Category Archives: Insurance

6

Inside Mega Medical Insurance

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If Congress ever stops obsessing about whether Vladimir Putin’s attire (or lack of) is an indicator of Russian foreign policy, maybe they can actually look into the running of the medical insurance companies. In the meantime, maybe this is what’s happening inside the boardroom:

Chairman: Gentlemen, we have invited you here for an explanation of why profit margins have plunged so dramatically.

Board Member A: The investors are very unhappy. Our largest shareholder had to use existing funds to make the payment on his ski lodge. Another had to postpone his trip to Fiji and Micronesia.

Chairman: Let’s start on the pharmaceutical side. What is going on, Mr. Hogg?

Lester Hogg (Pharm Guy): Well, you know that it’s hard to get companies to create new drugs because it’s so hard to get the government to approve anything. It’s all going generic.

Chairman: We’ve heard all that. Are there any new trends?

Hogg: A lot of people seems to be trying herbs and other supplements. We’ve even heard of psychiatrists prescribing them. That pulls people completely out of the pharm system.

Chairman: That makes no sense. Insurance doesn’t cover herbs. It has to be more expensive.

Hogg: Talk to the twits over there (points to the medical insurers). Copays for drugs keep going higher.

Julius Bones (Med Guy): You people can’t keep your costs down. We had to start charging them a percentage of the price instead of a flat fee. You said it was the only way to make a profit. The customers said the premiums were too high.

Hogg: And whose fault is that? You guys are letting patients get CT scans for a sprained ankle.

Chairman: We thought that forcing people into HMOs and such was supposed to keep costs down and profits up.

Bones: Well, it didn’t work out quite the way we expected. We thought that by forcing everyone to go through a primary doctor, a lot of the specialist fees would be eliminated.

Chairman: What happened?

Bones: Them. (Points to a team of attorneys)

Phineas Shark (Legal Guy): We have to make sure the doctors don’t get sued for malpractice.

Chairman: So you decide which tests are needed to protect the doctors?

Shark: In a manner of speaking. We make sure the doctors don’t make promises they can’t keep.

Hogg: So they try herbs instead of drugs.

Shark: There are fewer proven side effects. People don’t want to die from their treatment.

Bones (aside): That completely dries up the flow of money.

Shark: And we make sure enough tests are done to avoid missing a problem.

Chairman: So why aren’t we making money off all these extra tests?

Bones: Well, we made some reforms in the past that are cutting into those profits. We forced the providers to form groups for internal referrals and improved communication. And we made them switch to electronic communication.

Chairman: So??

Bones: So instead of taking the x-ray and sending the patient somewhere else for further diagnosis, the patient is referred internally and the x-ray is available for anyone in the system to see.

Chairman: What idiot thought that would be good for the insurance industry?

Shark: We never thought the medical world was organized enough to actually follow through. Our bad.

Chairman: This is totally unacceptable. It seems that every time we come up with something to protect our interests while still looking like the good guys, they figure out how to actually use it.

(He looks around the table.)

Chairman: I’m giving you insurance executives 90 days to come up with a way to exploit the holistic medicine industry or you’re gone.

 

5

Only in America

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I may have mentioned that we are short-staffed at work. Another one bit the dust at noon (12:30 to be exact). Mid-morning, a fellow stocker came up and told me that Jane (not her real name) was quitting at 12:30. It’s not all that unusual for people to leave with no notice, or even in the middle of their shift. The unusual part was that she told us that ahead of time that she would be leaving part of the way through her shift.

I think she was actually trying to be nice, coming in an staying until the deli was as fully staffed as it gets these days. It reflected the reason she was leaving. She wasn’t unhappy with the work, her coworkers or her hours (which should have given us notice that she was somewhat unique).

She had to leave because of health insurance. Specifically, too much health insurance. Like a large percentage of the country, our company makes us sign up for healthcare in the fall with coverage to begin January 1. Jane (not her real name) needed insurance. She was going to compare what the company offered with what she could find on the online “marketplace”.

I love that name for the government enrollment site. It makes me think of a Persian bazaar. Although from the sounds of it, at the beginning it was more like a freeway at rush hour. When someone has lost a load of cooking oil on the road.

So Jane, being a good American, wanted to make sure she had insurance on January first. Having the same luck as many Americans, she was unable to get on the government website at first. Or for quite a while. It probably would have been easier to get insurance in Mongolia, as some of you know.

So Jane made what appeared to be a logical decision. She enrolled for the company coverage. Of course, her big mistake was using the word “logic” anywhere near the words “healthcare insurance”. The company insurance is expensive, for adequate coverage. I had it for awhile and am still here to talk about it, so how bad could it be?

The insurance contains the standard rule that open enrollment is the only time you can enroll without a reason. Guess that’s  why they call it “open” enrollment. The only time you can make changes is if you have a “life event”. Gotta love insurance talk. Life events include major changes: birth, death, change in other coverage.

Well, lo and behold, Jane finally got the government system to work for her. And the advertising was right! She did find better coverage at a lower cost. It’s hard to believe our government was even involved. So she signed up for the coverage. All she had to do was cancel her company coverage and life would be good. Assuming that having medical insurance is one of your goals in life..

Well, apparently the company does not include finding your own insurance as a “life event” change. Individual insurance does not impact your ability to have group insurance. Being covered as a part of the entire national population is not considered group coverage.  They told her that she could not cancel her coverage until the end of the year. No exceptions.

For whatever personal reasons, she had two options. She could carry the two coverages for eight months or quit. As you may recall, we are paid enough to put us somewhere in the far lower end of the 99%. Paying for two coverages was not an option. So you can guess the rest.

Needless to say, there was panic in the deli. One of the full-time employees is on vacation for the next ten days (and then is probably going to be promoted out of the store). So the rest of the morning was spent trying to figure out how next week would be staffed.

It was your normal situation. The group can’t do anything, so they stand around arguing about how awful it’s going to be. Which it will be. Since Fridays are busy to start with, it became the perfect storm of angst. Nothing like a small space filled with semi-hysterical people to make an enjoyable workspace.

At least the team leader had the day off. She is one of the most excitable people I have ever met. Unfortunately, it’s not a positive energy. She probably would have smoked herself into a coma.

We had three people they interviewed and liked. One of them did not pass the background check. Looking around at some of the people who did get hired, I can’t imagine what heinous act that person committed to get turned down.

We are waiting for the other two backgrounds checks to come back. Management is sure they will be starting soon. So whatever the other guy did is apparently heinous and rare. One of those people is supposed to join me stocking cheese. Yeah, sure.

I love working on the floor. Grumpy customers are rare and leave after a few minutes. Grumpy coworkers go on forever. We are all going to need our mental health benefits soon.