A Glimpse Into the Bureaucratic Hell of Denying Health Insurance Claims

["Dave Farber" <farber () gmail com>]

Begin forwarded message:

> From: Dewayne Hendricks <dewayne () warpspeed com>
> Date: March 8, 2018 at 12:48:40 PM EST
> To: Multiple recipients of Dewayne-Net <dewayne-net () warpspeed com>
> Subject: [Dewayne-Net] A Glimpse Into the Bureaucratic Hell of Denying Health Insurance Claims
> Reply-To: dewayne-net () warpspeed com
>
> A Glimpse Into the Bureaucratic Hell of Denying Health Insurance Claims
> By Molly Osberg
> Mar 7 2018
> <https://splinternews.com/a-glimpse-into-the-bureaucratic-hell-of-denying-health-1823560356>
>
> Over the last few months, the Trump administration has begun to dismantle the Affordable Care Act, offering 
> short-term private insurance as an alternative. We thought we’d check in with some people who worked in the industry 
> before rules around pre-existing conditions and mental health parity were enacted: people whose jobs involved daily 
> management of strangers’ treatment, from an air-conditioned board room or an office building or a call center.
>
> Interviews have been edited and condensed for clarity. 
>
> Jeremy Beckham, 33, insurance sales, Wisconsin
>
> I was in sales between the ages of 19 and 21. I’d worked in other sales call centers, but the way the call center 
> industry was, insurance sales was a higher-paying job.
>
> When I was first hired—this is one of the top five insurance companies in the country—I had to go through a trainer 
> and licenser program. I was licensed to sell health and life insurance telephonically in 26 states. I want to stress 
> that even though I worked for this one company for two years, everything that happened there was very typical of the 
> industry. I’m not trying to tar and feather anybody specifically. There’s barely one bit of difference between any of 
> these companies. 
>
> So people would call and say, “I’m trying to get health insurance for me or my family or my kid,” and I’d try to sell 
> them health, life, and dental, all individual plans. Part of that process is that you screen people for pre-existing 
> conditions. There were three different stages of screening. The first thing, right at the beginning of the call, I’d 
> ask a couple questions sort of off-the-cuff. Frankly, if I knew they were going to be declined, I was wasting my time 
> talking to them.
>
> So I’d ask, casually, whether they had a history of heart disease, diabetes, cancer, heart attacks. Kind of develop a 
> rapport. That caught a pretty good chunk, diabetes especially. And I asked all that before I even made the sales 
> pitch, so the phone call would be, like, two minutes long. If they got declined I’d tell them what other options they 
> had, based on what state they were in. I had a computer terminal that told me what each state offered. Florida was 
> pretty good. Some states had literally nothing, and that was pretty hard. All I could say is, call other companies, 
> knowing they would decline them. Maybe I’d tell them to find employment somewhere with group health insurance.
>
> But if they made it through those kind of off-the-cuff questions, we’d go to the application process. On the very 
> first screen on my computer console, it listed something like 20 of the most common conditions that would cause 
> someone to be declined. If they had any of those there was no point in going further. They were things like chronic 
> obesity, pulmonary disease, chronic inflammation, ulcerative colitis. If at any point in your life you’d had a heart 
> attack or a stroke, declined. Most forms of cancer, but not all. Pregnancy. 
>
> It was so routine to inspire deep anxiety in people.
> For many people, this was not the first insurance place they called. They had already been declined. On our 
> applications, there was a question that was like, “Have you ever been declined from another company?” But there’s so 
> much uniformity; you either qualified with one of us or none at all. Pregnancy was an issue, too, though if you were 
> single and pregnant you weren’t always up shit’s creek. Many of the states allowed you to get on Medicaid, which was 
> almost always a better plan than what I was selling, anyway.
>
> So after that list of 20 questions, we’d really get to the meat. It was like, a 45-minute phone call, maybe. 
> Question: Have you or anyone on this policy ever had asthma? A history of osteoporosis? It was close to 100 
> questions. And after we completed it, I’d go to the underwriting department. They’d look at the application, and 
> obtain people’s medical records from the Medical Information Bureau, and they had the final say. Sometimes they’d 
> approve them cleanly, sometimes they’d flat-out deny. Or they’d approve you with a premium rate adjustment, like, 
> we’re going to approve you but your BMI is too high and you’re obese so we’re going to give you a 25% premium rate 
> increase.
>
> Some things, like asthma, we’d approve you, but with a rider. If you need an inhaler, or an emergency visit for an 
> asthma attack, we’d give you a policy that covers everything except that. People would be like, that’s the whole 
> reason I wanted to plan! Sometimes the underwriter would uncover that the person lied to me, and I don’t really but 
> every time you file a claim, all those insurance companies are sharing the information with each other. So that would 
> be an awkward conversation I’d have to have.
>
> There were horrible moments, fairly frequently. I got through it because you rationalize it in various ways. You 
> know, I just work here at the call center, I don’t make the rules. But there was a lot of moral discomfort. I 
> remember many times having to console people.
>
> This is one of the strangest circumstances, but I encountered it a lot: Sometimes when a mother and father split up, 
> it was common for the mother to get sole custody, and the father to be required by law to get insurance for the kid 
> as part of his child support. If he violates that, he can go to jail, be held in contempt. But we screened children 
> just as we screened adults.
>
> I would get calls from these fathers, but the kid would have a condition: autism, obesity, diabetes. And we’d have to 
> tell the father, “We can’t insure your son.” He’d be like, I’m going to jail. I’d maybe send an email or something, 
> but even judges in our legal system did not understand you couldn’t just go out and get health insurance. I’d be 
> like, “No one is going to insure this autistic son.”
>
> I’d be like, “No one is going to insure this autistic son.”
> One call I remember, we went all the way to the underwriter, and she got declined. It was a whole family: a wife and 
> husband, and a couple of kids. I was dealing with the mother and one of the questions was about infertility 
> treatment. Our plan by default did not cover infertility treatment. She said yes, I did have infertility treatment, 
> but I don’t want it anymore. I’m done, I don’t want any more kids. She was still declined, and I called the 
> underwriter. Here was the explanation: By law if you insure a woman and that women has a child, you are insuring the 
> baby from the moment of birth. And women who have infertility treatments, research shows they have a higher risk of 
> complications in pregnancies, babies with lower birth rates. So it’s riskier, but the idea was that since we don’t 
> want to insure this baby that she’s never going to have, we’re not going to insure her.
>
> [snip]
>
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