Have I mentioned that I hate our insurance company (companies, as it is)? Super Dad is likely cringing as he reads this, since he works for an insurance company. (A wonderfully generous and pleasant place to work, I might add.) I mean, specifically as the customer of a medical insurance company…I truly hate the experience.

You have to understand something upfront about insurance companies…they are for-profit entities. And their profits increase when they don’t have to pay your claim. So, regardless of how an insurance company markets themselves to you or your employer, they are better off if they can find a way NOT to have to pay you money.

Keeping this reality in mind makes it easier to understand why your experience, when trying to get a claim paid or authorization to get any procedure done, is such a horrendously painful experience. It may not make the experience feel any better, but at least you understand what’s going on.

This week’s runaround has to do with Kay and her wisdom teeth. And the lesson you will learn is: DO NOT LOSE ANYTHING THE INSURANCE SENDS YOU. As I reported this summer, the insurance had denied Kay’s wisdom teeth extraction, saying their dentist did not see anything wrong and wanted to wait until the teeth had started erupting.

Meanwhile, poor Kay’s bite has been shifting. So after a very circular, pass-the-buck between the dentist and the oral surgeon, the oral surgeon’s office wrote an explanatory letter of appeal. Within a few days the insurance sent us an EOB (explanation of benefits) saying they would indeed cover the procedure. Only (dun..dun..dun), we lost it.

Now that it’s time to actually schedule the appointment for Thanksgiving time, I find out that they did not send a copy to the oral surgeon’s office and that they supposedly can not send a copy to me in less than two weeks. So it’s back to the oral surgeon’s office to request that they call the insurance and request a faxed copy. (Some type of internal rule prohibits the faxing of this information directly to me…)

And there you have it. THE RUNAROUND. Besides the arbitrary rules, such as not being able to fax me something they’ve already mailed to me once before, there are subtle clues that the organization is all about giving you the runaround.
1. The automated answering machine asks you a never-ending stream of information/choices that make no sense: “Say your account number now, unless it starts with a letter, in which choice, press #3 and wait for the tone. Then read the number, leaving off the letter at the front, backwards.” Of course you’re bound to mess this up at least once, requiring you to start all over again.
2. The automated choices presented as a baffling long menu, forcing most people to press the number that repeats the baffling long menu, so you can figure it out.
3. Never in the menu options are any choices given to talk with a live person. Sometimes dialing “0” works, but not always.
4. Once you are in the cue to talk to a live human being, the wait really begins. Don’t hang up.

So what are some things you can do to make playing The Runaround a more likely game to win?

1. take notes on everything. The live human being gives you his/her name at the beginning. Ask them to repeat the name and write it down. This helps set the tone and gives you a paper trail of who said what to you when.
2. ask them to further explain or repeat anything you don’t understand.
3. ask the “why” and “how” questions. “Why can’t you fax that directly to me?” and “How do I file an appeal?”
4. Ask to speak with a manager if it appears that the person on the phone is stonewalling (but don’t be surprised if the manager does the same thing).
5. Ask about timing/deadlines of anything they are supposed to do. Mark that on your calendar and call back.
6. File the written appeals. Don’t give up.
7. Get yourself organized. I have a large notebook I throw all insurance information into. I’m actually thinking of getting canvas storage boxes of different colors to sort all important papers into (school, insurance, medical). The main thing is a system that is easily maintained.

Related Blogs:

Harder Than It Has To Be

Medical Subsidy or Holding Teeth Hostage

If Only I had the Energy...