Among his many accomplishments, the German author Franz Kafka is credited with bringing the modern understanding of the organizational creation known as "the bureaucracy" into being with his 1925 novel Der Process (The Trial).
A century later, American healthcare and the American insurance industry have nearly-completely perfected the behaviors documented by Kafka.
To wit, my wife's recent experience trying to resolve a claim, now six months old and still dragging on.
In the following, HealthCare Co. and BigInsurer have been used in place of the actual healthcare company and insurance company, and the names of the representatives have been changed to M and J, but otherwise the experience is exactly as described:
68 minutes on hold and counting ...
Called HealthCare Co., explained the letter from BigInsurer and was told to call the HealthCare Co. billing department.
Called them and then used my noggin and said, I’d like to do a conference call with BigInsurer as this is my second call regarding the same matter.
Got on the conference call and the two reps (M at HealthCare Co. and J at BigInsurer – both very nice thankfully) reviewed the claim.
HealthCare Co. billing said to call the HealthCare Co. office because they need to resubmit the claim with the correct codes --- J called the HealthCare Co. office and they said to talk to the billing department and who then transferred J back to M in billing.
It’s all about codes. The HealthCare Co. office billed my visit as an out-patient visit and not a preventative care visit.
But to add to the complication and confusion of billing codes … they kept talking about vitamin D – I said: "I didn’t get any vitamins." J said, "no no they are talking about blood work."
OH! Yes, I was sent next door (in the same building) to the HealthCare Co. labs, to get my blood work done.
HealthCare Co. Labs sent it to the hospital who in turn billed BigInsurer.
Yes, still on hold while I type the saga and updating the number of minutes as I hold. J has been checking back in with me for the past 58 minutes of the number listed at the start of this epic email.
She came back on line and said ‘not to say anything bad about that office, but wow there is a serious disconnect over there”. I can’t agree more. She finally was told to call the hospital, was put on hold three times and then disconnected.
I am now off the phone and waiting for her to call back hopefully indicating that she was able to get this resolved. Oh, the wonders of the medical industry!
Kafka would surely have understood, when he wrote:
Try to realize that this vast judicial organism remains, so to speak, in a state of eternal equilibrium, and that if you change something on your own where you are, you can cut the ground out from under your own feel and fall, while the vast organism easily compensates for the minor disturbance at some other spot – after all, everything is interconnected – and remains unchanged, if not, which is likely, even more resolute, more vigilant, more severe, more malicious.