As a mental health consumer, I wonder if health insurance was meant to work for me. Understanding and obtaining coverage for treatments other than routine visits and medication refills has been an ongoing and daunting task. When well, I’m relentless in protecting myself, but at my worst, it’s apparent how easily I could end up in serious financial liability. Over the years, I’ve made the following 4 observations that may help other mental health consumers navigate health insurance issues.
Sometimes providers are listed as taking your insurance, but you later find they do not. Other times providers are listed as not taking your insurance, but you later find out they do. Often times, not everything during a visit is actually covered. Most mistakes I’ve made with my healthcare revolve around assuming, so I’ve learned:
Never assume coverage without speaking with insurance and having the provider run your benefits.
With each new provider, I request they run my benefits prior to setting an appointment. With each new treatment, I call my insurance company to verify coverage. I ask questions, take notes, and triple-check everything. I go the extra mile to be sure what I’m about to do is covered, but this can be time-consuming and frustrating as I bounce from representative to representative, department to department.
I once had a single representative handling all my needs—this was the single best thing ever given to me by an insurance company. I’m no longer with that insurer (for reasons other than customer service), so I’m back to dealing with the reality of interdepartmental dysfunction.
The two major departments in any insurance company you may know are member services and claims, but behind the scenes, there seem to be many more. Some departments have departments within their departments. Adding to the confusion is the occasional outside company contracted to handle a department within a department within a department. The sheer size of health insurance companies may demand this type of structure, which by itself is not the issue. The issue is:
Communication between departments at some health insurance companies is broken.
The amount of phone calls it can take to resolve seemingly simple issues, along with the lack of accurate record keeping of my previous inquiries regarding these issues, gives the impression of systemic chaos. Recently I had a series of the same treatment that required roughly 15 unique claims. One mistake was made in regards to who-knows-what and in order to avoid financial liability, I had to:
• Speak to countless insurance reps
• During 45-75 calls (or 3-5 calls per claim)
• Over the course of 4 months
• To avoid a $20,000-or-so bill from my provider
Although extreme, my example illustrates a worst-case scenario that could have been avoided with a single point of contact, which leads to my next observation.
Companies seem, and often are, cold. People, on the other hand, can be warm—except insurance representatives, who commonly withhold their names and contact information. Why do they do this?
• To keep on track with their extensive workload?
• To avoid angry clients overwhelming their inboxes?
• Maybe something else?
Not knowing more about the person you’re speaking with can lead to forgetting that you’re speaking with a person. Beneath the stress of their day and their customer service protocols, this is an individual, and individuals have feelings. On occasion, I have connected with individuals who have fully facilitated a resolution to my issue. These people cared that I, not the company who pays them, got help. So how do you find these individuals?
• Ask (beg) for their help. Show them vulnerability. Let them hear that you’re not just an account number.
• Ask for their email address and phone number. They won’t always give it, but you won’t know if you don’t ask.
• If you don’t see a resolution on the horizon, continue to call back about the same issue until someone finally says (in one way or another), “Don’t worry. I’ll personally see that this is fixed.”
• Be nice to all insurance reps. If you’re angry, set that aside—it won’t help as it would with a local restaurant owner who is afraid to lose your business, which brings me to my next observation.
If you’re not angry on your first call, you will be on your next. Like traffic, the flow through health insurance customer service is an inevitable headache that will test your patience. But like traffic, there is nothing you can do at this moment to change how they operate, so why not accept it? You will get from point A to Z, but only if you choose to travel in traffic. In an ideal world, maintaining my mental health should not include a process that remotely resembles traffic, but this world is not ideal, so I wonder…
What if health insurance companies purposefully flow like traffic in order to delay or avoid making provider payments?
As I wonder this, I deal with reality, because If you don’t deal, or decide to get off an exit early, you’ll wind up lacking coverage or owing money. Keeping this mindset keeps me sane-ish as I push upward in my battle with mental illness; I recommend you do the same. Here are some parting tips:
• Use your provider’s staff to help fight for your coverage.
• Keep notes from conversations you’ve had with various representatives.
• Check your explanation of benefits (EOBs) regularly to detect errors before they become problems.