Wednesday, March 18, 2015

Sock puppets

Health insurance is all about limits. You can only see a chiropractor 20 times in a year. You can only pick up a 30-day supply of your prescribed medication. You can only see a specialist if you get a referral.

My question today is whether there should be any limits on the health insurance company? I’d like to cap the number of lies they can tell at a reasonable number, and require them to go through a medical review before telling more lies.

This morning’s example: Cigna denied a claim from March 3, 2015, because of a lack of precertification (prior authorization, prior auth, PA, precert, it’s important to keep shifting the terminology). But we had a precertification approved by Cigna last year, valid until April 14, 2015. When asked this morning, Cigna said that the precertification did not exist. Then Cigna said that the precertification had never existed. It took some forceful arguing before they were willing to admit that the precertification actually was on file exactly where it was supposed to be in their system, and that Cigna needed to approve the claim. But nowhere in there did the Cigna rep think there was any problem with her script or training requiring her to lie repeatedly, nor did she think that there was any good reason for me to be aggrieved about being lied to.

I think there’s a way to fix that. Require that all health insurance companies keep records of all communications with customers, including recordings of phone calls, along with all notes made by CSRs. Customers should have full access online, the same way that I can access claims information. (Right now, I theoretically have the right to get copies of those notes, but it requires notarized mailed paperwork, months of waiting, and an incomplete reply on disorganized printouts.) Then establish a Consumer Health Insurance Protection Bureau modeled on the Consumer Financial Protection Bureau, whose complaint system works quite smoothly for simple problems. Along with straightening out simple problems, the CHIPB could have a swear jar with a set penalty for each time the health insurance company lies to a customer in a recording or in their own notes. Maybe $20, with half going to the CHIPB budget and half being given to the customer? And a higher penalty for the health insurance company “losing” recordings or notes.

At the moment, Cigna doesn’t care whether they lie to a customer about a precertification, or about whether a procedure or medication is covered, or about whether a provider is in network, or even about what they themselves have said within the same conversation. Cigna loses nothing for lying, so over time they lie more and more. That needs to change.

If we ever shift to single-payer, we’re going to have a reintegration problem for health insurance company employees. We’ll have to train them not to lie, not to erase records and evade responsibility, not to see the customer and the provider as enemies. Because having thousands of Cigna reps working in Target without a lot of retraining is going to be hell on everyone. What, you want to buy socks? There’s going to be a waiting period for that, you can only buy 1 sock per week, we’ve never sold socks, the socks that your wallet covers are only available in a single store in New Hampshire, you have to prove that you tried stockings and those didn’t work, and the price for the socks will be randomly assigned 3 to 12 weeks after you’ve worn them.

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