Saturday, June 23, 2012

do do do do the shuffle.

The insurance shuffle.

Warning: Pushing play button is a must. Background music a necessity. Post too painfully tedious for unaccompanied reading.

Ready? Begin.

I just spent two freaking hours tracking down mental health benefits for two patients and following up on a claim payment rejection for another patient. (The third time I've had to call for the same claim. They just can't see to get it right.)

Best medical system in the world, who?

Oh wait, and I also spent an hour the day before in the same pursuit. These several unpaid hours included, but are not limited to, the following:


1. calling toll free numbers on the back of the members' cards

2. using automated system to punch in the following information

member ID number (8 digits)
member date of birth (8 digits)
provider tax ID number (9 digits)

3. being placed on hold (can last anywhere from 3 to 15 minutes)

4. speaking to customer service rep, asking her to repeat her name due to inaudibility or unusual pronunciation of common American name. hearing CSR sound annoyed with me for asking her to repeat. and then more annoyed when I ask her to spell. general rule: the more unusual the name the greater the annoyance

5. giving CSR no less than the following information:

member name whose plan I am calling about
repeat member ID number (8 digits)
repeat member date of birth
member home address
member home phone number

provider name (that's me)
repeat provider tax ID number (9 digits)
provider address
provider telephone number "in case we get cut off"

6. having call re-routed after the customer service rep realizes I am calling about mental health benefits, not medical while writing down the new number lest the call fails to go through

7. being placed on hold

8. repeating the same 9 pieces of information once the re-routed call goes through (see #3 above)

9. being given a new number to call after the CSR realizes her company is not the vendor for the particular type of mental health plan opted by this particular patient

7. calling the new number

8. repeating steps 2-3

9. having my mobile phone cut off, apparently due to battery run down (not the fault of the insurance company, granted, but a modern hazard nonetheless)

10. repeating steps 2-3

11. being told there are no CSR available as the office has now closed (it is one hour later on the east coast where, I have now learned, too late, the company is located)


1. Repeat steps 2-8

2. Repeat steps 2-8 again for next patient

3. Learn I am not on a particular plan's provider network that covers three sessions.

4. Call network manager to inquire about becoming a network provider in order to get paid for these three sessions.

5. Being told this particular plan's pay scale does not differentiate between various provider levels (masters level license versus phd level - that's me) and would I be willing to accept half my usual rate (which is already half my preferred rate).

6. Telling the network provider manager I will not accept this insultingly low fee (I mean, I do have my standards, I didn't go to college 13 years in order to earn less than a carpenter's hourly rate and I am not going to step up and reward these greedy insurance bastards who pay their CEOs millions whilst stiffing those of us in the trenches actually doing the difficult, expert, and sometimes emotionally harrowing work)

7. Calling the patient to inform, sorry, I will not be able to accept her particular insurance plan. And I really am sorry. I understand financial barriers.

8. Five minutes with head on desk resisting the urge to bang furiously.

Ok, this is all in a day's work, folks, when new patients come through the door. Do we wonder why the lists of mental health providers, psychiatrists most especially, on our networks is shrinking? This is why. Or one of the reasons why. The increasing cost of tracking down benefits and unpaid claims through the labyrinth maze of automation and bored-to-the-point-of-frazzled reps.

Obtaining some patient benefits are more straight forward than this but there are far too many of these scenarios.

When I do go through this I want to scream, pull out my hair, throw my phone across the room, hunt for the battery that has flung from the phone, crawl, ball up into fetal position, cry, moan, whimper, and finally, surrender, decide it is time for me to be the patient and let some other psycho-schmoe go through this benefit assessment process in order to file MY claims.

Oh wait. That's right. I don't have mental health coverage because I am self employed. I cannot afford to see me.

So I blog. Instead. The shrink is on the couch. As I recently read on a blog header, "It's cheaper than therapy." (I would love to give a proper shout out here but I cannot remember whose blog. Can anyone help me out?)

Update:  Shout out goes to Jen on the Edge.  And a shout out of thanks to smalltownme and Jenn at Juggling Life for identifying Jenn as the author of "It's cheaper than therapy."  


smalltownme said...

Jen on the Edge has that brilliant little gem on her header.

Becca said...

I cannot afford me: love that!

Coffeypot said...

I often wonder if a shrink ever needed a shrink. You hear a lot of nasty shit so where do you store it?

Mental P Mama said...

Good stinkin' grief. Something's gotta give.

Magpie said...


Jenn @ Juggling Life said...

Isn't that Jen on the Edge?

I cannot tell you the relief it was that the UCSD Eating Disorder Clinic had just negotiated a contract with Aetna.

Martin Willoughby said...

I don't charge much...and I'm available on this blog. So, tell me ALL about it. Oh yes, you just did.

There was one call centre I had to call many years ago (NTL a defunct telephone company), for which I got a book and a cup of tea ready before I dialled as I knew I'd be there for 20 minutes or more.

Green Girl in Wisconsin said...

There is a special kind of afterlife awaiting call centers and the insurance companies who devise them. Of this I am confident.

Susan said...

I hear you! All the putting in of the numers and then the repeating all of them again really gets to me. And those prompts never seem to get you where you should be - so why do they insist on using them?

Kaiser mental health does not differentiate between the social workers, psychologists and psychiatrists. When you sign up for service you just get sent to the next in line - even if their area has nothing to do with your issues and you know there is a particular doc who does. Plus, if you start with one and it isn't working out, you can't change.

One daughter went because she was having major stress related issues and the social worker she got just kept trying to get her to say we were abusive. Not only was it a waste of time and money, she now has a negative view of counseling.

Ben Ditty said...

Oh, wow, this is terrible. I wish things in this country could get better :(

Jason, as himself said...

I've seen that one too. Oh, smalltownme gave us the answer.

I was just thinking that after all of this craziness you would need therapy yourself! Thank goodness you have a blog.

Let's see. What would I tell you if I were you? Hmmm.

How do you think you could deal with this frustration in a constructive manner?