03/04/2008 10:38 am ET Updated Nov 17, 2011

Why Being A Health Insurer Means Never Having To Say You're Sorry

Yes, reading about health insurance is so dull it can cause hysterical blindness. But please bear with me, dear reader, as I share a snippet of an illustrative phone encounter I had with my family's healthcare provider the other day. I promise to keep it short.

ME: Hi. I'm calling again about an out-of-network bill we paid last summer, because we still haven't been reimbursed for it.

THEM: I see by our records that you were missing the two-digit code signifying that the procedure was outpatient.

ME: But we cleared that up months ago, and you said we'd be getting a check in 15 business days.

THEM: Oh. It seems that we have to return it to your physician, because we need more information.

ME: (Inaudible cursing) After eight months of follow-ups, what else do you need to know? What's his favorite word? What sound or noise does he hate? If Heaven exists, what would he like to hear God say when he arrives at the pearly gates?

Well, those are the obscure questions James Lipton from the Actors Studio always asks. And I didn't say those lines; I just thought them. In any event, the hapless apparatchik on the other end of the line doesn't care how I respond - she's speaking in code. What she really wants to know is: How long can we keep from paying you? How much money can we make on the float on this huge check, which you're not getting in your own account? How many phone calls are you willing to make before you give up?

We're playing a game, and we both know it. In a free market system, the theory goes that if I don't want to play with my health insurance carrier anymore, I can take my marbles and find another company that's more copacetic. Unfortunately for consumers, it's been my experience that they all play dirty. That's because a large chunk of their profit margin relies on giving the worst possible service to their customers.

We've experienced months-long delays due to "misfiling;" failure to notify us that a single digit in the many requisite codes is out of place or incorrect, thereby providing an excuse to withhold payment; bills being forwarded to the wrong departments; denials to providers for no apparent reason. Most of the time, when they're called on it, they admit that whatever happened on their end shouldn't have, but they never apologize, nor do they call it a mistake, exactly. Withholding payment as long as possible is their default mode. It happens by design.

In this particular case, we're not talking about an inconsiderable sum: We're talking about $3500. It's a ridiculously high bill because we incurred out-of-network expenses, something we try not to do. But this isn't always the insured person's choice to make. A couple of years ago, our eldest son was crossing a street in another city when he was hit by a car (he's fine now, at college and happily removed from my bills-induced bellyaching). Then, less than a year later, my middle guy needed emergency surgery, and two weeks after that, he broke his nose. Shit happens to everyone, no matter how careful and dutiful they may be, and perversely, often within a short time frame. Then shit has to be paid for.

Fortunately for us, we're in a position to pay this particular bill upfront. And since we're fully covered through the workplace, we don't have to resort to visiting ER's for routine health maintenance or worse, because we've had to neglect a situation we would otherwise have treated until it reaches the crisis point, as many Americans must. We have access to doctors, and when we need to see ones who are "in the system," the process is less painful and byzantine. I know it could be worse, and that it is worse for millions of Americans. Here's hoping that the next president will resist industry pressure and bring legislation to reform the system, so it works for consumers, and not just insurance providers. There are a lot more of us than there are of them.