Thus Spake Zuska

As I recently reported, my mother’s wallet was stolen last week, containing her bank card, driver’s license, and insurance and Medicare cards. This has resulted in hours and hours of work for me to deal with replacing the cards, working with the bank to contest the fraudulent charges on her account, etc.

I’m going to tell you something the health insurance company probably won’t, because I’m not sure that the people who answer the phones even understand that their system works like this.

When you call to report your lost or stolen insurance card, the insurance company will naturally want to issue a new one for you, with a new number on it. This is a good thing, as you don’t want someone who might have stolen your card or who might find it to be able to use it and generate fraudulent health care claims that you will have to spend hours dealing with on top of all the other nightmare of paperwork you are already handling. You want that old number canceled, and you want a new card with new number issued.

Sadly, however, you will have to wait for that new card with new number. And wait. It could take up to three weeks for you to get it. I don’t know why, in this modern age of computers and all manner of fancy technological achievements the youngsters have these days, it should take three weeks to (1) cancel old card and number, (2) assign new number to account, (3) produce new card, and (4) mail new card to account holder, but it does. Just remember, this is the best health care system in the world at your service.

In the interim, it would be to your advantage not to need any sort of health care or prescription medication service whatsoever. Should you be so unfortunate as to actually need to use your health insurance during this period, here is what the health insurance company will advise you to do:

Explain to the health care provider that your card was stolen, that the old number is no longer valid, that a new card is being issued with new number, and that as soon as you have the new number you will inform them of the new number and they can bill using the new number.

In practice, here is what you should do:

Explain to the health care provider that your card was stolen, that the old number is no longer valid, that a new card is being issued with a new number, and that as soon as you have the new number you will inform them of the new number and they can bill using the new number. IN THE MEANTIME, they can verify that you still have insurance coverage, BUT NOT BY USING THE AUTOMATED SYSTEM when calling the health insurance company. Not even if they try to look you up using your social security number and birthdate. The automated system will just inform them that “you do not exist within the system”. Instead, they must persist and insist upon speaking with an actual, live human being who, unlike the automated system, can use your social security number and birthdate to look you up in the system and verify that you do, in fact, have health insurance coverage, even if you do not currently have a valid insurance number.

Why the human being can use the exact same information to locate you in the system that the automated system cannot process to locate you in the system, I cannot explain to you. I am a Goddess of Science and Empress of Engineering and Avenging Angel of Angry Women. These, however, are not sufficient credentials to parse the mysterious ways of American health insurance companies.

I tried to impress upon the person I spoke with at my mother’s insurance company that this bit of information is something that would be useful for them to share with their customers who call to report lost or stolen cards. She responded that she was sorry I was not told that my mother’s card would be deactivated. No no no…I WAS told that. I was NOT told that when providers tried to look her up using social security number and birthdate, they would be told she does not exist in the system. That she would appear to have no health insurance coverage at all. I believe the reason I was not told this is because the people who handle phone calls from “members” do not understand that the system works this way. They seemed surprised to find out – from me – that this was the case. I begged them to report this to a supervisor and have the information disseminated so that it could be provided to future members who called in with lost or stolen cards but I am not hopeful.

I have been working since June 26th to arrange an appointment, scheduled for next Tuesday, for my mother to receive a pain shot for her severe back pain due to spinal stenosis. Getting this scheduled required coordination with two doctor’s offices, a clinic, the assisted living home, a nursing unit, and a pharmacy, because of my mother’s complicated medical conditions. The entire thing nearly fell apart today because the pharmacy was not able to dispense a medication my mother absolutely must have administered to her this Sunday and Monday prior to the appointment, because they could not verify her health insurance coverage.

Fortunately for my mother, she has me on call 24/7 to manage her health care and clear up crises like this. I have learned how to wade through the system and deal with stuff like this. What about the average soul who doesn’t have someone to do this for them? Who has to be at a job during the business hours when one must be on the phone chasing down answers to problems like this? (And it can take hours and hours.) What about elderly people like my mother, who would just be overwhelmed and confused and not even know where to start? There has to be a better way.

Comments

  1. #1 MikeMa
    August 14, 2009

    I work and have worked nearly all my professional life with databases that provide this information and I have no idea why the data look-up fails for providers.

    I have a couple of guesses though.
    1.) Providers have a ‘provider’ flag that incorrectly disallows ssn look-up whereas employees have an ‘employee’ flag does allow it.
    2.) There is a special format for entering one of the pieces of data and the providers do it wrong while the employees do it right.
    3.) The bastard insurance companies add a reject service in as many places as possible. This is just one more.

    Glad you can take time for your mom.

  2. #2 Peggy
    August 14, 2009

    Your mom is fortunate to have you helping her sort this out. Dealing with insurance is confusing and frustrating even when you are healthy and have plenty of time to wrangle with the service reps.

    When my dad was in the hospital at the beginning of the year his insurance company – which had just gone through a corporate merger – changed his insurance number twice within two months without any sort of warning. Fortunately my mom received those notices and could change the number with his doctor and the pharmacy and the hospital. I don’t know would have happened if there hadn’t been someone to take care of that for him.

  3. #3 Dr. Chandler George
    August 14, 2009

    The easiest thing to do when you’re waiting for a new card is recommend your doctor’s office speak with your insurance company ahead of time. That way they have time to wait for a professional (i.e. HUMAN) to come to the phone, because they’re calling on their own time. And by the time you go in for your appt. you’ll already have your insurance on record. Just bring the card in as soon as you get it.

  4. #4 Tony P
    August 15, 2009

    I bet it’s because they disable the card/account on the automated systems side but not on the internal database.

    The automated system is probably just a daily/weekly/monthly snapshot of the main database.

  5. #5 Historiann
    August 15, 2009

    Zuska, thanks for writing this post. In addition to being yet more helpful documentation of how “the best medical care in the world” is predicated on the notion of DENYING health care to people because it’s more profitable for corporations (and that’s what happens in most cases of stolen cards, I’m sure–no card = no claims from you!), you also show how this “best system” depends heavily on the volunteer labor of family members, usually women family members, to ensure that their elderly relatives and household dependents get what they need. Yet more profit for hospitals and insurance companies if they can extract free labor from us! Awesome.

    I hope your mother’s pain shot goes well and does the trick for her. I also hope your long personal bureaucratic nightmare is over soon.

  6. #6 insurance
    August 16, 2009

    An insurance premium is the money charged by insurance companies for coverage. Insurance premiums for services differ from company to company, so it is advisable that individuals shop around for insurance premiums.

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