Corporate Response in AskMe

May 28, 2009 8:19 AM

Interesting response posted in this recent AskMe regarding insurance woes.

I've been returning to that question to see whether Clarkstonian has posted any follow-ups (I'm obsessive that way), and noticed this comment from the insurance company. HAP created a MeFi account today, for the purpose of offering advocacy and assistance to Clarkstonian's family.

Is this good? Bad? Indifferent? I don't know, but I was interested to see the health insurer go to that length to make contact and offer advocacy services, and sort of wondered how often we see something like that happen in AskMe and what we think of it.

posted by bunnycup to MetaFilter-related at 8:19 AM (54 comments total)

I guess the prospect of bad publicity for HAP lit a fire under somebody to take action.
posted by Marisa Stole the Precious Thing at 8:24 AM on May 28

It seems pretty awesome to me. I just hope that it's actually helpful for the clarkstonian family.
posted by snsranch at 8:27 AM on May 28

Usually if there's an AskMe that mentions a small business and I know the people involved [the mint.com example is the one I'm thinking of] I'll drop them a note and say "Hey, you might want to comment in that thread..." We see people registering accounts to do this sort of thing pretty infrequently. My general feeling is "huh, that seems like a savvy PR move" combined with "since clarkstonian can follow-up, we'll know if they were just blowing smoke or not..." It's very very easy to say "I'm listening" and much more difficult to actually listen and be able to do something about a problem. You see businesses trying to use Twitter for this sort of thing with good and bad results. I was able to tell Greyhound.com that there was a busted link on their website via Twitter which probably would have been impossible pre-cluetrain times.
posted by jessamyn at 8:30 AM on May 28 [1 favorite]

This is another good reason to name businesses that are mistreating you.
posted by grouse at 8:34 AM on May 28 [5 favorites]

Wells Fargo did this a few weeks back, too, and it was mentioned in a podcast. I, for one, like this trend. Companies doing proactive outreach like this is a good thing.
posted by Plutor at 8:38 AM on May 28 [1 favorite]

This is another good reason to name businesses that are mistreating you.

The downside, however, is that sometimes people do not just name the businesses, they pillory them and rant about them in AskMe. We've got good Google page rank so we've seen those attacks shoot up in Google rankings causing very angry responses from whoever the aggrieved business is. So, we're in this awkward position where it's clear that someone feels they had a bad experience with a business, but on the other hand, they could be a lunatic, totally misremembering, or otherwise wrong. So, we get stuck in a weird place with someone who is not a member email-hollering at us because one AskMe question has basically destroyed their Google rep. While I generally feel that this has more of a levelling effect than anything else (more often than not I think truth wins out) the spleen-venty nature of some of these shame-and-name questions (not referring to this one at all) can make things a little awkward here.

In this question specifically I think Clarkstonian's reporting of events worked out great. "I tried this, I talked to these people, I am having this problem, I am seeking this resolution" but I caution people to look at this as some sort of a Consumerist "fuck those guys" forum.
posted by jessamyn at 8:39 AM on May 28 [1 favorite]

I caution people to look at this as some sort of a Consumerist "fuck those guys" forum.

IIRC, Consumerist posted something a year back or so that one creative way to get a problem solved would be to do an AskMe about it, and I remember that not sitting all that well with me. AskMe is a phenomenal resource, but I would have hated to see AskMe turn into an offshoot of consumer griping. Let me be clear: my uneasiness was only related to the blurring of lines that Jessamyn is describing.

In this post, I think it works out well - the intent was to solicit the advice of the AskMe community, NOT to rant with sufficient page rank to bait a response out of the company involved. That the company saw it and stepped up to create an account and respond is a great, but unanticipated result, in my view.
posted by bunnycup at 8:44 AM on May 28 [1 favorite]

they could be a lunatic, totally misremembering, or otherwise wrong

Or a competitor out to ruin blah blah blah.
posted by Sys Rq at 8:57 AM on May 28 [1 favorite]

I agree entirely, jessamyn. I don't think the ranty "questions" are good at all, whether a business is named or not. But I have sometimes found a calm, well-written story of disappointment with a business that is not named and wanted to know the name so that I could avoid them in the future. Having that information is good for the community.
posted by grouse at 8:58 AM on May 28

I was able to tell Greyhound.com that there was a busted link on their website via Twitter which probably would have been impossible pre-cluetrain times.

I hope they got on the cluebus considering the business they're in.
posted by mullacc at 9:21 AM on May 28 [8 favorites]

Heh, I just emailed Jess about this and now I see there is already a post about it.

I have to say, something about the response sets off alarm bells with me, especially the "I'm very concerned that no one here has had direct contact with you or does not understand your needs" part. This could be the insurance company trying to help, but the last part feels, to me, a little bit like the insurance company wanting the family to not get lawyer.

I'm not really sure why it sets of those particular alarm bells -- possibly residual ill feeling toward insurance companies stemming from my own accident -- but it does.
posted by anastasiav at 9:32 AM on May 28 [4 favorites]

Funny thing about Greyhound.com, they still haven't fixed the markup on the link to their Twitter page.
posted by skynxnex at 9:49 AM on May 28

I'm not really sure why it sets of those particular alarm bells

The reason it sets off alarm bells with me is that insurance companies are for profit businesses that are beholden to stockholders, and claims to really want to listen to their rate payers and really help them are usually not entirely true statements.
posted by Meatbomb at 9:50 AM on May 28 [4 favorites]

"I'm very concerned that no one here has had direct contact with you or does not understand your needs"

At first, I read the word "here" to mean, "here at AskMefi". But it's possible that the person meant "here at my insurance company".
posted by Houstonian at 10:13 AM on May 28 [1 favorite]

The reason it sets off alarm bells with me is that insurance companies are for profit businesses that are beholden to stockholders, and claims to really want to listen to their rate payers and really help them are usually not entirely true statements.

Well, companies are not monolithic with a Borg-like unity of goal and purpose. The people working in the "HAPListens" division are ultimately beholden to the company at large, but they are hired to make customers happy and they probably really do actually want to listen to their customers and help them.

Think about it this way: it is against the financial interests of a store to accept returns of merchandise. Nonetheless, many do, and often the person working at the return desk wants nothing more than to make the return process go smoothly.

The truth is, all companies are for profit businesses, and many non-profits have practices and goals that make them virtually indistinguishable from for-profit corporations. And even though their goal is to make profit, most of them manage to provide a good or service that approximates the price they ask for it. If a company doesn't, then unless it has a total monopoly (which, to be fair, can sometimes happen in insurance) its customers will abandon it for a competitor.

A good counterpoint is information infrastructure companies, who do tend to monopolize an area. The web is filled with horror stories of the bad customer service provided by phone, cable, and broadband internet providers. Even then, for a vast majority of its customers, things still work.
posted by Deathalicious at 10:18 AM on May 28 [1 favorite]

I think this is evidence that "we" are growing large enough that The Man has begun to take notice. I hope their intentions were sincere -- insurance companies can sometimes be evil prevaricators who stall & obfuscate for the sake of hoping they won't have to live up to the letter of their policies. I had a go-round with some kidney stones about 2 years ago, & my credit is now utterly trashed.
posted by Devils Rancher at 10:20 AM on May 28 [1 favorite]

The reason it sets off alarm bells with me is that insurance companies are for profit businesses that are beholden to stockholders, and claims to really want to listen to their rate payers and really help them are usually not entirely true statements.

On the other hand companies are not completely homogeneous and there can be special internal employees in charge of making sure customers are being treated fairly. If a particular department is mainly concerned about profit and another department is more concerned with customer satisfaction, getting better treatment can sometimes just be a matter of getting your complaints heard by the right people within the company. I have no specific knowledge about how HAP is set up, but it's not unthinkable that the person who responding is really trying to help. I agree that in general for-profit companies only do things that benefit themselves in the long run though.
posted by burnmp3s at 10:21 AM on May 28 [1 favorite]

Also, I'd be concerned about the authenticity of the HAPListens account. All we really know is that there's someone who *says* they are from HAP, but how can we know that it's true?

I'd certainly advise the family involved to be very cautious about disclosing any personal information to this person until they are able to verify that Angela is who she claims to be (e.g., call the HAP headquarters and ask for her).
posted by jasper411 at 10:29 AM on May 28 [2 favorites]

Should this individual from HAP be expected to be able to identify the member involved using company resources? I would say yes, but perhaps they have several claims from parents whose daughters' backs were broken when 67 foot dead ash trees fell on them in a public park.
posted by preparat at 10:31 AM on May 28 [1 favorite]

preparat, that doesn't mean it's easy for them to search that way.
posted by grouse at 10:38 AM on May 28

Also, I'd be concerned about the authenticity of the HAPListens account. All we really know is that there's someone who *says* they are from HAP, but how can we know that it's true?

The email address is from hap.org, which appears to be their official website. It's the first result on Google for HAP at least, which would be no small feat for a scam site.

Should this individual from HAP be expected to be able to identify the member involved using company resources? I would say yes, but perhaps they have several claims from parents whose daughters' backs were broken when 67 foot dead ash trees fell on them in a public park.

I highly doubt that random employees can lookup arbitrary claim data. Especially considering this is confidential medical information we are talking about, there are most likely very tight controls on who gets access to customer identifiable information.
posted by burnmp3s at 10:38 AM on May 28

The insurance racket business depends entirely upon taking in more than it pays out; continued profitability demands maximizing the former and minimizing the latter. Therefore, I don't think cautious skepticism re: "customer relations" necessarily equals cynicism, nor is it remotely unwarranted, nor should it be discouraged.
posted by Sys Rq at 10:38 AM on May 28 [1 favorite]

This could be the insurance company trying to help, but the last part feels, to me, a little bit like the insurance company wanting the family to not get lawyer.

Agreed. One thing that does not set off my alarm bells is that the company does not attempt, in the post at least, to dispute that the situation sucks or that the poster shouldn't get a lawyer or anything of that sort. Further, they do not try to hide who they are. We could address or respond to them directly if we, as the MeFi community, would like and they are not putting up barriers to that.
posted by Pollomacho at 10:53 AM on May 28

It's one thing -- and an all-too-common thing -- for a health insurance company to dick around with its customers when they're in a desperate state. But if somebody purporting to be from a health insurance company decides to come into our yard volunteering to advocate for a clearly distressed parent whose daughter is grievously injured . . . .

Well, Angela, I hope you have lurked here long enough to realize that you need to follow through because MeFi. follows. up.
posted by FelliniBlank at 11:04 AM on May 28 [3 favorites]

Also, I'd be concerned about the authenticity of the HAPListens account. All we really know is that there's someone who *says* they are from HAP, but how can we know that it's true?

Based on what we can see on the backend, there's no reason to doubt in this case that it's someone from HAP.

But, yeah, that's another one of the odd wrinkles in this sort of thing, and in that sense it's good that we usually hear from one or two people when something like this goes down. Though our toolset at this point makes it pretty easy to catch something like this when it happens.

And echoing the notions above that however weird and unlikeable the implications and produce of an explicitly-for-profit business model for insurance companies is, they are nonetheless staffed by and large by actual living, breathing, and generally empathetic human beings. For every penny-pinching snake in the (likely upper tier of) a claims department, there are ten or fifty people who have the really trying job of working to help possibly-upset, possibly-angry, possibly-preemptively-hostile people navigate through the territory of getting properly and promptly compensated for having life take a shitty turn.
posted by cortex at 11:06 AM on May 28 [2 favorites]

Usually if there's an AskMe that mentions a small business and I know the people involved [the mint.com example is the one I'm thinking of] I'll drop them a note and say "Hey, you might want to comment in that thread..."

I just reviewed the Mint thread but didn't notice any comments from Mint staff - did you just mean you told them about it, or that they had replied? Is it a different question?
posted by odinsdream at 11:17 AM on May 28

As someone who works in the insurance/legal sector (not health), I am appreciative of Cortex's and others' comments pointing out that sometimes actual human beings who work in the field day in and day out separate from the robotic must-profit machine, and actually want to help.

We have had many such individuals at Oxford, my family's health provider, who have gone out of their way to be helpful and kind when our family has had both medical tragedies and mundane issues as well. Sounds like Angela by reaching out is one of that set.
posted by bunnycup at 12:03 PM on May 28

FelliniBlank: Well, Angela, I hope you have lurked here long enough to realize that you need to follow through because MeFi. follows. up.

What is this now, Sparta?

I'm no fan of health insurance companies but threatening a person by name who, I might add, reached out with an offer of help, is not cool, however vague the threat may be.
posted by Kattullus at 12:14 PM on May 28 [2 favorites]

did you just mean you told them about it, or that they had replied? Is it a different question?

When I signed up for Mint a little under a month ago, I got a forum message from their user experience person saying "hey are you jessamyn from MetaFilter?" and I said yeah. It was a nice note and he said he'd tell people to be extra nice to me, or something. This was sort of amusing considering that my experience with Mint so far has been sort of assy. Anyhow, when I saw that thread, I wrote the same guy a note a day or two ago saying "hey people are talking about mint on AskMe, let me know if you'd like to comment, I could set you up with an account" and I didn't hear back.

However, my feeling about Mint is that it's someone's shoestring project and while they might be staffed with some of the friendliest most well-meaning people, they sort of suck at support and troubleshooting and/or "owning" a problem (I've gotten a lot of really weak email responses from them that don't even seem to have read my emails or have a sense of what my ongoing issue is). So, if Mint works for you, it's terrific but if it doesn't work for you, you're really SOL. That is my Mint experience. Them not replying in the thread seems sort of par for the course, but maybe they're just slow.
posted by jessamyn at 12:28 PM on May 28 [2 favorites]

Sounds like Angela by reaching out is one of that set.

It may well be that HAPListens is doing well by their insured. It could also be, though, that they would prefer the insured talk to them than talk to an attorney. It could also be a combination of both.

In the end, though, the OP really doesn't have the time or energy to fight these battles out, one by one, even if she has a liaison at the insurer to take her calls and address her complaints. It will involve endless back-and-forth (get this form from your PCP, now that form from your specialist, well that was the wrong form, get this one instead, etc etc). Best to hire someone to do it for her, so she can concentrate on helping her daughter get better.
posted by palliser at 1:03 PM on May 28

I'm just hoping that HAPListens sticks around after this is done and gets to know the site a bit better. It would be fantastic to have a member here who started here under such unusual circumstances only to become someone who posts and comments regularly.

Oh, who am I kidding? I just want to see them drunkenly flame out in a thread arguing over the minutia of why pirates are cooler than ninjas.
posted by quin at 1:30 PM on May 28

However, my feeling about Mint is that it's someone's shoestring project and while they might be staffed with some of the friendliest most well-meaning people, they sort of suck at support and troubleshooting and/or "owning" a problem

Part of the problem is that what they are doing is inherently difficult. They are getting account access through Yodlee, which in turn is accessing a wide variety of accounts without much support from the companies that run the account websites. As a programmer that task seems like a massive never-ending maintenance nightmare.

For example, at one point my PayPal account (along with everyone else who was using Yodlee's) was disabled because without warning PayPal decided to start locking the accounts of anyone who used automated methods to log into their website. Even for small changes like a different page getting shown after logging in will foul up Yodlee's access code, and someone will have to investigate what happened and update the code. Add in the fact that it's a free service and there's just not enough of a financial incentive to spend all of the time required to making sure all of the account aggregation works flawlessly
posted by burnmp3s at 1:35 PM on May 28 [2 favorites]

The reason it sets off alarm bells with me is that insurance companies are for profit businesses that are beholden to stockholders, and claims to really want to listen to their rate payers and really help them are usually not entirely true statements.

Interesting fact that it takes about 5 minutes with google to uncover: HAP is not only not a publicly-traded health insurance company, but it is apparently a nonprofit owned by a nonprofit hospital system. While I do pretty much agree with Deathalicious that in most of the health market (and maybe elsewhere too) it doesn't make that much a difference whether a health care plan or hospital formally structures itself as for-profit or non-profit, I must admit that when I ran across that thread yesterday I quickly became extremely irritated. It's bad enough that we can't have a halfway-decent conversation on the blue about health care without it quickly degenerating into "AMERICAN HEALTH CARE SUCKS, WHY DON'T YOU JUST FIX THAT WITH SOME SINGLE-PAYER SAUCE, HUH?" literally no matter what aspect of health care is being talked about. (Not that I always disagree with the sentiment, but once you've heard it once it gets tiring to have the next 50 comments repeat the same damn thing with no additional insight, just venting.) I hate that the level of conversation never really elevates above a not-particularly-good comments section of a local paper, but c'est la vie, I can handle the fact that metafilter just isn't that good at talking about the subject that happens to be near and dear to my heart, that's the way it is sometimes.

However, I really think it's neither helpful to the site nor the questioner to drag your political opinions into a question in AskMe and grind-grind-grind your axe when it doesn't stand a damn chance of actually helping him with the problem. I can't imagine how confusing and frustrating it would be to be in Clarkstonian's position right now, trying to understand what he needs to do to secure care for his daughter, and I don't know how HURF DURF INSURANCE SUCKS helps at all. The people who stepped up and gave him concrete advice about steps to take and how to proceed should be applauded. The people who had nothing else to add other than "they're doing this to screw you because health insurance sucks"--which I suppose was ostensibly answering his question about why his policy won't cover a particular doctor, and I guess answers don't get deleted just because they're wrong--well, I think they did a real disservice to the OP. It's hard enough to find good information about how to navigate a health crisis without the political commentary that does nothing other than lower the signal-to-noise ratio.
posted by iminurmefi at 2:28 PM on May 28 [6 favorites]

Oh, who am I kidding? I just want to see them drunkenly flame out in a thread arguing over the minutia of why pirates are cooler than ninjas.

"Are you seriously claiming that pirates are better at swordfighting? Are you fucking kidding me? You know what, how about HAPshutsthehellup."
posted by cortex at 2:48 PM on May 28

I'm no fan of health insurance companies but threatening a person by name who, I might add, reached out with an offer of help, is not cool, however vague the threat may be.

Whoa, I'm genuinely sorry if that was how that comment sounded; it was absolutely not intended that way. All I meant was that this isn't the sort of anonymous drive-by site where, if some joky sockpuppet offered help without meaning it, people would be oblivious. I think a lot of people will follow the thread to see if Clarkstonian gets some help and will probably complain here about unethical behavior later if this is just hot air or PR. I didn't mean anyone would harm the person, whoever it might be.

Nobody asked this HAP-rep, if (s)he is one, to make this offer of assistance, creditable as that may be, but if you speak up to make such an offer, people will expect you to back it up and have every right to hold you and your organization to that.
posted by FelliniBlank at 3:26 PM on May 28

Part of the problem is...

You've explained the general situation better than anyone I've been in contact with at the actual site.
posted by jessamyn at 3:45 PM on May 28

FelliniBlank: Whoa, I'm genuinely sorry if that was how that comment sounded; it was absolutely not intended that way. All I meant was that this isn't the sort of anonymous drive-by site where, if some joky sockpuppet offered help without meaning it, people would be oblivious.

Now that I read it again I can see that.
posted by Kattullus at 4:43 PM on May 28

I put one of the "insurance sucks" comments in there. I did it in response to clarkstonian's apparent lack of understanding of the nature of insurance companies ("I don't understand how the insurance company benefits by denying an 18-year-old proper care... Their seeming total indifference just boggles my mind"). I don't think I did it with added hurf durf, and my intent was to help clarkstonian unboggle their mind and get a clear view of what they were actually dealing with, to help them understand that lawyering up was indeed their best option.

I live in a country that does have taxpayer funded universal health care, and by and large it works. There is no way that an Australian (or even an American injured and seeking care withing Australia) would ever find themselves facing anything like clarkstonian's current horrible choices.

If I'm axe grindey, it's only because American policy and American attitudes are so often held up as universally correct here (in Australia, not MeFi) by people who you'd think would know better. I'm shit scared of having my present high standards of healthcare dismantled at some point by pollies who think that the American way must automatically be the correct way, regardless of how plainly broken its present state is. So it's in my own best interests to do what little I can to persuade as many Americans as possible to think about why they're currently hurting, and exert pressure to get that breakage attended to before the contagion spreads elsewhere.

So, why don't you fix that with some single-payer sauce? Have a look at Britain's NHS. Have a look at Australia's Medicare. Neither system is without flaw, but both of them are far, far better than what you have now.
posted by flabdablet at 6:22 PM on May 28

So, why don't you fix that with some single-payer sauce?

This is what sort of gets me. Do you want to know why I specifically am not fixing it? Or do you want to know why the US isn't fixing it? The issue isn't so much that most people who are consumers of health care don't see that wisdom, it's that dismantling the current system involves a huge loss of status and cash to a lot of the insurance/health care/big pharm status quo and they're not giving it up willingly or without a huge fight.

We're still seeing them making appalling land grabs like Bush's completely insane and harmful prescription drug fiasco that wasn't actually that long ago. So, we elected someone whose idea of a health care plan was more in line with what the majority of Americans think is a good idea and in the meantime we lobby and write letters and try to make the US a more just place.

But it doesn't happen overnight and while I don't think that you personally flabdablet are a real aggressor here, the fact is that there's often a non-US-resident more than willing to jump into a thread about a health problem and be like "the US is fucked and broken, your health insurance sucks" and it's tiresome. The general MeFi population, if I can generalize a bit, is on board with health care reform in the US. Being dicks about it, especially when someone is going through a huge crisis, is nasty shit and we see it too often here and it's not going to make the US get single payer health care any more quickly.
posted by jessamyn at 6:46 PM on May 28 [9 favorites]

Do you want to know why I specifically am not fixing it? Or do you want to know why the US isn't fixing it?

B.

and be like "the US is fucked and broken, your health insurance sucks" and it's tiresome

What we get far too much of in this country's discourse is the line about "private health insurance is a vital part of any health system, and if it weren't for private health insurance the public system would be overloaded and unaffordable" and that's tiresome.

But I agree that being dicks about anything doesn't often help.

Pax.
posted by flabdablet at 8:39 PM on May 28

cortex: And echoing the notions above that however weird and unlikeable the implications and produce of an explicitly-for-profit business model for insurance companies is, they are nonetheless staffed by and large by actual living, breathing, and generally empathetic human beings. For every penny-pinching snake in the (likely upper tier of) a claims department, there are ten or fifty people who have the really trying job of working to help possibly-upset, possibly-angry, possibly-preemptively-hostile people navigate through the territory of getting properly and promptly compensated for having life take a shitty turn.

A few years ago, I worked a shitty, shitty sales job. That was a story in itself, but I knew a woman who worked one building over in a large insurance company's “resolutions” department. She was the richest cubicle worker I've ever met; in the year that I knew her, she made a hundred and fifty thousand dollars. How? Because she was the most successful adjuster and mediator in the office, and because she'd single-handedly prevented a million dollars worth of claims that year. Not only were all the specialists there paid on “commission” (at a rate that was directly structured against the dollar-value of claims they'd prevented)—this was open and obvious, and she won a number of bonuses for large accounts that she “resolved with minimum payout.” And I can tell you that, in the finest tradition of modern salesmanship and its ludicrous rationalizations of the basest stupidity, she was absolutely convinced that she was doing her clients a favor by keeping the bottom line low and thereby keeping insurance rates affordable for everybody else.

Now, I know that I have no way of knowing whether all insurance companies work that way. I know that it's largely my own cynicism that impels me toward the conclusion that insurance companies see any larger potential larger claim as an opportunity to save themselves money. But I've had a hard time seeing it any other way, especially since reading David Berardinelli's particularly eye-opening account of Allstate's “Good Hands or Boxing Gloves” policy (yes, they really called it that) of strenuously discouraging litigation (they handed out brochures about what an awful experience it would be if you even talked to a lawyer) and minimizing payouts until the very moment that they couldn't prevent a client from exploring the possibility, at which time the company was instructed to litigate so forcefully and so aggressively that clients would welcome smaller settlements merely to remove the stress that the dispute was causing them.

Like I said, I know that nice people work at insurance companies—but I don't think it's irrational to believe that the nice people aren't the ones that get assignments like the one described in the post in question. Or to think that it's a bit interesting that the insurance company prefers to remain somewhat aloof of the situation until the client is seriously considering talking to a lawyer, at which time a nice, helpful person from HAP suddenly appears to provide support.

The insurance industry needs a good deal more regulation than it gets right now.
posted by koeselitz at 10:36 PM on May 28 [4 favorites]

flabdablet: If I'm axe grindey, it's only because American policy and American attitudes are so often held up as universally correct here (in Australia, not MeFi) by people who you'd think would know better.

How ironic. Living here in America, I frequently find myself trying to resist the temptation to grind my own axe because the US is so often held up as universally wrong.
posted by koeselitz at 10:46 PM on May 28

flabdabet, I appreciate that most people who make those comments aren't doing it to be malicious. It probably is confusing to look at the American health care system and wonder why people put up with something that works so poorly. But, specifically in response to this:

I did it in response to clarkstonian's apparent lack of understanding of the nature of insurance companies ("I don't understand how the insurance company benefits by denying an 18-year-old proper care... Their seeming total indifference just boggles my mind").

I would submit that while your intentions were good, you don't have a very good understanding of the nature of Clarkstonian's particular insurance company either. That's understandable, particularly as you're not in the U.S. (hell, most people here don't have a very good understanding of different types of insurance and how they work, and that in and of itself is a pretty good argument for simplifying the payment system), but it is frustrating to see someone jump in like that to "explain" something that they themselves don't really understand.

HAP is an HMO. The way that HMOs work is that you get lower premiums now in exchange for less choice down the line when you need a doctor: they only cover doctors that are in their network, and if you go out of network you don't get any coverage at all--you are on your own. (Sometimes an HMO will authorize out-of-network physicians, usually if they don't have a contract with anyone in the specialty needed, but they try to avoid that.) It doesn't really have anything to do with shareholder profits or greed or inherent evil: it's just the way that all HMOs are structured. It's how the insurance contract is written. That's what an HMO is on a pretty fundamental level. This is in contrast to PPOs, which are almost always more expensive in terms of monthly premiums, but where the insurance company will reimburse you both for in-network visits and also out-of-network docs (albeit at a lower level, say 60% of the cost rather than 80% for in-network). This is almost certainly why HAP is telling Clarkstonian to not continue treatment with the doctor who originally saw his daughter at the time of the accident, and to take her instead to what are presumably in-network doctors of the same specialty with whom the insurance company has negotiated lower rates (or who are maybe employees of the insurance company, depending on its structure).

I thought for a bit about posting the explanation of all this in that thread, but after thinking about it for a few minutes, I decided that the finer points of HMO vs. PPO and the trade-offs between the two weren't really that helpful in the end (especially since I didn't know what sorts of "magic words" he might need to use to get an out-of-network referral from an HMO, although I'm sure some exist--I was hoping others with experience working at HMOs could jump in with that). Since I didn't know the circumstances of how Clarkstonian came to have an HMO (maybe it was the only option his employer offered, maybe it's the only affordable insurance in his area, etc etc) I also worried it risked coming off as "well that's what you signed up for" and blame-y when I'm sure that's the last thing he needs. However, that's why it was kind of irritating to see people jump in with "explanations" who apparently didn't understand the nature of what he was dealing with, and why it was happening.

As a side note, I do work in DC on issues of health care reform, and if you'd like to know why I personally believe "single payer sauce" is not the silver bullet for fixing our health care system I cannot recommend highly enough reading the article in this recent FPP. The sickness in American health care goes way beyond who is paying the bills; we have a broken delivery system that is going to keep pushing costs higher and higher no matter who is paying, private insurance companies or the government. Changing who pays is in some sense re-arranging deck chairs on the Titantic, although hopefully any overhaul of payment systems will give us a chance to go in and fix some of the delivery issues.
posted by iminurmefi at 7:30 AM on May 29 [4 favorites]

So, why don't you fix that with some single-payer sauce?

This is a genuine question: isn't her problem that she wants to see a particular, highly expert neurosurgeon who specializes in these particular injuries, instead of just a regular old neurosurgeon? It was not my impression that this sort of desire is invariably granted under any health-care system. I could be wrong, though -- can you just see any doctor you want, the most specialized and highly regarded in the field, as soon as you want? That seems logistically difficult.
posted by palliser at 7:43 AM on May 29

"I'll drop them a note and say "Hey, you might want to comment in that thread..." - jessamyn
Woohoo, kickback city! What's the best thing you've gotten so far??
posted by Grither at 11:01 AM on May 29

I got a rock!

Aside from beer and places to crash, I don't think I've gotten anything in the way of schwag from my many MeFi back-and-forths. Other than this job.
posted by jessamyn at 11:45 AM on May 29

Haha that's too bad. But hey, free beer is better than no beer!
posted by Grither at 12:00 PM on May 29

I don't think I've gotten anything in the way of schwag from my many MeFi back-and-forths

IIRC you got a whole pile of cool shit from Kabul.
posted by Meatbomb at 12:47 PM on May 29

I got a bunch of cool schwag in the MeFi Button/Sticker/Other Random Stuff Swap last year. We should do another one of those at some point (as long as I'm not the one doing all of the work to organize and coordinate everything).
posted by burnmp3s at 12:56 PM on May 29

IIRC you got a whole pile of cool shit from Kabul.

Yes! But vendors/businesses haven't given me anything as a quid pro quo sort of thing. I love that hat, and the bag still smells appealingly of woodsmoke.
posted by jessamyn at 1:06 PM on May 29

dismantling the current system involves a huge loss of status and cash to a lot of the insurance/health care/big pharm status quo

Does it, though?

Government insurance coverage would most likely be minimal, and would require additional outside insurance to bump it up to half-decent levels. (That's how it works up here, anyway.) The people who do the bump-up are people who can afford it; many of these people--or their employers--can afford to pay a bit more than what their coverage would cost by today's standards. The insurance firms would take in more money relative to their payouts, since the most-used bottom tier is covered by the government. It would be a different business model, but not necessarily less lucrative.

As for health care and pharma: If more people could access them, more people would access them. Win-win-win.
posted by Sys Rq at 1:10 PM on May 29

As Bank of America, which my tax dollars support to the off-key tune of 25 billion has seen fit to give me a fit and charge me $240.00 for less than $15 worth of hamburger overdraft fees, over the course of 2 days, I would like to use the exact same formula to assess the payback for the loan I, as a taxpayer, gave them.

If I charged them what they charged me:
Figure they loaned me $15 for 2 days and charged me $240.
That, and I'm sleepy, but I think it equals an annualized percentage of 292000.00% (not compound interest mind)
So apply that to the loan we gave them. 300 million americans donating their share of 25 billion.
That means you gave B of A $83.33.

So at the end of one year, B of A should:
Multiply $8.33 by 292000%
and pay each of us $243,323.60

In burgers.

Someone help me if I missed the maths please.
posted by vapidave at 2:28 PM on May 29

can you just see any doctor you want, the most specialized and highly regarded in the field, as soon as you want?

I can do that without risk to my credit rating, yes. Well, as soon as an appointment can be arranged, anyway. I need a referral from a GP to see a specialist, but that's the only organizational hoop to jump through.

As for paying for medical treatment: Medicare (that's the Australian Medicare, not that thing from the bizarro world with the same name) has a scheduled fee for any given medical procedure ("item"). Who pays what to whom depends on whether the medical service provider in question "bulk bills".

If you have a Health Care Card (which certain classes of people, mainly low-income earners, have an automatic right to), then most doctors will bulk bill you; some doctors and/or clinics will bulk bill anybody. If you're covered by bulk billing, you sign an authorization for the service provider to collect their fee direct from Medicare, and walk out of their office paying nothing at all. Health Care Cards also entitle their holders to pay trivial amounts for prescribed drugs included in the Pharmaceutical Benefits Scheme. Drug companies hate the PBS, because the PBS is a single buyer that's almost as big as they are; it levels the playing field very nicely.

If you can't be bulk billed, then you pay the service provider whatever fee they charge, and get a receipt that identifies the item numbers I've been billed for. You take that along to a Medicare office and they refund you the listed Medicare rate for those items. The difference between what you pay the provider and what Medicare pays you is called "the gap" and it's possible to get private health insurance that covers at least some of this.

If you don't have gap insurance, there's the Medicare Safety Net, which refunds you 80% of gap payments over a certain not-very-high yearly threshold.

About the only way to cost yourself vast amounts of dollars on medical care in Australia is to book yourself in to a private hospital. That's expensive. But overstretched and underfunded though they may be, the standard of care available in Australia's government funded public hospitals is just excellent - and I can walk into any one of their emergency departments, and get seen after a non-life-threatening wait in non-life-threatening surroundings, and if I'm admitted as an inpatient I pay nothing.

And you know - I look at what I've got access to, and I look at what Americans have to put up with (insurers that dictate what doctors you can see and what they're allowed to do for you? Arrgh!) and it just makes me want to weep tears of frustration, because most of the opposition to government funded health care in your country doesn't need to go much further than invoking the S word and your elected representatives just crumble. It's pathetic, this fear of socialized medicine. Just pathetic.

iminurmefi, I did read that New Yorker article, and I did come away from it with a more complete view of the total clusterfuck that is the US medical treatment system. And I still think that making the Government the major payer has to be the first step in cleaning out those Augean stables. It seems to me that nothing much is going to change until you actually get your elected 800 pound gorilla in charge of the money, and start forcing hospitals to organize themselves more like the Mayo and less like Doctors Hospital.
posted by flabdablet at 5:44 AM on May 30 [3 favorites]

can you just see any doctor you want, the most specialized and highly regarded in the field, as soon as you want?

Well, you can see them as soon as you get an appointment and no amount of waving cash or having an insurance card will get you to the front of the line in Canada (and despite the propaganda, wait times are not excessive). I know a lot of older people with health problems (heart disease, cancer etc) and all of them shop around getting appointments with different doctors until they find a good mix of a doctor they like/timeframe for treatment they are comfortable with and everything is covered by OHIP. When my fetus was diagnosed with anacephaly the foremost expert in Canada on her genetic disorder was beside my bed in twenty minutes (okay, I was lucky he lived close to the hospital; but really, I could have been seen by any doctor but our health care system thought I was important enough for him, never mind the fact that I didn't even have money to pay for parking at the hospital).

Illness and money are the two biggest stressors in many people's lives, combining the two is just deadly. My heart goes out to clarkstonian and his family.
posted by saucysault at 7:58 PM on May 31