My New Liason To the Senior Partners
[categories: insurance company, duplicity]
Back before the end of the year I wrote a little about difficulties with an insurance company regarding a disability policy for my wife that we've been paying into for nearly eight years (I underestimated earlier), which we had to make claims against in 2005 once it was clear she was going out on disability from work for an unspecified stretch. As I say, we were experiencing some problems.
(At this juncture I have no intention of identifying the insurance company involved. There's no point in bringing that information into play in this forum. My expectation is that the struggle outlined here is not unique to a single insurance company anyway, and the function of this and subsequent, related posts is to reinforce my own recollections, keep my thoughts organized, and to perhaps help map the minefield for someone else who will later find himself dealing with a similar situation.)
The following day (December 29th) my wife was talking with a front-line rep from the insurance company, and the word then was that the latest claim - now for a full two months at least of payments - would be processed within two business days. She was effusive with her "thank you"s, which made me wince. It's not something I'd have even come close to doing in her place under the circumstances, as it felt more than a little like thanking a bully for the promise that one's hat or jacket was about to be returned, but at least things appeared to be moving ahead.
Appeared to be.
The end of year holiday weekend ensued, and we knew that it would be at least the frist Tuesday of the new year before we had a shot at something appearing. Tuesday came and went without a word, then came Wednesday with the same silence, so she called them.
Somewhere between the previous Thursday and this Wednesday a need for additional forms - one from the doctor and another from her employer - had become essential to the process. Indeed, as I was to find out later, they had been essential all along.
Not that anyone was moving to tell us anything about it until we asked.
The insurance scam rolled forward.
I was in work for a long day, and found out the details that night. A busy Friday kept me from getting into it. It would have required time and focus I couldn't spare. However, come Monday, I decided it was well past the point where I became personally, directly involved.
I called their general claims number and talked to Ethan - while there was no last name involved and so seeminhly little reason to use a pseudonym, I'll use one nonetheless - and realizing he was merely the unfortunate front-line operator for them I simply laid out the case to him, pausing twice to clarify that none of my ire was directed at him, personally.
I didn't raise my voice. I never came close to resorting to profanity. I kept it clean, clear and at a measured pace.
I outlined how their methods had become clear over the preceding two months.
A trail of a call for forms and detail, then silence. When a follow-up call is placed, they are told one of the pages wasn't received, and that's all that's holding it up. It's re-sent -- faxed, and the machine provides a mini-facsimile and information to show that it was properly transmitted and received. Some more waiting. Another call placed. This time the paperwork's in a que, but after some pleading they're told it'll be moved up and be taken care of shortly, but evertthing's in order. Another wait. Another call to check on it. A form was missing some key information, and a different one than what they have is required from the employer...
They prey on the good intentions of people who are at a physical, emotional, and (with ample help from this process) at a financial nadir. People who are feeling isolated and powerless. People who want a way out of the cold darkness, and scurry hopefully from one glowing Exit sign to the next as each, in turn, snaps to black. People without leverage. Without an advocate. Thoughts of an attorney feel absurd. They don't have the money to pay their bills on time. they make minimal payments. They borrow from relatives. They begin to count on grace periods surrounding due dates. Eventually they're evading creditors. How could they afford a lawyer? Even if they retained one on a contingency basis they would lose part of the money, and they need all of it. They needed it weeks or more ago. Besides, hiring an attorney to battle an insurance company smacks of hiring one vampire to fight another.
The company is faced with their worst case scenario: An open-ended policy they could be required to pay on every month for an unknown stretch of time. This isn't how it's supposed to work! The House is supposed to always win, right? If things worked that way, why, it wouldn't be much of a profit-driven business, would it? Isn't this the U. S. of A?
So, every deception and delaying technique is brought to bear in the pursuit of leaving a policyholder as stressed as possible on every level. Perhaps even so bereft of energy as to simply fold. To give up. Eventually - ideally - the policyholder will miss a payment on the policy and the account will be closed. A happy conclusion. A strong quarter. Smiling shareholders. A stronger nation. Apple pie all around!
Haven't these years of GOP-driven fiscal policies demonstrated amply that the good of the shareholders is of paramount importance? Any dead weight that drags down the quarterly report, well... this only helps the terrorists. A true patriot would pull himself up by his bootstraps, turn to the Church for help, or otherwise expire and decrease the surplus population. This is a Time of War, you know. You either love Freedom and get with the program or go pray to Allah.
Okay, most of those last two paragraphs was just between us -- none of that got into the conversation, as I'm not going to dilute a campaign against an agent of fear and darkness with sarcasm.
I did make it clear to Ethan --
-- and I want to note that my original intention was to ask immediately for a supervisor, but by the time I got through it was within spitting distance of 5pm, and no one with any real authority is going to be available at one of these centers after 5pm. So, I decided to use Ethan as a dry run and hope that some of the notes he'd pass along would help set the stage --
-- I endeavored to make it clear to Ethan that we represented a different case.
The policyholder here was not isolated. I was here to be an advocate. While the lack of anything resembling a prompt payment had created some financial stress, it was more in the line of uncertainty. Once it became clear that we could not count on the money by any known date, all finances had to be rationed in the event that it was solely my paychecks we would be hopping between. Islands in the stream, to risk invoking Hemingway. (But if there's an author to be invoked in a ham-handed fashion, well, who better?) They were the only things we could count on. This cast a cold shadow over Christmas and New Year's, and saw us step into the new year under a pall.
I made it clear that while journalists weren't likely to be a terror, they could be invoked as a factor. However, there was no need to even entertain thoughts of lawyers.
This is 2006. A year of highly-contentious political races.
A year rife with political scandals. Financial scandals. Anxious politicians. Incumbents and challengers, each anxious for any issue which would allow them to play the role of advocate for the people. Champion of the besieged on a stage before an aging demographic. Opponent of a currupt, soul-withering Darkness. To put a finer point on it, they're anxious to grab hold of the clean end of the stick and throw the spotlight on corruption that doesn't involve them - to violently mix metaphors.
Even in the case of candidates who have received money from the insurance lobby, the gains in political capital from taking up this cause would blow away the value of any sum of money that's likely to come into their own campaign.
All of this I (surprisingly quickly) laid out for Ethan.
Once I finished he informed me that the company had just recently created a special category of worker to address just such concerns! Imagine that. Why, surely this is a sign of the Divine Finger reaching into my life, right?
Okay, so none of us are that gullible. I just have to check every so often. All that drinking and TV over the holidays softens one up.
I would be called at the number of my choice the following day, before noon, by a special liason. My personal conduit to the senior partners. (A repeat of the titular and applicable reference for fellow Angel fans.)
This morning I received the call from what I was told is our official connection to the insurance company from here forward.
Let's rename him in the spirit of his position: Pontius Wormtongue.
I'm certain the surname fits - anyone placed in this position with an insurance company is almost certain to know what the true score is, and his function is to mollify, to pacify and attempt to make everything appear reasonable and fair and the other is likely to be an aspect of his function, attempting to wash away guilt and - for a gold star performance review, a plaque and a bonus - us away with it.
Certainly, there's always a chance that Pontius is at heart a straight-shooter who's been indoctrinated from the other side, and sees a world filled with scam artists looking to defraud a fine and noble institution that exists to help the truly unfortunate... who happen to be policyholders. I have three cents in my left front pocket, though, and I don't know that I'd bet all of it on that possibility.
Introductions made, I recapped my statements of the day before. I made it clear that their explanations do not wash with what's occurred over the past two months, and the pattern of abuse is clear to any reasonable observer.
Oh, another special note, should any of you be multiply unfortunate enough to find yourself in such a conflict, it's at this stage of the dealing that we find another element in their arsenal of smoke and mirrors: They'll begin dropping references to phantom letters which reportedly have spelled out in detail what forms they've needed all along. See? They were above board and clear as an azure sky. It's a failing on your end that caused things to gum up and bog down. Letters which, of course, never arrived in one's mailbox. Had they arrived, of course, they would have been torn open within two seconds of being spotted by people who had been waiting for something, anything, of substance from the company. "Balderdash!" we say, for there are women-folk present and our mothers may hear of this.
For your own amusement and potential later use, though, remind yourself to do as I did and inquire after these letters, including which dates these letters were sent. Take notes and keep them. It could be fun a little later on when either they arrive and one looks at the posting date, or when one looks at the date on the "copies" one requests later in the process. Never repeat the date back to them. If they're going to lie to you then let them do all the work remembering the fabrications.
Establishing that nothing could be done to correct the past (something I mentioned) we shifted the discussions to what needs to be done now. I needed to know - exactly - which forms we needed now, and then to map out which forms we would need at which specific junctures in the months ahead.
From now on everything that is specifically needed will be spelled out in advance. By Monday I should have the forms we've been "missing", and as Pontius gave me his fax number in reference to this it is to be presumed that I will be able to deliver them that way. This will enable him to "shoot them over to" the claims department.
My intent is that henceforth each item sent will be either faxed (where permissable) or sent via Certified mail with Delivery Confirmation (possibly overkill, but it's what I'm deeming necessary at least to start) if an original is necessary. Shortly after it's marked as received (via the fax report or online tracking, respectively) I will be calling to confirm that it's been added to the file and get an update on when the next check will be issued. Depending on the estimate I'll be calling at least one more time during that cycle to be sure that matters remain on track. At each time I will be sure that it is unequivocally stated that all is right as rain, and we lack no information nor critical paperwork. If they can't give me that assurance then I am to handed up the chain. If they are unable to give me that assurance, then I will be calling back the next morning. If nothing is clearer, I'll talk to someone after lunch. I fairly routinely put in long days, and if need be I can create the pockets of time I need. I get more work done in work after hours anyway; fewer distractions.
I will at no stage in the process pretend that this is a wonderfully smooth and cooperative system. There's nothing in what I'm anticipating worthy of granting absolution. This is purely pragmatism. This is a case of me, in order to protect my family, taking on a new, running assignment. All of this is necessary because the system as it exists is intended to discourage and discontinue payment on claims. I - at least we hope - have moved us out of the main by being the squeaky wheel.
I will always resent being forced to do that.
Comments
What a damned shame that you have to add so much to your already entirely overburdened schedule. Between working outrageous hours and running a household, taking care of an ailing spouse and two sons...it really sickens me to think of you having to go through that crap. But most of it is exactly what I would have suggested.
Perhaps, once this gets rolling a little more, all the hands on won't be necessary. I'm keeping my fingers crossed.
I don't suppose they've given you any kind of E.T.A. as to the check you've been awaiting for two+ months now?
Because of this, there are no real bureaucratic limits placed in my way; if I really WANT to cut someone a check, I can do it, even if they don't seem to be able to get their claim paperwork correct.
This isn't going to be true in your situation. The person who cuts checks is somewhere in the middle of the maze, and that person never takes calls. They are buffered by an endless array of people who do not cut checks, they simply process claims. And the claims procedure will be complex, because, yes, the insurance company has no interest in making it simple, and in fact, all their interests lie in making things as difficult as they can, within the framework of generally very corporate friendly state and Federal guidelines.
It's important to remember in cases like this that you're dealing with an enormous and impersonal labyrinth. You may be correct that this is all a deliberately designed obstacle course where the ultimate goal is to get you to miss a payment so they can remove you from the pay out roster... but you're never, ever going to get to talk to any of the architects of the maze. The people who answer the phone, and who call you back, and who make the promises, and tell you about the various procedures, are wage slaves like you. They are doing what they are told to do, because their calls are monitored and someone is checking their paperwork and you, as a customer, are in a highly scrutinized category -- which is to say, they are cutting you a check every month (supposedly).
This means supervisors higher up are indeed going over every transaction, and looking for reasons to delay or deny your claims. Therefore, anyone in the process anywhere that does anything to expedite the process on your behalf will, most likely, endanger their job doing it.
And, again... you will never talk to anyone who can actually sign a check and mail it out to you. That power is reserved to the Senior Partners, or, rather, a minior they keep in a desk drawer, behind stout locks. You can't get to them. You can just get to the people who feed that minion the paperwork necessary to get that minion to eventually cut the check.
Ultimately, I think your best bet is to either find a lawyer who will work on contingency so you can sue these people, or to get a local consumer advocacy reporter to pick up the story and start investigating it.
While lawyers may seem like 'vampires', well, politicians are worse... they're older, more powerful vampires who are, most likely, already on the patronage lists of the insurance company you are fighting. You need someone with a personal motivation to go after the company on your behalf, and that would be either a ratings hungry reporter or a corporate lawyer looking for a big contingency.
S.G.: We're at the stage where there are two forms that are required. We should have them in hand by late Monday or sometime Tuesday, when I'll be able to fax them. Then I'll be pressing for an exact timetable.
H: At each mention or suggestion of a call center I had your work situation in mind, but as we both noted there is a significant - and I would note huge - difference in the operations you've worked for and the one I'm dealing with. Your paymasters want to keep every monthly packet of cash coming in that they can. The lords of insurance I'm dealing with view us as a gangrenous limb. Also, a single account can represent a large, open-ended source of loss for them.
At this stage I've applied pressure and as a rsult been bumped up the chain to a special handler. So long as at no time to I mistake this man as my personal advocate, we should be able to move this forward. The next critical juncture is determining what happens and how quickly once the newly-requested forms are received and acknowledged. If he attempts to leave it with an "I'll shoot this over to Claims so they can begin processing it" my stance will be that at this stage the process should be ready to go, not some start from a cold stop. Slap those sole documents into place and shoot out the overdue money. If there is not a reasonably precise and rapid timetable coming from him, or I suspect I'm about to be shined on for a few days while they sit on it, I'll press to speak directly to Claims. Barring that, I will be calling back at least once every day.
If he objects to my contention that these documents were newly-requested I will continue to emphasize that as none of the correspondence he's referenced have ever come here and almost certainly have never been sent. We know the mailman and he knows us, any correspondence from an insurance company is printed in type -- they were not mis-delivered - and they were not ignored as junk mail on this end.
As for the rest, ultimately all options are on the table, though I have strong opinions on each. I will note that I have an old classmate who has been a print journalist - often on the muckraking beat - who's been with his newspaper for at least 15 years.
As for politicians, yes, they're vampires of their own stripe, but what they will want from the process is to me is largely an intangible ether. It's a mutually beneficial alliance, with the primary consideration (well, beyond the claim monies, of course) for me being whether or not the P.R. capital is going to a candidate I would endorse. As for the insurance lobby money, I've already addressed that to my satisfaction in last night's piece.
In both cases there are other trade-offs, but any more specifics on that and my options, though, aren't anything I should be spelling out in public.
I am clear that this is a series, not a motion picture. This will be an ongoing, adversarial relationship. My highest pragmatic aim is to counter them often and to a sifficient degree that our file attains the equivalent of a write-off status for them, and they come to find it's easier to simply process and pay, process and pay than expend constant effort trying to derail us.
Getting them to pay is step one, setting up an exact procedure to keep the checks coming is a very immediate step two. I will have to remain diligant and vigilant so that there will be no valid reason for surprises. No valid reason for there not being a one or two day window in each month where the check is scheduled to arrive. Once this is achieved, I will have to keep my guard up - always - but it will have reached the stage of playing a game with a hardass rules lawyer.
All I can give is moral support and my goofy nature to offset the merde you're going through.
Come over soon and we'll play Guillotine (the card game); every head you chop off will have the name of an insurance person attached to it.
Bon courage, mon cher ami.