greatest private schools and universities.
Upon graduation, without any field experience these ivy leaguers who will most likely be white will be employed by the insurance companies assuring their spots in the corporate hierarchy. As a result Monique will never be given a fair opportunity to rise up the corporate ladder, bring money into her community, or worry about her social responsibility. In effect her children will grow up without a mother who has to work constantly to pay the bills. The children will have no guidance and have to attend lower income public schools with no money for books, computers, or sexual education. There’s a good chance that one of Monique’s children will get into drugs, another will parent a child at a very young age and neither of them will ever have the opportunity to attend college. As a result little George W. Bush, having just graduated from Yale (where he never had the intelligence/grades to attend in the first place but most certainly the money and lack of pigment) will have his place secured in the hierarchy. Monique and her children will have their places secured as well.
The company hopes that after being misled through automated services and constantly redirected the member will just give up. Instead of going through all the hassle they will just pay it themselves and stay in debt. As a result they will never be able to move from the lower class to the ever-dwindling middle class and one day upon the high perches of the 1% that actually control everything. For a good example watch the movie The Rainmaker starring Matt Damon and Danny Devito, or read the book of the same title by author John Grisham.
It’s easy to break a persons back who is already on their knees. These individuals who seek healthcare through the insurance companies are already bewildered, are already ill. Why should a sick person have to put up with any of this? The last thing they want to do is worry about why their insurance company isn’t holding up their end of the bargain, hence the reason they usually give up. It’s a small price to pay for the insurance companies when some members actually follow up on their services and claims. Unfortunately for us the person at both ends of the line happens to be Monique. We are the same person attempting to figure out the same problem and finding no answers.
The higher ups are sitting back with their feet up sipping on champagne in their private jets flying off to their private islands. They marvel at how we don’t get it, they spit on us and look down upon our broken backs, dirty hand and sniffling noses. But if history proves anything its that things move in cycles and if Karl Marx is right, there’s a revolution coming, hopefully sooner rather then later.