It takes a village to get an insurance company to use some common sense

If you needed another example of why our private health insurance system is broken, you needed to look no further yesterday than Isaiah Breen’s tweet thread about a guy who fell into the bureaucratic black hole of the insurance industry and tried to get some common sense to prevail.

It was pretty obvious what was going to happen. The social media pressure on the insurance company would mount and surely common sense would prevail.

In today’s update, yes, common sense prevailed. But what about the people who don’t have the power to marshall the forces of common sense?

  • Jim in RF

    I know I’m not breaking new ground here but the health insurance industry (and its kissing cousin pharma) might be the worst offender at improving the human condition in modern history. Worse than the railroads and grain traders of the early 1900s. Worse than the coal barons in the 30s and 40s. The worst of them all — what would top it? What’s unbelievable is how many people and pols just blindly support it because its a business and the invisible hand of capitalism must never be questioned. And because they’ve been bought off.

    • And, like pharma, HUGE donors to the people who could change the situation any time they wanted.

    • Mike

      And, I would argue that it’s only capitalism in the cartel, or trust, sense of the word. They’ve rigged the system so that it’s extremely difficult to access any health care without “insurance,” which is something you pay for even when it doesn’t really do you any good (like routine exams and procedures). “Protection” payments to the mob are a valid analogy.

  • kevins

    God help us. Our priorities as a nation leave much to be desired. I am glad he could advocate for himself and was assertive enough to get the state involved.

  • Erik Petersen

    He got 20 days grace on his Jan payment and his $379 premium pays for $1400 worth of services…. Its not obvious that’s what’s broken.

    He obviously got fairly illiterate and inelegant treatment from telephone customer service. I’m not surprised there, professionally speaking those are $30/hr jobs that the companies have always tried to get by paying like $15/hr.

    • kat

      Although I agree that customer service people should be better paid and trained, that is not the issue here. The issue is the industry norm in health insurance and health care payments that if something is missed, the patient must pay some sort of arbitrary consequence. Often a huge consequence.

      • Erik Petersen

        Right. I agree with that sensibility. I don’t know what you properly allow for deviations for actuarial discipline re payments there if you get my drift…. If policies lapse you have to kick them out of the coverage pool at some point

        • In life insurance you have a 30 day grace period AFTER due date before a policy lapses. And even then, you can restore coverage, as long as there’s been no change in insurabiity, with a payment.

          • Erik Petersen

            I am surprised there appears to be merely 20 days grace on Breen’s example here. I had an exchange policy, and it might have been with HealthPartners. I think I experienced more flexibility re payments.

          • Jack

            I am so glad about that grace period since I missed that bill and literally found and paid the bill on day 30.

            I need to be a better housekeeper….

    • lusophone

      It was most definitely not within the power of the person on the phone to reinstate the policy or not. They are given a script and procedures and have to follow them. Common sense also wasn’t what fixed this problem. It was the higher ups not wanting the bad publicity.

      • Erik Petersen

        Oh absolutely… ya know, the capriciousness of cowing to Breen, who is connected in politics, because of his social media, is at least as damning as the premium snafus / lack of notifications. You read Breen’s feed there and he is self-conscious of that.

        CSR obviously went off script and free styled though. That explanation for their change in grace policy could not have come from a script… much too inelegant and precise actually, its like a Kinsley gaffe.

    • // his $379 premium pays for $1400 worth of services.

      That’s not how insurance works and it’s not what the premium pays for. The pool pays for the $1,400 worth of insurance.

      • Erik Petersen

        Premium goes into the pool, pool pays the claims

        • That’s right. That’s how it works. Your premium and a single claim is irrelevant.

          What paid for the $1400 claim is the $1400 the insurance company collected to pay the $1400 claim.

          • BJ

            And Health Insurance is exactly that, unlike life or auto, because it’s not actually insurance. It’s managed care. For a fee they will pay the bills for a group of people, and the group fees cover everyone’s health care expenses.

          • jon

            They also negotiate price breaks…

            Not uncommon that out of $1400 the “pool” only pays ~$400.

            It’s all there on the “this is not a bill” statement the insurance companies send you…
            This of course means that either the provider can still turn a profit charging $400 for $1400 in service, or they are gouging the people with out insurance to make up the difference…

          • BJ

            >gouging people without insurance

            Yeah, I doubt that. People without insurance probably just don’t pay at all (at those rates).

          • jon

            Yeah, if they don’t pay then it gets sold off to collections agencies.

            The $1400 owed to the healthcare provider will be sold by the health care provider for ~$56 (4% of original value on average), and depending on the exact terms the healthcare provider might get some percentage of whatever they manage to collect.
            The collections agency turns a profit at collecting ~$150 and the hospital will see the same amount back as they would for an insured patient at ~$800 collected… (very rough calculations in my head) of course this is a market where those who pay are covering the collections cost of those who don’t. Basically the collections agency will try to get as much as they can.

            https://www.youtube.com/watch?v=hxUAntt1z2c

  • It is usually best to treat these high-priority bills a bit differently, so I suggest automatic deductions from a bank account, credit card, or whatever payment system is appropriate. Healthpartners, like the rest of them, will allow you to manage your accounts online and will email you when statements are ready for viewing as well as when the automatic payment transaction is completed. Since the payment is the same every month, it is easy to set up and budget.

    • kat

      But it is the health industry norm to penalize people for simple errors, like the bank delaying a payment. Sometimes the payment due amount will be changed without notification- then they will cancel a plan or send to collections. No other industry that I know is so quick to screw over the customer.

      • Well, knock on wood – no problems here with it – yet!

    • Sara Leiste

      Automatic deductions aren’t always as automatic as they are supposed to be. Bill pay has randomly not paid things that I scheduled, and then told me that I did it.

    • jon

      I got a “collections” call from Comcast when I was on auto pay…
      After they tried to guilt me for a while I finally got them to tell me what I owed… $0.

      They sent to to their internal collections department for $0… turns out they took the auto pay out a day late, and that triggered their systems to have me get a call, and by the time that happened the auto pay had already come out…

  • Brian Simon

    Wait, I was told we have the best health care system in the world. What happened?

    • BJ

      best health care system in the world != worst health care payment system in the world

    • jon

      You were lied to… and if you believed it they probably kept lieing to you…

  • boB from WA

    This came to mind when I read this:
    https://www.youtube.com/watch?v=H54BxzFoI44

  • Jeff

    Single payer anyone? I suppose that would be like automatic payments. At least then the government could impose standards on the industry.

  • MrE85

    Speaking as someone with personal insight (cough) on this kind of issue, I can tell you it followed a well-known pattern, Organization denies payment/service to a client. Client takes case to media/social media. PR pros advise “pay up.” Firm holds firm. More bad press, Firm changes mind, pays up/provides service. PR pros try to clean up mess.

    Lather, rinse, and repeat.

  • Jay T. Berken

    A number of years ago I rented a car with my family in Arizona. About 30 miles into the trip, the tire light goes on, so we take the first exit and pump the tire up. The light did not go off and after reading the instructions, it was very confusing to how to get rid of the light. We went to the next rental dealer to get a different car which they said that didn’t have that car, but we could bring it in to fix the tire. Found out that a tire had a little hole to patch, but another tire had its cord showing. I got the tires changed with no charge and when I got home, I called for a refund. They said they’ll take $50 off. I said pound sand because I had my family in a car that was not safe, so I filed a report. A month past to five months while calling in between with no word on resolution. So I put the case number with the company attached on Twitter and Facebook saying how ridiculous that it has been five months and got a response within the day.

  • AmiSchwab

    when my german friends ask why do i stay in germany? america is(was) so great. i just mention stories like these.
    here is a real national emergency.

    • jon

      Give it two years and it might be labeled and funded as such.

  • Sonny T

    When the two choices are 1. Keep the old insurance (DFL) or 2. Replace with new insurance (GOP) I wonder what we’ll end up with?

    • JamieHX

      I don’t know where you get the idea that Democrats want to “keep the old insurance.” Democrats have mostly preferred single-payer or something like that for decades. They devised and passed the ACA because they thought it was a step in the right direction that they might get some Republicans to support.

      • Sonny T

        Sorry, but it was a step in the wrong direction. The ACA cements into place private insurance.

        We can be assured both parties will oppose single payer. Some brave voices are being heard, mostly within the DFL. Let’s support them and not the party, however. Let’s not get fooled again.

        • All of the idea for universal and single payer health care have been proposed and introduced before. Republicans (they were Republicans then; they wouldn’t be now) and Democrats actually came up with good ideas together. They also had popular support. But because two southern Democrats (who would be Republicans today) didn’t like them, they suffocated and died. They were the two chairmen of committees in the House and Senate.

          Nobody fooled anybody. The ACA is what it is because one party favored the status quo; it’s the best that could be accomplished.

          Anyone who pretends to have been fooled is either (a) lying or (b) wasn’t paying attention when they should have been on the phone.

          The health care lobbies who provide the money to portray supporters of health care for people as unAmerican are too great and can’t be defeated. You thank the justices who gave us the Citizens United ruling for sending the United States down a path from which it will never return.

          • Sonny T

            The flaks successfully sold the canard that the insurance companies opposed Obamacare. They practically wrote it:

            https://www.huffingtonpost.com/david-belk/the-obomacare-paradox-the_b_8735042.html

            If that’s not gettin fooled I don’t know what is.

          • It’s a bad idea to pay attention to flaks and anyone who does is responsible for getting suckered. That’s the job of flaks.

            If you’d paid attention to the legislation and the months of debate in the Baucus committee, you’d have known what was going on.

          • Sonny T

            If you already knew the insurance industry was behind the ACA you are in the tiny minority.

            My point remains valid. In 2020 we will again be offered the same false choice: Insurance or insurance. Baucus or no, I think I can tell what’s going on.

          • Well 2/3’s of Americans can’t name all three branches of government so I’m not particularly distressed that I’m one of the few who actually pays attention to what government is doing.

            I see nothing to indicate that the fools who get their information from political ads and echo chambers won’t do so again in the future.

            They deserve what they get.

            BTW, an ACA that kept insurance companies in power is still better than the status quo the Republicans wanted and spent four fruitless years trying to accomplish.

            If you lived in 2009 and you didn’t hear “public option” every night on the news, and wonder “hey, I wonder what that is”, well, there’s no hope for you in 2019 either.

            https://prescriptions.blogs.nytimes.com/2009/12/16/liberal-group-sees-disaster-in-senate-plan/

          • Here’s a story from way back when politicians were talking about a public option.

            It didn’t happen in secret. It was right there. On the news.

            https://www.mprnews.org/story/2009/10/27/health-reform-minnesota

            The public option was eventually dropped.

            Guess what party didn’t want it?