High Friction Health Care and Trust

 

What the heck is going on? I got a taste of what my wife deals with on a regular basis with our health insurance company this week. I had a plumber that did something similar with, "I can't finish this job until I get your pressure regulator to code for another two hundred dollars." Of course, this doesn't slip out until your main shutoff has been cut out of the system. If you're a supply-sider, this is simply a provider of a service maximizing their outcomes. You Atlas Shrugged-types probably appreciate the plumber's quick thinking. I, on the other hand, call these shenanigans and it's typically a) the last time that person gets my business, b) I make sure everyone that asks me for a reference knows who not to call, and c) tightens up my contract reading skills and cynicism for the next person I have to deal with. Of course, you can sum this up as adulthood, right?

Back to health care. A couple of things have come up recently that make me wish I could just deal in cash directly with the Doctor. 

Exhibit A: My wife needed to get a COVID test due to possible exposure from someone who ended up positive. She sets up the appointment, confirms that it's covered by insurance, gets the test, and lo and behold, a bill in the mail for the portion 'not covered'. Excuse me? She multitasks for hours during the workday, bounced from person to person, and eventually, they back out the billed portion and issue a refund. She asked point blank why they billed her when it was clear that it was covered, and the non-answer was something around a clerical error. If it was me (and probably easily 1/3 of America), I would have just paid the stupid thing because I trust 'the system'. If I was a waiter or a stock clerk at Costco, I would have pissed away my break on hold, only to hang up so I can get back to work.

Exhibit B: Knowing what we just went through with my wife, I submit a claim and because of my work with construction and contracts, I include everything I can think of as an exhibit, cross reference all of it in the cover letter, and provide a direct contact number in the event there are any gaps. I don't shotgun the info; I take their claim process and guide the reviewer line-by-line through their claim requirements. In spite of this, I get a letter (by the way, why do these things need to be done by snail mail and not online? Oh yeah, friction) saying my claim requires more information and if they don't hear from me in fifteen days, case closed. I call them up, spend about 20 minutes on hold (I'm working from home and have the luxury of sitting on hold, so no problem), get bounced to another person, five more minutes on hold, and we start reading through their scan of my mailed-in paperwork and compare it to the 'missing information'. Dates of service? Check. Diagnosis code? Check. Physicians signature? Check. One escalation case number and a 'We'll have this resolved in three business days' later, and we're getting somewhere. Or I just got to the next level of health-care Jumanji.

For most of us in the world, our businesses would fail if we treated our customers like this. People talk about 'Murica having this great health care system, but the business model doesn't serve the consumers, the doctors, and heck- they don't even seem to be very happy themselves! My hypothesis on why we're in this loop is the same reason Obamacare couldn't reach its potential. Too much middleware between the providers and the patients and too much financial incentive to keep it this way. If Joe the Plumber screws me, he only does it once. My State Farm agent not acting in my best interest? I get mailers every week from Geico, USAA, Hagerty, etc. (she's fantastic, by the way- she has our loyalty and I feel like we understand each other very well after 15 years and the 'check quote' from competitors every few years). If my neighborhood Thai restaurant repeatedly adds 3 sodas to my bill at 3 bucks apiece and hopes I don't notice, I quickly find a new restaurant. 

Obamacare, love it or hate it, could have had the potential to a) free people from working shitty jobs just for the healthcare, b) could have introduced market-based choices that would force insurance providers to act in someone's interest other than their own, and c) provided the subsidies necessary to stop poor people from using the ER as their primary care physician, cranking up the rates that everyone else pays. Feel free to wag your finger at me about socialism, death panels, and my oversimplification, but you can stuff it. Our health care system is wasteful, expensive, rife with errors, and full of people that don't advocate for you. Could it be worse? Of course. Could it be better? Absolutely. I'm not even close to medicare age but I can already tell that management of my personal health care is going to be at least a part-time job in about 12-15 years.

I'm just one guy with one opinion, but when trust is a commodity in short supply, we all need to do the following to avoid shenanigans from your friendly service providers, whoever they may be. I used to expect this type of thing on my trips to Mexico or the Middle East, but I feel like we're only batting .500 in these great United States for trusting people in the current business environment:

• For healthcare, call your provider first, ALWAYS. Timestamp the call and get the name of the person you talked with. Unless you're bleeding out or are in an absolute emergency situation, that simple phone call could save you thousands.
  
• Read the contract. Really loud, for the people in the back: READ THE CONTRACT. Whether you're renting a car, buying a house, or signing up for a cell phone, if you don't read and understand that baby, you're going to cry when the other party rolls it up and whaps you in the head with it. You don't need your attorney to review every piece of paper you sign, but (especially if you're not great with finances), you need to read that stuff. Contracts never mean a thing until someone thinks they're aggrieved. If you didn't read it, chances are your case may simply be a specific exception in the contract that you signed, and are thus bound and look stupid for not reading the contract. I certainly made my share of terrible, 'forgot to read the fine print' mistakes between 17 and 23 or so. Hell, the first contract I signed in my life sent me into the Navy! Just kidding- I read every damned word of that thing (and my parents' divorce decree, which happened to be an exhibit since I was under 18- interesting reading, to say the least).
  
• Make sure your scope of work with a contractor is provided in writing. Handshakes don't mean much in many parts of the country, and if you're trusting a stranger on a handshake, odds are his hands are all over your wallet. HUGE caveat- I'm talking about Northern Virginia and my entire career's worth of experience here. Example 1: Japan is one of the most honest countries I've ever lived in- you can be drunk and throwing money all over the room and they'll neatly unwad it, put it in an envelope, put the envelope in your pocket, and get you a safe cab ride home. Example 2: I have a client in Indiana and I nearly weep with joy with every contractor I've worked with. Thin contracts, kind of squishy scope, and yet they do the right thing every time. Exceptions abound (just not in healthcare, cable TV, mobile services, car sales, credit cards, etc.).
• Keep a close eye on your own finances and make sure you ask uncomfortable questions when anyone calls you up eager to churn your account when you're meeting your goals and everything seems to be on track. They never seem to call during down markets, do they?

I drifted off-course, but the bottom line: Not bothering to read the fine print or ask (even if only to yourself), "How are you screwing me?" to nearly every business interaction in your life is one of the most costly mistakes you can make. Not fighting for what's yours just emboldens people to make the next shakedown a little more egregious and it becomes that much harder for us as a society to recover, especially the poorest among us. It might not be you (today), but eventually it'll find you. Remember the Nasdaq meltdown? The 2008 housing crisis? Remember those tax dollar-fueled bailouts? That was us- it always comes back to us.