Saturday, May 30, 2009

They're Penetrating the Bureaucracy!

Anyone remember this well-written scene from The Incredibles? It begins with Bob Parr being pulled in to see his boss. Bob works for Insuricare, a medical insurance company.

Mr. Huph: I'm not happy, Bob. Not. Happy. Ask me why.
Bob Parr: Okay. Why?
Mr. Huph: Why what? Be specific, Bob.
Bob Parr: Why are you unhappy?
Mr. Huph: Your customers make me unhappy.
Bob Parr: What, you've gotten complaints?
Mr. Huph: Complaints I can handle. What I can't handle is your customers' inexplicable knowledge of lnsuricare's inner workings! These people are experts! Experts, Bob! Exploiting every loophole, dodging every obstacle! They're penetrating the bureaucracy!
Bob Parr: Did I do something illegal?
Mr. Huph: [reluctantly] No.
Bob Parr: Are you saying we shouldn't help our customers?
Mr. Huph: The law requires that I answer no.

Well, Brent and I have penetrated the bureaucracy of United Health Care. We've learned it's all about knowing "the inner workings" or the secret passwords and handshakes, as it were.

The birth center I am going to found a letter in their insurance files for me that makes quite nice ammunition. Apparently earlier this year another client of theirs had beaten UHC into submission and got them to pay at in-network levels for both the birth center and the midwife that attends there. They reluctantly agreed to this after admitting that there were no other providers in the client's geographical area that offered the same services.

Really???

Anyway, the letter was from UHC to the birth center giving notification of their intention to pay in full.

YEA!!!!

So armed with this information Brent called the insurance company. It only took about an hour on the phone and talking to three different people, but we think we will soon be victorious. At first it was "I'm sorry, sir, I just don't know what the procedure would be for that", or "Oh, I think it's this other department that you need to talk to". So after going back and forth between Care Coordination and Benefits someone happened to slip out the phrase coverage gap exception.

Eureka! We discovered the secret password that would allow us to at least start the process of what it is we want. Since people working in such large organizations aren't allowed to think for themselves and can only read from a script, you have to use their special vernacular for them to get to understand you.

So Brent went back to Care Coordination and asked for a "coverage gap exception". Suddenly they knew what he was talking about. They explained that this meant that in order to qualify there had to be no in-network providers that provided the same service. Yes, he agreed to that. The process was begun.

Then he was asked for my diagnosis. Umm. Isn't that kind of obvious considering he was requesting to go to a birth center? Anyway, he said "my wife is having a baby". Long pause on the other side of the phone. Brent could hear the woman rolling her eyes as if to say "Yeah right, there's nowhere within 30 miles of your residence for you to give birth."

So Brent said "You'll find there are lots of hospitals in the surrounding area in-network, but there are no birth centers."

Long pause.

"Huh." Again do we hear the rolling of eyes and the passing of judgment?

"Oh, yeah. You're right. Okay."

So, long story (sorry about that) short: we think they're gonna cave. They said the request had to be processed and they'd send a letter to us and the birth center in a week or two.

The moral of the story? It's a pain in the arse, but it is possible to "penetrate the bureaucracy" if you are dogged enough to learn the secret passwords.

Go forth and conquer.

2 comments:

We are HamakerLove! said...

YAY YAY YAY!!!! I am sooooo happy for you! This is going to be sooo much more what you want. I am sooooooooooooo times infinity glad for you.:)

So we are like a day apart in due dates, who do you think will have their baby first?:)

shelley said...

lol at the diagnosis umm, my wife is having a baby. still laughing.