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It’s Called Friction

Posted on Mon, 21 August, 2017

It’s called “friction”. The mind-numbing, infuriating bullshit you have to put up with when you deal with your medical insurance. You know the drill; you call hoping to get something accomplished, like reimbursement for out of pocket costs and they dick you around.

First it’s difficult to get a live person on the phone – that’s because they want you to give up in frustration. Otherwise you’re likely to get what you want if you talk to a live person. Once you’ve spent 30 minutes on hold they will dick you around some more with not being able to find the claims you submitted, tell you you’re not covered for whatever you’ve called in for.

All of this is intentional to get you to give up in hair-pulling frustration, probably grabbing that martini glass for which you’re calling in the first place – to obtain inpatient rehab. In the words of Joe Pesci, “they fuck you at the drive thru”. For our purposes here, we’ll change it to “they fuck you at your insurance”, but just know that this is the best movie line, ever. #lethalweapon4 #leogetz

 

Where Does It Come From?

Friction is the soft term used to describe the business costs associated with doing business, and in the case of big insurance, it means they will go to great lengths to postpone paying you as long as possible. Frankly, they hope you will give up so they don’t have to fulfill the very business they are set out to do: cover you medically. There’s no hope when you call for mental health services. Particularly because they spend the first 10 minutes of the call trying to assess if you’re suicidal. I am never suicidal when I place the call. However, I usually am quite lethal by the time I have gone through this scenario.

These companies are in the business of making money and to that end they will deny giving you any, in the form of coverage or reimbursement, for as long as possible. What’s the secret you say? Persistence.

 

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Take a cue from Elizabeth Warren #neverthelss #shepersisted. It works for me every time. I do not accept insurance as a clinical provider because they are horrible to deal with and mental health coverage for MFT’s is offensively low. I am a consumer within my family role and managing the referrals and costs for a family of 4 is nearly a part-time job in itself.

To that end, I spend more time than I would like following up on claims, making sure I make them work and ride out their attempts to dissuade me; their friction. Since I am a provider I know a thing or two about CPT codes, ICD-10 codes, where to sign and where not to sign because the payment goes to the provider if it’s the wring line. Even with all this, they still claim it’s not clear, something is invalid, or they haven’t received it at all. My personal favorite was when I called to follow up on a letter stating they couldn’t read my claim. When I had them pull up the image they read it verbatim. I laughed and there was silence on their end. I was a little bitchy on that call, but they had it comin.

 

Friction Happens To Everyone

I had a client call me recently extremely angry because they were getting the run around from their insurance stating my Tax ID was incorrect. I call bullshit. My ID is perfectly correct, typed plainly for all to see. This is friction. I told him so and encouraged him to do what I am encouraging you to do; make your own friction and push back. Unless you hear “your plan does not cover that” or “you haven’t reached your deductible yet”, don’t take no for an answer.

In fact, it’s not always wise to accept “your plan doesn’t cover that” as a final answer. Most people won’t read the horribly boring fine print of their policy but we should. I had this personal experience last year when dealing with educational testing for my kids. The first call I made elicited I was covered and had to pay nominal copay amounts. I was overjoyed. It was the best experience I had had to date with insurance. I proceeded with the testing only to find out $8,000 later that it was not going to be covered. I call bullshit again!

I had the name and call date of that person I originally spoke with, I obtained collateral documentation from the kids pediatrician to support the referral they made, and then I threatened them with a small claims lawsuit if they went against the original information I was given.

I can be a bulldog. And it worked. I was reimbursed $7500 within the week. The remainder was the copay I expected to pay.

 

I have intentionally not named the compaies I have had these experiences with because I’m smarter than that, and they’re all the same anyway. They are all in the business of keeping your money to earn interest for as long as possible, so the names are irrelevant. I have had no issues however with the auto insurance company or dental insurance, so maybe there’s hope.

 

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Good References for this subject:

Health.com

NBCNews.com

 

Jodi Klugman-Rabb is a licensed Marriage and Family Therapist in Marin and Napa Counties. She specializes in connecting with clients on a humorous and practical level, helpful when specializing in ADHD, trauma and anger/communication skills. She uses EMDR to treat traumas and fears of all types. She is the mom of two funny and awesome kids. Connect with Jodi on her website www.jkrabb.com or https://www.facebook.com/JKRabbMFT

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A blog written by a hip, sometimes irreverent shrink who’s been around the block and calls it like it is

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