When Health Insurers Practice Medicine

2019 was not the best year for me

In the middle of the year, I had to change employers, which meant new health insurance. I have a family member who has some health issues which require expensive medications, so we normally meet our deductible a few months in, finish up our copay a few months after that, and pay nothing at all during the last few  months of the year.

However, in 2019, getting new insurance meant that my deductible reset to zero in the middle of the year, and I had to start paying full price all over again, which cost me thousands of dollars in unanticipated costs. As if that was not bad enough, the new health insurance was not only about twice as costly as the old one.

This new insurer was truly horrible. To save money, they kept refusing to cover the brand-name medications that has been prescribed , and replaced them with cheap generics that were often ineffective. One such medication is Singulair, a Brand-name asthma medication that is seriously expensive. The generic did not work, so I had to pay full price for the brand-name medication. This had never been a problem with the old insurance company, but the new one kept refusing to cover medications that we had been using for years, and generally giving us the run-around. To add insult to injury, they insisted switching to three-month prescriptions in the middle of December, knowing that we would be on a new plan on January 1st. And they wanted $600 for a three -month supply of Singulair. It was cheaper for me to pay out about $250 for a one-month supply of Singulair that was not covered by Insurance at all. As they say in England, “Merry Bleedin’ Christmas”.

On one of the many occasions that I was forced to call them, I was told that several different generic versions were available and that we should try them and find one that works. I am reluctant to do this; my family is not a beta-testing lab for an insurance company looking for ways to save money. If they want us to do their quality assurance testing for them, they should be paying us for the privilege, or at the least, providing us with free samples. For those who believe that generics are just as good as brand-name medications, I recommend that you do some research; at the very least, check out a book called: “Bottle of Lies”

I keep getting phone calls and junk mail informing me about various telemedicine and telehealth services, in which I can get in touch with Doctors and nurses via the telephone or Internet 24/7. While this is a wonderful idea that will become more and more prevalent over time, I am not comforted by the fact that this service is provided, not by healthcare providers, but by my Health Insurance company. In my opinion, this is a conflict of interest, as their primary goal is not to provide better healthcare service (which is not their job; they are an an insurance company, remember?), but to reduce, minimize and eliminate claims.

Bottom line: Health Insurance Companies should not be practicing medicine; they should stick to paying claims.

Don’t! Stop!

When booking a flight recently, I made the mistake of giving the airline my phone number. This is what happened:

• First, they tell me to reply STOP to cancel.
• Then when I do, they tell me to reply STOP * to cancel.
• Then they tell me that I am opted out.
• Then they tell me that they are sending messages again.

Good Grief!

Disillusioned

I am a creature of many passions, two of which are playing games and writing. So last year I decided to combine those two passions and write a book about a game that I enjoyed playing. And so the Assassins’ Creed: Pirates Game Guide was born.

I originally released it in two versions: a free version and a paid version with ten extra pages of personal research and information that was not available anywhere else. I figured that if folks liked the free version that they would pay a few dollars for the paid version.

I was wrong.

The free version got hundreds of downloads, but in spite of my lowering the price from $4.99 to $2.99, there were only a handful of sales. The market has spoken. Or more specifically, the freeloaders have made their point. I made a mistake, one that I will not make again.

As a result, I am reducing the free version to a “preview” version that features only the first twenty-five pages of the book.

This will doubtless upset some people; you may thank the huge number of freeloaders who do not value the many hours of work I have put into writing and publishing this book.

Don’t blame me, blame the freeloaders.

Anthem Sings the Blues

I got this message from the good folks at Anthem yesterday:

That’s right, folks, Anthem got hacked.

 Let’s take that apart, shall we?

“Anthem was the target of a very sophisticated external cyber attack.”

I love the wording here – has anyone ever admitted to being the target of a simple external cyber attack?

“These attackers gained unauthorized access to Anthem’s IT system and have obtained personal information from our current and former members such as their names, birthdays, medical IDs/social security numbers, street addresses, email addresses and employment information, including income data.”

Translation: “We just released the identity thief’s treasure chest. Everything you need to open bank accounts, take out loans and generally pretend to be someone else, just ad a fake ID.”

“Based on what we know now, there is no evidence that credit card or medical information, such as claims, test results or diagnostic codes were targeted or compromised.”

It is obvious to me that they were struggling to find some comforting news to tell us, but the fact is that most of Anthem’s customers have Health Insurance through their employers. Since they do not pay Anthem directly, Anthem does not have their credit card details.

As for medical information, most people don’t really care about others knowing what ailments they are suffering from. Indeed, most will happily tell you if you stand still long enough. It is my understanding that HIPAA, the medical confidentiality law of the land, was originally created to prevent Celebrities’ medical secrets from falling into the hands of the press. It obviously works; I didn’t find out that Michael Jackson was bald until after his death.

So… the identity thieves’ wildest dreams have come true, but stuff you don’t really care about is totally secure. It really gives you the warm fuzzies, doesn’t it?

So… what are Anthem going to do?

1. Notify all customers whose details were filched. I haven’t been notified, but I have noticed a surge in the number of calls to my cell phone from numbers I don’t recognize. I made the mistake of answering one, and was greeted by a heavy Indian accent. I pretended I couldn’t hear him, and hello-hello-helloed at him until he hung up. Then I added the number to my reject list. Coincidence? Perhaps… but I doubt it.
2. They are offering “free credit monitoring”. We’ll see what this looks like, but I suspect that this will be the cheapest option on the table. What they should do is offer the customer a paid subscription to an Identity protection service like Lifelock, or offer to pay the fees to lock/block your credit report with the “big three” Credit Reporting agencies. Time will tell.

Moral: If you run a big website, it’s not a matter of if you get hacked, it’s a matter of when.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Understanding IVRs – a quick primer

For those who were wondering, IVR isn’t some new form of birth control, it stands for “Interactive voice response”, which Wikipedia defines as “a technology that allows a computer to interact with humans through the use of voice and DTMF tones input via keypad.”

You and I know it as a device that is designed to keep the customers away from real people. I also call it “The Runaround”.

Here are are few of the commoner phrases that you may hear, along with their translations. Enjoy the show:

• “Our Menu Options have Changed” – Last week, someone got through to a real person. We have taken steps to make sure that this does not happen again.
• “Due to unexpectedly high call volumes…” we didn’t hire enough people.
• “…all of our representatives/associates are currently serving other customers/guests.” – we didn’t hire enough people.
• “For a better experience, please check out our website”– we didn’t hire enough people.

Now you know

A matter of policy

I have noticed of late that medical practitioners have started implementing “cancellation policies”; where you have to pay for an appointment if you cancel within 24 hours of the appointment. This is entirely understandable; if a patient does not show up, they are left spinning their wheels and waiting until the next customer shows up.  This is particularly aggravating for Dentists; nobody wants to go to the dentist, and cancellations are common.

This is reasonable if they call you the day before the appointment to confirm, and give you the opportunity to cancel. Recently my Dentist changed this cancellation policy to 48 hours. Eyebrows were raised.

You change your policy on cancelling appointments, and I will change my policy on making them.

I am henceforth implementing an “I-won’t-make-appointments-in-advance” policy. At the end of the appointment, when they ask to schedule the next one, I will politely decline, then set a reminder for the appropriate date… and go on my merry way.

 

Let’s see who wins this one.

When Cheap is not always Cheerful

Back in May, I purchased three tickets to travel with Airline A at a cost of over $270. I later had to cancel the tickets due to the illness and subsequent death of one of the passengers. But surprisingly death is no excuse; they hit me with huge fees, and I got about $91 of the $300 back as a credit.

Compare this with Airline B, who gave me credits for the two still-living passengers, and a full refund for the deceased one.

Guess who I’ll be flying with next time?

On the Record

Over the past few months, our cellphone use has been bouncing around, which required changing our plan several times. On one month we had to raise our minutes from 700 to 2000 (we were a thousand miles from home, planning an unexpected funeral at the time).

My CellCo had started to make “mistakes” in their billing process — I use quotes because the “mistakes” were always in their favor. They also started to “forget” promises that they had made to us a month before. When my latest bill arrived, they had forgotten to apply a credit that they had promised a month before  — at the time, they said it was “too late in the billing cycle”. Yeah, right.

Fortunately, I had recorded the call when said promises were made. When I played the relevant part of the call back, the rep got really angry.

• First he told me that I wasn’t permitted to record the call. I replied that I was; when Verizon said “this call may be monitored or recorded for Customer Service purposes”, it did not say by whom, and I interpreted the statement, quite reasonably, as permission.
• Then he tried to say that it was illegal to record calls if the person you were calling was unaware. I said that that was not the case — it was legal in most states (including mine), as long as at least one party (me) was aware that it was being recorded. He disagreed. I told him that he was welcome to check with the legal department — or with Google.
• Finally, he said that CSRs don’t like being recorded and would hang up if they were told that they were. I replied that I would make it a point not to upset them by telling them. I also said that had I not recorded the call, I would not have had a leg to stand on; a point he could not refute.

He applied the “promised” credit, and we parted amicably — at least I would like to think so; I guess I’ll find out next time I call Customer Service.

What do you think? Was I out of order? Was I breaking any law? Was he right to get angry with me?

Mind the Store

It would not be entirely unfair to paint me as an Android fanboy. But the word is loaded with negative connotations — perhaps it would be more accurate to say that I am a fan of open standards.

While I like Apple products, their “we-know-best” attitude sometimes leaves me less than enthused. This is perhaps the reason that I have been sporting an Android-based phone for over two years — first a Motorola Droid X2, then a Samsung Galaxy S3, both through Verizon, (damn them, but that’s another story).

Over those two years I have probably spent over $100 in the Android Market, now known as the “Play Store”, much to my annoyance (the earlier name was far more apt, in my opinion). I love the ecosystem that allows a programmer to create something, sell it for a a dollar or two and still make a fortune.

There are, however, three glaring flaws in the Play Store that I have encountered — besides the name, of course — that need to be addressed:

1: You cannot mix credits and cash.

I recently received a credit from a developer as a “Thank-you” for helping to test their game. I was purchasing a $2.99 game and had $2.79 of that credit left. The obvious thing to do would be to use up the credit and charge the remainder to my card… but that is apparently too much to ask – the Play Store’s payment system does not allow “split-payment” purchases.

2: A fifteen-minute refund window is way too short.

A play store purchase may be refunded within fifteen minutes. This makes sense for a quick-download, short-attention-span game like Quell or Cut the Rope, where a quarter of an hour is ample time to ensure that the program works properly on your device, but this is not the case for some “big” games that use a stub program to download gigabytes of data before the game can be played. By the time the download is complete, the refund windows is long gone. Solution: Let the developer decide on the length of the refund window.

More than two hours after purchasing the game and it *still* hasn’t finished loading…

3: You can no longer set an individual app to auto-update.

This used to be possible, but with recent updates to the play store, the only option is the global one, which is NOT what I want. Interestingly, the option is still there on my Nexus 7 tablet, but has disappeared from my phone.

 

 

Goodbye Insight

My cable provider, Insight Communications, no longer exists. They were bought by Time Warner Cable last year, and today the “Merger” is complete.

I put the word “Merger” in quotes because most of the uses of the word are both highly amusing and incorrect; when Company A buys Company B, B usually refers to it as a “Merger”, while A refers to it as an “Acquisition”.

One way to tell a real merger is to look at the name of the resulting entity. “JP Morgan Chase” is the result of a merger. So is “Lockheed McDonnell-Douglas”. So, for that matter, is “Time Warner”.

The result of the Time Warner/Insight “Merger” will be called… “Time Warner“. It is not a merger. Let’s call it what it is: Time Warner is eating Insight alive.

All that aside, I have been with Insight since they were TKR Cablevision. I have found their service to be fairly good; they answer the phone promptly, it is not too hard to get through to a real person, and their repair crew are very responsive… but they have a nasty habit of sneaking in up-charges on your bill when they think you’re not looking.

• A couple of years ago they added a $7/month “connection charge” to my phone service. I didn’t notice until a few months later, and they refused to remove it. They try to pass this off as a “Government Mandated Fee”, which it isn’t… and the FCC caps this fee at $6.50.
• More recently, they started charging me a “rental fee” on my Cable Modem. This is interesting, considering that I have owned my Cable Modem for about eleven years.
• When I first got my Home Phone Service with them, it cost $18/month. Now it costs $39. For local home service, with NO long-distance. When I asked them about this, they told me that I could get a better home phone service, but I would have to pay them $80 for a Cable Modem.
• Every January they raise everybody’s prices and see who kicks up a fuss. If you kick and scream and threaten to leave, they give you a “promotional discount”, but they will NOT lower the price back to its original level.

It is easy to complain, but in the past, I have simply called them up and told them that if I cannot keep this bill under $100/month, I would start amputating stuff and surfing on over to the competition. Perhaps this is why my service costs $98/month (for Internet, Phone and Cable TV), while a family member pays $150 for the same service.

Insight were a slippery company to deal with, and the second most adversarial company that I do business with (the first is Verizon Wireless, with whom I am under contract until next May)

So goodbye, Insight, and Good Riddance

Time Warner, I will be watching you. You have been Time Warned.