A Letter to my Health Insurance Company

This column appeared in Balance Magazine today.

Dear Mr. CEO Sir:

I’m really sorry to bother you. I’m sure you don’t know me, but I’m one of those folks who dutifully writes a really big check to you twice a year for my really high deductible health insurance policy. To date I have paid you premiums somewhere in the neighborhood of $43,965.87 – but who’s counting? I know you don’t get those record profits (and CEO perks) by charging bottom basement prices. I also wanted to thank you for ponying up that $29.32 after I finally met my $5500 out-of-pocket deductible for my emergency room visit last year. You shouldn’t have! Since your correspondence regularly assures me that we are Partners in Healthcare, as your ever faithful check writing associate, I just have a few matters I’m hoping you can clarify.

Now let me start by saying that I know how much THE COMPANY cares. You really do and I am deeply touched. When I called your customer service number yesterday, a female voice repeatedly told me so. Since she also advised how valuable my time was, I decided to put it to good use and peruse the War and Peace sized copy of THE CONTRACT. I must say, it was riveting. At regular intervals, the cheerful woman’s voice broke into the block of 80s movies hits that even Otis Elevator deemed too offensive to pipe into its little moving boxes. But to be honest, sir, the rendition of St. Elmo’s Fire was enough to make me want to gouge my eardrums out with anything on my desk in arm’s reach. Although I only got to read for 47 minutes (and notably never found anything which THE COMPANY actually covered), I did learn that self-inflicted injuries sustained while waiting on hold with THE COMPANY are specifically excluded. (see page 27, subsection VII, paragraph 4) Glad I didn’t reach for that Bic!

But the ever-so-helpful customer service rep, Tim, made those 47 minutes worth the wait. I told Tim that I had received my explanation of benefits, but didn’t understand why THE COMPANY had denied one-half of my claim. I felt pretty certain that Tim wanted to say, “Well duh, we deny everything,” and hang up but just he sighed loudly and typed in my claim number which cleared things up in pretty short order. Tim advised me that, “the second procedure was included in the first so the second wasn’t covered.” Silly me, I knew there was a simple answer!

I know that should have ended the conversation, but I just couldn’t hang up – I asked more questions. I mean, THE COMPANY is looking out for my best interest, right? So when I asked for more explanation, Tim’s irritation with me grew quite obvious. I explained that the procedure involved two completely different body parts so it just didn’t make sense to me how one could be excluded. Now I’m sure that Tim’s high school biology class and THE COMPANY’S 30 minute training session (Motto: Just Say No!) gave him more than adequate knowledge of the inner workings of my female plumbing and the ability to determine the medical necessity of procedures. So I suppose it was rather brazen of me to question his wisdom. But Tim’s final comment was that I was to blame improper scheduling. “If you’d had the procedures done on different days, they both would have been covered,” he explained. So what’s the moral of the story: stirrups twice, get your price? Bet that policy would change if Mrs. CEO was in the saddle.
And while I’ve got your attention, sir, just a couple ideas to shoot around the boardroom. Far be it from me to criticize THE COMPANY but you might want to have the calculators there checked out; they don’t seem to be functioning properly. The calculators in the benefits payable department seem to only be equipped with the subtraction key, since every claim I submit has some amount subtracted. But clearly you do have some calculators with an operational addition key. They’re just dandy in the premium billing department since every bill I get goes up on average of 15%.

It also might be time to review the REASONABLE AND CUSTOMARY AMOUNT allowable. I know, call me crazy! But the last time amount THE COMPANY deems reasonable for an office visit was appropriate was when I wore diapers.

And speaking of billing, I have enclosed my check for the next six months’ premium. Please note that the amount due has been reduced; this bill exceeds my REASONABLE AND CUSTOMARY AMOUNT payable. But don’t blame me, it must be the calculator.

Now that she understands company policy, Denise Malloy regrets not scheduling her hip surgery on two different days. 

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