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Annie talks to the bureaucrats who come between you and your doctor

Via Dr. Grumpy. I have to quote the whole thing because it's so damn good:

Yesterday I was walking by Annie's office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.

Annie: "I'm calling because you people denied an MRI on a stroke patient?"

Pinhead: "Before we discuss this, I have to inform you that this is a recorded line."

Annie: "Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn't happened."

Pinhead: "Let me look up the tracking number... Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call."

Annie: "Oh, now THAT's a surprise."

Pinhead: "What do you mean?"

Annie: "Is this line really being recorded?"

Pinhead: "Yes. It's to improve customer satisfaction."

Annie: "Oh, goody, because I'm sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review."

Pinhead: "We do this to save our customers money on unnecessary testing."

Annie: "Okay. Then let's just stop wasting each others time. Forget the intake coordinator, forget you. Since your only job is apparently to tell me that my doctor needs to call your doctor, couldn't your company save money by firing you?"

Pinhead: "Um, I hadn't..."

Annie: "Think about it. You have benefits and a salary, right? I mean you're not doing this as a volunteer job, are you?"

Pinhead: "No, but I..."

Annie: "So wouldn't your company save money by firing you and instead getting a computer that automatically denies every damn test and sends a fax telling us to call for a peer-to-peer review? Then we can just let the doctors talk directly to each other from the beginning, which is what you bozos want anyway. Think of the money saved by cutting all of your jobs."

Pinhead: "Oh, but you can't mean that?"

Annie: "Oh but I do mean that. And I'm glad we're being recorded. Let's consider the current situation. You are basically a worthless automaton. A computer could do your job for far less. And at this point you've incurred the wrath of all the medical professionals in the country as well as the patients. You and all of your superiors ought to be out of a job due to your blatant inefficiency. And don't think we don't save your denial forms, and your names, and document it all in the chart."

Pinhead: "I..."

Annie: "Nothing personal you understand, just a suggestion. I'll have my doctor call your doctor. Have a nice day".

Pinhead: "No, wait! I..."

Annie hung up.

Yes. That's the industry that the administration, the press, the FKDP, and the A list want to bail out. Yay!

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coyotecreek's picture
Submitted by coyotecreek on

......of these Pinheads to come onto a blog and post from their perspective?

I would love to hear how they feel - seriously this particular Pinhead must be weeping in his/her beer tonight.

So sorry to Annie and her family for having to go through this shit.

coyotecreek's picture
Submitted by coyotecreek on

Can we get him/her back here?

The information s/he provided will help with drug rejections....we need to know more.

Thanks, lambert, for knocking me up the side of the head.

coyotecreek's picture
Submitted by coyotecreek on

"Anguished in the PA Department - United Health Insurance Inc"

I forgot these are just hardworking people trying to keep their jobs.

Sigh.

Submitted by lambert on

Not all, but many.

Our feudal overlords regard facing the peasants with agonizing moral dilemmas as a bug, not a feature.

BDBlue's picture
Submitted by BDBlue on

claims people that socialized medicine was coming,* but I did not enjoy reading that exchange so much. First, these people have terrible jobs working for terrible people. So do a lot of Americans. Second, they're being used as leverage to keep the insurance company afloat (think of all the jobs!) even as they're being outsourced and downsized and paid crappy wages. Third, the lousy healthcare situation in this country is not, in fact, the workers' fault.

And I know, in theory, we all have choices and the insurance company employee made hers. But I also know that when it comes to feeding ourselves and our families, we all do things sometimes we'd rather not. Like take a crappy job denying people's claims.

I dunno, I'd rather beat up on the execs and leave the claims people alone.

* Keep in mind I have that much desired government coverage and I was still reduced to this due to frustration. Because even if I have better coverage than most, it still sucks and I still get denial of care via paperwork bullshit. I'd opt into Medicare in a heartbeat.

gormenghast's picture
Submitted by gormenghast on

Annie's Pinhead is, no doubt, weeping in his/her beer. If the monitored call (and they are all monitored) is his/her second or third failure to "take control of the call" then he/she is now on probation. If he/she was already on probation for similar failures, then this call got him/her fired. He/she will not be allowed back to his/her desk or to say goodbye to the few colleagues not out on FLMA for stress. He/she will be told to wait fifteen feet from the building to which place, a supervisor and a security guard will deliver his/her personal belongings in a cardboard box in return for the security badge he/she needed to get out of the building. He/she has effectively been "disappeared". The next day, people will wonder what happened - in two days they will have forgotten his/her name. At first he/she will be elated and relieved that he/she no longer has to do this god awful job, not to have to watch all those fellow employees arrive early for work so they can sit in the parking lot sobbing or throwing up before gearing up to go in the building, live in fear of losing a job he/she hates - it feels great until he/she remembers that it took six months to find the job because there simply is nothing else out there.

Nevermind, he/she will remember that for months CEO's have been flying in from all over the country, having rah rah meetings just down the hall, new computers have been ordered, plans for a new building have been discussed, 160 temps ordered for January, rumors of some major insurance companies moving into the state abound, everyone ramping up for millions of new customers - it was always going to be so. He/she knows that the only people who make it in the insurance business are those who simply don't give a shit about the insured, but he/she is 49 years old - how to stop caring now. Maybe the next insurance company that moves to town will have a sit and scan documents department.

signed Anguished

Submitted by lambert on

In some ways, this sounds like cube-dwelling in any other large corporation.

Incidentally, am I right in thinking there'd be a lot of medical coding opportunities with single payer as the systems got integrated?

gormenghast's picture
Submitted by gormenghast on

In days of old, (pre-2000 really) the insurance agent who sold the policy was hands on, whether it was an individual policy or group, the agent guided claims through the system. Around the year 2000 the major insurance companies decided that an agent's time would be better spent selling "financial products" and that claims would now be handled by call centers. Initially the call centers were run like huge cheerful agent's offices with emphasis on empathy for the insured, customer satisfaction and "doing the right thing". The call center consulting business grew by leaps and bounds, their main thrust being that they could teach businesses how to maximize productivity and profits by battery hen methods, decreased call work time, timed bathroom breaks, staggered break times to prevent employees from becoming a "group" etc. The insurance companies quickly discovered that if they made a proposal to move into a southern state with a large unskilled workforce, said southern state government would pay for the building, the equipment, the training , the consultations and give a tax break to boot. So yes it is like cubicle living in any other corporation, if that corporation suffers as many employee breakdowns and has supervisors with stop watches outside the bathroom.

Single Payer would open up enormous, higher paid opportunities in the area of medical coding. Standardized claim forms, standardized billing would lower administration costs and therefore premiums, more insured means more jobs - government jobs! Single Payer is obvious, simple, cheaper, ethical, moral and right - we all know it - they all know it!

Submitted by lambert on

... when are you going to start posting some of this terrific stuff, instead of burying it in comments?

gormenghast's picture
Submitted by gormenghast on

I tried it in some small measure, during the massive, although mostly under reported, Medicare Part D Prescription Drug War - it was bloody, I got the sack and Wellpoint is still standing. The only way Single Payer is ever going to be achieved is for Americans to pretend they are French for a day and take to the streets. In France the government is afraid of the people (as it should be) in the US it's completely the other way around.