[Sober Living] Tripping Over Insurance

After seeing Doctor-Number-Five, I filed a formal complaint with my insurance company about my grievances. Although this “Tripping On [The American Healthcare System]” series has provided some interesting writing content, I still would have preferred everything get resolved the first time, or the second time, or the third time, or the fourth time… If that was tedious, try dealing with these mindbender headaches, or, this insurance company. About one month later, I received this reply:

I will quote the letter below, with [editorial redactions].

You stated that you saw these providers on various dates but are dissatisfied with all of them. You felt belittled, you were given a prescription that worsened your headaches, one provider only spent 30 seconds with you and another just gave you a note for work. [Doctor-Number-Five] was the only one that listened. [The healthcare coordination company] wasn’t helfpul.

[This insurance company] is dedicated to improving the quality of care delivered through its practitioner network, and member satisfaction is an integral measurement of the success of this effort. We have an extensive quality program that includes the evaluation of all concerns regarding quality of care, or service, brouhgt to our attention by our members or their families.

The review of our participating providers consists of many components, including statistics that measure the quality of service. The number of grievances filed against a provider and the types of concerns expressed by our membership are significant portions of this review. Your concerns will be kept on file for this purpose. However, the proceedings and the outcome of this process are confidential.

Thank you for taking the time to inform us of your concerns. We take all complaints seriously and use them as opportunities to improve member satisfaction. If you have any questions or further comments, please call Member Services at the toll-free number on the back of [your card and not on this letter].

That’s about as much as I would have expected.

I carried this note around for about a week before I decided that writing this essay would suffice for my reaction to this letter. What could I do? Their Member Services department would not have the information in their system. They would look up the case, look up the records, and it would just say “complete” or it would quote this letter.

They would put me on hold to determine their communication.

They would say “sir” more often than necessary. They would apologize more often than necessary. The person I would be talking to over the phone, and I can picture the voice from a call center contractor, somewhere, would be trained to provide the most politely vague answer possible, like what we just read.

What is there to do now?

I could file another claim, but I don’t think there’d be much use in that. I’m just getting really tired of all this bureaucratic bullshit. At least I’m seeing progress now. I think that’s why so many of my colleagues told me they couldn’t have tolerated the number of doctors I’ve seen, and would just live with headaches.

Why would you live with something you know is not normal?

I ask these questions rhetorically. I have one colleague specifically with chronic migraines that accepts the headaches rather than try to solve them. Why would I ask him why he accepts them? What would his answer give to me? A sense of why I am motivated toward my headache’s root causes and he’s not? Someone like that is not a person that I would learn much from, not that there’s anything wrong with him, he’s just the sort of person that would take this letter and just accept that there’s nothing that can be done.

I accept the letter but I’m doing more about it.

This letter is proof to me of the abysmal state of the American Healthcare System. For my fictional world “The Story” takes place in, Eville Medical was more of a joke name, not entirely rooted in any over-disdain for my four years working in healthcare IT. When I wrote my first novel, it was more of a loving tribute to my experiences along with some actually useful information if you wanted to become a healthcare IT goon, too. When I go to write my second novel, I’ll let Sammohini’s experiences guide the novel’s tone, but I can’t help that all these underwhelming healthcare experiences might influence that novel’s tone.

We’ll see after I get over these headaches and write it later this year.

If I could summarize those four years in a concept, it’d be red tape. I agree with some red tape. We need rules and regulations to keep things under control. If that means that not everyone has administrator access to their workstations, to install whatever program or virus they want, then that helps keep things working smoothly. If it takes months to get the approval and installation of a program, however, there’s a breakdown in structure. Bureaucracy like this letter reminds me of those days where we’d have to go through all these layers of red tape just to do something.

The converse of that is more dangerous.

Letting patients have access to any medication they want, or letting any user install anything they want, can help level the playing field, but only if the medicine-user or the computer-user know what they’re doing. Through this process, I have to say I went from being the general victim of headaches to having some degree of education around the fundamental basics of headaches. Where they are tells us what they are and how to treat them. It’s like telling someone your computer doesn’t work versus your browser automatically closes out before you can finish reading this essay.

Technical support… doctoring… auto repair… it’s all similar.

This letter doesn’t give me any actionable remedy for my psychological pains over my healthcare experiences. Complaining to the anonymous helps relieve pressure.

I wonder if I should dedicate the next novel to these failures?

Endtable:
Quotes: None, other than the novel.
Sources: My personal and professional experiences.
Inspirations: While planning what essays I wanted to write, based on my writing calendar and my Zomqueue, I looked over upcoming Sober Living slots, thought about what other things I could write about, and this one and the upcoming Tripping On Vitamins came to mind.
Related: Other Sober Living essays and the “Tripping On [The American Healthcare System]” series.
Photo: I wanted to obscure the names of the guilty.
Written On: 2020 January 21 [30 minutes, plus a few minutes typing the letter. From 9:54am to “bureaucratic bullshit” 10:02am. From 6:23pm to 6:45pm. While listening to Here Come The Baton. WordPress.]
Last Edited: 2020 January 21 [First draft; final draft for the Internet.]
My big goal is writing. My most important goal is writing "The Story." All other goals should work toward that central goal. My proudest moment is the most recent time I overcame some fear, which should have been today. I'm a better zombie than I was yesterday. I'm not better than you and you're not better than me. Let's strive to be better every day.