An eye-opening experience
To the editor:
As a health professional, I have renewed respect for anyone outside of health care forced to navigate the private insurance system. If your insurance is bad, mine is worse.
My employer selected self-insurance designed by out-of-state businessmen whose knowledge of medicine was the first aid badge in Boy Scouts. Next they outsourced prior authorization to somewhere in the Southwest. The customer service agent “Angela” refused to reveal her last name, and I suspect she is part of the witness protection program. My call was monitored.
Angela has even less medical knowledge than the creators of my insurance plan, so she was not discouraged by the lack of documentation upon which she denied my authorization. More phone calls, faxes and emails resulted in the arrival of two letters on the same day, one denying and one authorizing my procedure.
Finally, in its infinite wisdom, my insurance company rejects all capable medical talent at a “competing” hospital four miles from home but will approve providers 200 miles south. The formula used to calculate in-network and out-of-network reimbursement exceeds my Calculus II education, but the unknown is the allowable customary reimbursement for a procedure. This is a closely guarded secret, kept by all front-line customer service representatives. Kudos to anyone who can crack that code.
I envy those with Medicare, Medicaid and Obamacare. Someday I may be as fortunate.
Dale Gordon
Caribou
