Why is health care reform so difficult?  I suspect it’s because the system is just too damn complicated.  How much money could be saved by just simplifying the system already in place?  A little standardization could go a long way.

Today, I attempted to make an appointment with an optometrist.

I’d like to get some new contacts and glasses this weekend.  We went through the usual, name, phone number, and reason for the appointment business over the phone, but then the conversation turned to insurance.  Um, okay I guess.  I had expected to produce my card at the counter at check in, but if they need to confirm coverage before they even book the appointment, I guess I understand.  I’m asked for the name of my carrier and I break out my spankin’ insurance card.

Whoa.  Now what.

There’s a Cigna logo at the top left, it says “GWH-CIGNA Open Access Plus” across the top in the middle, it lists “Connecticut General Life Insurance Company” at the bottom, and links to GreatWestHealthcare.com on the back in the fine print.  So, you tell me.  Who is my provider? I can understand the partnerships and whatnot that all these insurance companies are involved in, likewise the need to have separate entities for life and health versus casualty and property arms of their businesses, but why not settle on ONE name and put it PLAINLY on the card somewhere it makes sense, relevant to the type of insurance?

Post-secondary confusion.

Next, I’m asked if I’m “primary.”  Well, the card has my name on it, so that means I’m primary, right?  I’m not a dependent (I think).  I work in education, so “primary” means “elementary school” to me.  Then it occurs to me that the plan is through Vanessa’s employer, so maybe she’s the primary.  I end up telling the guy at the eye doctor this detail just in case.  Maybe she’s primary and I’m just spouse or something.  I like to think that organizations who are capable of tracking your medical expenditures down to the penny over a monthly, yearly, lifetime timeframe, broken down into types of costs and how much they’ve paid on your behalf for each would be capable of associating a married couple on a group insurance plan, but what if I’m wrong?

Benefit Limits Hold ‘Em

After getting off the phone with this guy (who is going to call me back to let me know if they even take this insurance, despite the fact that they took it when Vanessa went there a couple months back), I sat there looking at this card.  In addition to the multiple insurance companies named on it, there’s a handful of numbers too.  Some bold, some not, some larger than others.  There’s “IIN,” which is bold, with a big, bold number next to it.  Then there’s Control, which is also bold, although not all caps and has another bold number next to it.  Beneath that is Issuer, which is not bold, although the number next to it is.  We’ve got the smaller print Group Plan with a bold number next to it right above my name, which is only marginally larger than the text around it and bold (no mention of “primary” anywhere on the card, let alone next to my name).  Under my name, there’s ID, which is standard text with another bold number next to it and, to the right, there is Payer ID and number all bold, but even smaller.

WAT.

I presume that, right now, a stranger is looking up a phone number for Cigna in his computer (he didn’t ask me for a phone number) so that he can call and confirm they accept the plan.  What if he should be calling Great West Healthcare?  What if he should be calling Connecticut Life?  What if I’m not the primary and he assumes that I am because my name is on the card?  Would giving him one of those other numbers made any difference?  How much time is wasted by healthcare professionals trying to figure out what the hell is going on because the insurance companies can’t get their shit together and make a modicum of sense?  What if this location actually does accept my insurance, but because the card is so overrun with details of absolutely ZERO use to the insured, I didn’t identify my coverage correctly and they refuse my business?    How much money is lost because providers spend so much time trying to figure out the legal clusterfuck that is the insurance industry?

Simplify and Save.

I think the healthcare reform legislation stinking up Washington these days is more along the lines of healthcare expansion.  Reform implies reconsidering something and making it better.  If healthcare reform is focused more on expanding the current mess to more people, they’re only going to make things worse, I think.  On the other hand, if they could streamline the process and make insurance easier to understand and use, more people would benefit.  Some standardization would go a long way.

“We appreciate your choosing us to provide for your vision/healthcare needs.  While we’re setting your appointment, could you please give us the name of your insurance carrier from the top of your card and the plan number directly below your name?” How sweet would that be?  Instead, I get a call back from the optometrist’s office confirming that they do take my insurance, but the carrier tells them I only have dental.  Unbelievable.

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