Monty Python and the Health Insurance Business in California
9 November 2007 at 12:50 pm dhoopes 2 comments
| David Hoopes |
My wife was talking to our dental insurance company the other day and John Cleese, Michael Paline, Eric Idle et al. came to mind.
Wife (Chris): I don’t understand why you haven’t paid us for this.”
Dental non-insurer: “You went over your limit.”
C: “It was our first visit.”
DN: “Sorry.”
“You don’t pay for teeth cleaning?”
“Oh yes. We do.”
“But you are not going to pay for this visit for teeth cleaning?”
“No, I’m sorry but you can only do it so many times per year.”
“That was the first time.”
“Sorry.”
“Can you tell me why you haven’t paid the January visit?”
“I don’t think we’ve received the claim.”
“I’ve sent you that claim five times”
“Oh, that’s right. Sorry. We need to see the x-rays.”
“The dentist sent you the x-rays 10 months ago.”
“Well, we don’t have them anymore.”
“Where are they?”
“We sent them back.”
“Where did you send them? I didn’t get them.”
“We sent them to who[m]ever sent them to us.”
“Who was that?”
“Whoever we sent them to.”
“So, you had the x-rays but now you don’t.”
“Correct.”
“And you don’t know where they are.”
“They’re with whoever we sent them to.”
“The dentist didn’t receive them.”
“I guess he didn’t send them.”
Pause
“What about the follow-up visit after the x-rays.”
“We need a more detailed explanation.”
“How so?”
“We need to know why the dentist built the tooth up before putting on a crown.”
“What’s the crown going to fit on if the tooth isn’t built up?”
“Ma’am, that’s hardly my problem.”
“Is there someone else I can talk to?”
“Certainly.”
Dial Tone.
Next week: our regular health insurance company. Preview:
“I’m sorry but you didn’t put his license number on your form.”
“The doctor is part of your company’s network.”
“No he isn’t.”
“Yes, he is.”
“No he isn’t.”
“It’s on your web site.”
“Not it’s not.”
Stay tuned!
Entry filed under: Ephemera, Former Guest Bloggers.
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Organizations and Markets 
1.
stevphel | 9 November 2007 at 7:40 pm
They seem to be doing an excellent job of risk management (i.e. minimizing any cash outflows) LOL!
2.
Eric H | 10 November 2007 at 8:34 pm
Hehehe, I had the same experience last week.
“Why haven’t you paid this?”
“The hospital didn’t have an authorization.”
“But you just read me the authorization number.”
“Yes, that was an authorization for Medicaid.”
“But we don’t have Medicaid, we have you.”
“Exactly.”
“Uh…? But our PCP admitted him.”
“The hospital is different. Do you want their number?”
(Now talking to the hospital)
“Why didn’t you request authorization?”
“We didn’t have your information.”
“We tried to give it to you on admission …”
“Oh, we can’t take it then.”
“… and then we tried to contact someone after admission. The nurse said …”
“Nurses don’t take that information”
“… she could give a message to the proper person, but nobody contacted us.”
“So you didn’t give us the information.”
“Actually, we eventually did. My wife let the caseworker copy her card …”
“Really? What was the caseworker’s name?”
“Can’t you look it up in the file?”
“No.”
“Well, I don’t have the name. Let me get my wife to call you with it.”
Later, with my wife.
“Did you give her the name?”
“No, but she said there is only one caseworker in that department.”
“So, the same person who asked me for the name knew that there is only one caseworker? WTF?”