Ascribing to Malice
So… the kidney stone turned out not to be a kidney stone after all. In some sense, that’s good news, because very few conditions are worse than a kidney stone. My joy at the news, however, is greatly diminished by the fact that I’m still in pain, and getting passed from doctor to doctor in an attempt to find out what the problem is. Each appointment takes a few days. Each test takes a few days for the results to come in. And several steps aren’t medical at all, but a few days’ delay waiting for our insurance to pre-approve a procedure. That’s a mighty slow process when it hurts to walk around the house. But I’m not here to gripe about that, because these delays are justified: offices are busy with other customers, so I can’t just drop in and get service, tests take time, and doctors need tests to make an accurate diagnosis before prescribing treatment.
I am here to gripe about the unnecessary delays. The step I completed today was waiting for insurance approval of a second cat scan, this time with dye, and two x-rays. The insurance company refused, insisting instead that I see a surgeon first.
I balked at the promise of another delay, and began asking questions, like: Why? We-e-ell, because we want to eliminate the possibility of a hernia. But my GP checked for a hernia and didn’t find any indication of one. Would a surgeon be able to tell any more from a purely external examination? We-e-ell, maybe not, but he could give his official approval for the cat scan and two x-rays your GP asked for. But I’m not getting the tests for my amusement, nor did I make them up on my own initiative; isn’t my GP’s request sufficient? We-e-ell, we didn’t realize your GP already considered hernia. Tell you what: the approval for cat scan without dye is still applicable all the way to April 29, so you could use that to get all the cat scans you want, with or without dye, until then. And we don’t need to approve x-rays.
So, ultimately, it turns out they didn’t need to approve anything at all. The procedure they use to prevent unnecessary medical tests in fact permits any number of unnecessary medical tests, as long as they’re taken within the space of about a month. I’ve waited five uncomfortable days, counting the weekend, for a legal step that was both ineffective and entirely unnecessary. And when the insurance company finally did get back to me, it was to insert another unnecessary step. Only by complaining did I make them rethink the idea. And not only would the extra step serve no purpose, it would cost the insurance company money. Let me repeat: they wanted to pay more money to drag out my treatment.
Napoleon famously quipped: “Never ascribe to malice that which is adequately explained by incompetence.” Maybe. But in the hard-eyed world of the insurance industry, it takes a special breed of incompetence to work that way. Presuming my case is not isolated, the predator-infested free market is supposed to make short work of slow, fat, diseased companies that simultaneously harm their customers and spend extra money to do it. So where are the sleek insurance companies ready to offer faster service at a cheaper cost (because they spend less by avoiding needless costs)?
Somehow, I suspect Empire Blue Cross/Blue Shield is not doomed to extinction. Rather, it’s working just the way it should…by some perverse logic. Perhaps it costs more to hire people who can execute a more effective approval procedure than it does to live with an ineffective one. Perhaps apparently pointless trouble serves to discourage enough patients, or let them get well on their own, to make up for any expenses with the patients who go through with it. Perhaps some federal law—and federal laws do not live by the law of the free market jungle—makes this ineffective procedure the most cost-effective within legal bounds. I don’t know, nor am I likely to find out. But in the meantime, I’m getting a brush-up on my assertiveness training.