The Rainmaker

Remember the movie adaptation of John Grisham’s book The Rainmaker?  In the film, Matt Damon plays a straight outta law school fresh-face assigned to work with a couple, characterized as a bunch of rural yokels, whose son has leukemia.  Big Insurance Company, Great Benefit, refuses to cover the claims, and refers to dying Donny Ray’s parents as, “stupid, stupid, stupid.”  They even put that in writing.

I’m not the sharpest knife in the drawer, but I am no dummy.  With the fire of a thousand suns, I loathe being treated like a sucker.  I’ve abandoned all hope for customer service assuaging any dissatisfaction I may have.  My customer “service” experiences time and time again have taught me that the service element is quite dead. Call it what you like, and pretend having a statement about your service mission legitimizes the bullshit you’re shoveling onto my plate; by and large, customer service, with Elvis, has left the building.

You may recall that my son had what I understood to be an MRI of his brain completed last July.  Imagine my dismay to receive a bill from the service provider indicating I still owed them $1,197 for that procedure because my insurance company denied payment.  I formulate informed questions based on whatever clarity I have in a given situation, and I’m a public educator, so I don’t have a ton of “extra money.”  Prior to the procedure I called my insurance provider, and Ron, Great Benefit’s jolly representative, told me it would be covered.  This conversation occurred in June.

Employees working in a call center

I sought resolution today, but lacked the fortitude to speak directly with “customer service”–this I knew like I know my name.  I’d hoped that contacting them from work–you know, where there are other people who sorta expect me to behave like a professional and not an enraged lunatic–would prevent any random acts of violence toward property and possibly inhibit a barrage of profanity heard from here to Mumbai.  Swearing rarely gets you what you want in the “service” world.  And yeah, I’m way overusing the quotes today, but you see the whys and wherefores, right?  Instead, I took to my keyboard and drove the Representative Chat Autobahn.  Note: I had to edit a wee bit–obviously my insurer isn’t Great Benefit.  Although like the fictitious literary corporation, my exchange left me feeling a bit unreal.  Also, the parenthetical comments were communicated only in my twisted little head. 

Yolonda B. has entered the session.
Yolonda B.: Hi, thank you for contacting Great Benefit Insurance! My name is Yolonda and I will be glad to assist you today! Please note that if you are inactive in the chat session, you will automatically be disconnected. Staying active will help us answer any questions you have more efficiently. How can I help you today?
WENDY WEIR: We received a large bill from one of my son’s providers. I am curious why so little of the procedure was covered. Is it the family max has yet to be reached?
Yolonda B.: I am very sorry to hear that you received a large bill. I can definitely review the claim for you and determine where these charges came from. Who is this claim for? (You’re not sorry, so stop trying to ingratiate yourself.)
WENDY WEIR: Number 1 Son, from Children’s Hospital of Wisconsin
Yolonda B.: Thank you! Can you also confirm your son’s date of birth?
WENDY WEIR: Big kid’s date of birth
Yolonda B.: Thank you again! Do you also have permission to speak on his behalf today?
WENDY WEIR: I do. (Some days I feel like the child wouldn’t brush his teeth unless I freakin’ reminded him to, so YEAH, until he’s covering his own insurance premiums, I’m allowed to speak on his behalf.)
Yolonda B.: Thank you so much. What is the date of service that this bill is for?
WENDY WEIR: July 3
Yolonda B.: Alright I was able to find the claims for that date of service, what is the total amount that you are getting billed?
WENDY WEIR: I don’t have it in front of me, but it is near $1000
Yolonda B.: Alright I am showing that there is one claim that has processed with your benefits and is showing a patient responsibility of, $502.87. There is also another claim for another service that your son had done for $605.50 that is listed as patient responsibility due to this procedure needing to be approved before it was done. Did you give written permission before this service was received that you would be responsible for the cost?
WENDY WEIR: I called Great Benefit before the procedure to ask if it was covered, and was told it was. Given that, I’m sure I signed off on that consent. You can imagine how displeased I am now to read your last question, as I am sure now that I will be stuck with the balance.
Yolonda B.: I am terrible sorry to hear this Terry. In order for these charges to be considered the provider can submit scientific evidence that shows this service is safe and effective for your son’s condition. (it’s terribly sorry; terribly is an adverb modifying an adjective describing your fake emotional state.)
WENDY WEIR: My name is Wendy, not Terry. (I know you have 20 chats going on at once, but drop the “you’re my friend and you can tell because I am using your first name bullshit.”  You’re busted.  Fucking pay attention to your customers.)
Yolonda B.: Sorry about that Wendy. (So glad I called you out on that Yolonda.)
WENDY WEIR: My son has muscular dystrophy. I am 100% certain we would not pursue an MRI of his brain otherwise. No one chooses MD or MRIs just for fun.
Yolonda B.: This provider did not bill in for an MRI, so that could have been where the miscommunication happened. (Miscommunication my jiggly, middle-aged ass!)
Yolonda B.: The billed in for a Magnetic Resonance Spectroscopy.
WENDY WEIR: Well, I don’t hold a doctor of medicine degree, so am unfamiliar with the nuances between those procedures. Great Benefit doesn’t cover spectroscopy then?
Yolonda B.: Your son’s doctor can submit scientific evidence that shows this service is safe and effective for your son’s condition. That is correct, this procedure needs to have a prior authorization before its done, it is currently listed as a procedure that require review based on the information that the provider would have. (And I would know this how??)
WENDY WEIR: Thank you for that last bit of information. I will contact his neurologist. I would like a copy of this transcript so I can refer to it when I contact them. How can I get a copy of this?
Yolonda B.: Unfortunately there is no way to print transcripts at this time, however I can give you a reference number for our conversation. Otherwise you can try to highlight the conversation, hit Ctrl +c and then hit Ctrl +V into a separate document.
WENDY WEIR: I’ll take that reference number please. Thank you.
Yolonda B.: Of course, that reference number is blahblahblahblahblah. Again, I am terribly sorry that I could not deliver better news about this claim today Wendy. (Maybe you’re a little sheepish that you screwed up my name, but I don’t for a microsecond believe you’re sorry, and not a trace of terribly sorry.)
Yolonda B.: Aside from this claim information, was there any other questions for me today?
WENDY WEIR: No. Good bye. (F-ers.  OK, that one I voiced aloud.)
Yolonda B.: I hope you have a great rest of your day. Thank you for using Chat. (Yeah, the rest of my day is gonna be just dandy, thanks to the outcome of this keen chat, thanks)
Yolonda B.: Goodbye Wendy.
Yolonda B. has exited the session.
You are the only user left in the session (There is some kind of metaphor here, but my brain is too exhausted to flesh it out.)

So where does this leave me?  Just like The Rainmaker’s Donny Ray’s poor mom: Stupid.  Stupid.  Stupid.

I contacted my son’s neurology clinic, hoping they can aid my navigation of Great Benefit’s Sea of Semantic Smoke and Mirrors. Between this and the return of The Walking Dead, I don’t know how much more my heart can take in twenty-four hours.  Wish me luck, good people!

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12 thoughts on “The Rainmaker

  1. I firmly believe it is standard insurance policy to deny anything presented to them – even if they cover it. They figure eventually they will wear you down and you’ll pay. And they’re right. Most people will just pay whatever it is rather than go thru the mind-numbing process of fighting the machine. They tried this with me when Sade was born. I threatened them with the unlimited copies I could replicate and send to them to refute their denial, with appropriate paragraphs highlighted, and usually one sentence referencing my attorney’s advice. I have a 90% success rate with my “I’m more insane than you are” approach.

    Liked by 1 person

  2. There are few things in life more infuriating than fighting with an insurance company. Please, collect my premiums for a gazilliion years but don’t pay for anything when I actually make a claim! And you have nothing but time to deal with this, right? If you had a prescription from your big kid’s doc that said “MRI” then that’s what should have been billed, not “MRS” (also known as NMR) which is a different procedure. It’s possible that Children’s may have submitted the wrong billing code or procedure code to Great Benefit. Your son’s physician should have a copy of the prescription and so should the hospital (either an electronic copy or a paper copy somewhere in their files). You might want to contact the billing office at CHW and ask them if they billed for MRS when they should have billed for MRI (and tell them to review the prescription). The prospect of another customer “service” call is mind numbing for sure, but $1100 is a lot of money. Give ’em hell, Terry!

    Liked by 1 person

  3. Yep, customer service is a lost art, a dead language. In every industry. All we have left is the veneer of helpfulness — that cheerful, friendly way service reps have of saying, in so many words, “F*ck off.”

    I feel your pain, Wendy.

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    • Your response made me giggle out loud! I guess if I’m being told to f-off in a chipper tone, I’m not supposed to mind as much?? Yeah, I’m that naive, which is insulting too. I’d almost rather they go the direct route in telling me how they’re going to screw me over. There’s still something to be said about honesty! hahahahahahaha

      Liked by 1 person

    • I continued to hope for that too! I just received another bill for the same amount, so my optimism is pretty well tapped at the moment. I need to get on the phone this time, but THAT takes some time to work up to. Thanks for the support!

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