"It sucks & I am so sorry" - Insurance Company Employee Apologizes For Doing His/Her Horrible Job

[kpete]

Insurance Company Employee Apologizes For Doing His or Her Horrible Job
By Susie Madrak Friday Sep 25, 2009 7:00am

I found this in the comments over at Corrente and wanted to share it:
http://www.correntewire.com/our_uniquely_american_health_system_revisited#comment-152259

"

Insurance companies reserve the right to make changes to their formularies at any time, but are supposed to notify you and allow you one month's supply of your current drug in order to give your medical provider the opportunity to "pre-authorize" your access to said drug. Your doctor cannot simply write a letter saying "I'm the doctor by god, and I want the patient to have this drug". No, he must provide evidence that he has "stepped" you. Stepped means that he/she has tried you on "approved" A, B and C drugs to little or bad results first.

Now, A and C may no longer be on the formulary, so they don't count, so he/she has to find out what approved drugs are on the formulary so that he/she can say that they have been tried and if that is true, or he/she will say it is true, then it will go to the Pre-Authorization department.

If the PA department can't sort it, say because your diagnosis does not fit neatly into what the insurance company says the drug can be used for, albeit that it works for what ails you, the application goes to the in-house pharmacist. The in-house pharmacist (average salary $90,000 per annum) will make the final decision based on following company guidelines and keeping his/her job. If the decision is that you get the drug, then said drug will be approved for you as "off formulary", moved to class 3 and if your co-pay was $25.00, it will now be $60.00 or more.

If the drug is not approved, then you will be properly stepped with the ineffective, approved drugs before your pre-authorization can be reconsidered. After you have been stepped, the drug will still be off formulary and the co-pay will still be increased. It sucks and I am so sorry.

Signed Anguished in the PA Department - United Health Insurance Inc

"

http://crooksandliars.com/susie-madrak/insurance-company-employee-apologizes

[LynzM]

1. Why do we all continue to play by their rules?!

Gah, it makes me SO ANGRY! What if everyone working for the insurance companies could just quit, refuse to go to work, and if doctors offices refused to interact with them, and just billed patients on a sliding scale somehow. You know, good old days or whatever. Wishful dreamy thinking.... /sigh :banghead:

[RadiationTherapy]

2. Just llike Muley Graves in Grapes of Wrath

Who do we shoot?

It is a clever form of protectionism for criminals, beauracracy is.

[Echo In Light]

5. "Government is the shadow cast by business over society." - John Dewey.

[Donald Ian Rankin]

6. Because you don't have an alternative.

The problem is not that the health insurance companies provide a deeply-flawed form of health-care, it's that the state doesn't provide any kind of health care at all.

The health-insurance companies first duty is to their share-holders - it's not their responsibility to ensure that people have health care.

The state's first duty is to its citizens - it is its responsibility to ensure that people have health care. In most Western countries it performs that duty; in the USA it doesn't.

Health-care companies screwing over their customers wouldn't bother me (much) if there was a decent alternative. As it is, they have a captive market.

The solution is to introduce state-funded health-care.

[Barack_America]

3. The worst job I ever had was at a well-known Cancer Institute.

I thought it would be great and, even as support staff, I'd be involved in providing compassionate care for cancer patients.

Nope.

I was tasked with harassing people with upcoming appointments for their insurance information. Did they have their referrals? Could they prove to me that they were covered?

Want to feel like shit? Make a person with cancer cry over concern about money.

That job was a rude awakening to my 19 year-old self. I still carry those lessons with me.

[enlightenment]

4. The first 'office' job I ever had; I was 18 -

was working for a group of anesthesiologists. There were about 20 of them in a PC; my office handled billing.

My job was to make harassing phone calls to people whose insurance hadn't coughed up the full payment. I lasted about a month, increasingly horrified both by seeing the inside of insurance billing (the percentage they would pay for a given procedure) and the soul-sucking agony of making someone who was probably still recovering from surgery feel even worse.

I finally walked out after refusing to make a second dunning phone call to an 85 year old widow with no family around her, who was recovering from a laparotomy.

It's been over 30 years and I still cringe when I think about that job.

[Demeter]

7. My Mother Worked for Aetna Many Years in Claims

the horror stories she would bring home...and this was 25 years ago, before it really got weird.