Thursday, January 27, 2005

The Donald would be proud

Tuesday, January 11.

Two people have stopped me in the hallway to thank me for intervening on their behalf on the health insurance issue this morning.

I'm glad that they are pleased, but how the hell do they know that I did anything?

"Bonnie, get Paul in here, please."

Five minutes later, Paul is standing in my doorway.

"Has someone been talking to the employees about TLQ?"

"There's a lot of buzz out there. Apparently someone's calling them. I'm guessing it's someone from TLQ and not here."

"Aren't they calling us today with their plan?"

"They said three days, right? Today is the third business day."

We call Marna's office. Her assistant says she would like to schedule a conference call for 1:00. OK, when was she going to call and ask for an appointment?

"Go out and speak to a few of these people before 1:00 and find out who's calling them," I tell Paul.


12:30. I am eating at my desk, as usual. "Paul is here to see you," Bonnie says.


Paul takes a seat across from me. He's got a FedEx envelope in his hand. "TLQ is calling our employees and telling them that all their old insurance claims are being paid."

"I see."

"They're telling them that they're releasing payment without delay."

"Sounds good."

"No, it doesn't." He holds up the envelope. "Here's the first round of checks they wrote."

Our plan is self-funded, meaning that, up to a certain dollar amount, we pay our employee's medical claims out of the company's money. It sounds expensive, but it's actually cheaper this way. Also, we're usually able to pay a discounted rate.

"How much is there?" I say. I'm starting to get nervous.

"Thirty-seven thousand dollars," he says.


"It gets worse. You know Libby, from the call center?"


"There's a claim in here for her husband. Chemotherapy, or something. A really big one. And it's a pre-existing condition, something that he had BEFORE he came on our insurance. It shouldn't be covered under our plan. She's submitted claims before for this and they've been rejected, as they should be."

"How do you know all this?"

"I know because she tells me the whole story every time I pass her in the hallway!"

I look at him, rubbing my chin.

"Don't you see what this means, Steve? They're just paying the old claims to get rid of them quickly! They're not checking to see whether or not they're covered under the POLICY!"

"Jesus Christ," I say. "And now, they're calling employees to tell them their bills are being paid!"
"See what I mean?"

"If they make representations to the effect that they are going to pay these claims, the employees are gonna try to hold them to it," I say.

"Especially Libby!" he says.

Dan Johnson can't make the conference call today. I call Marna's office.

"Your conference call is scheduled for 1:00," Marna's assistant says.

"Get her on the phone now," I say.

"Sir, I am happy to help you, but we don't tolerate rudeness."


"One moment, please."

"This is Marna."

"Marna. Steve and Paul."

"Gentlemen!! What can I do for you?"

"Marna, I'm looking at $37,000 worth of 90-day-old claims here."

"Yes. We FedExed them last night for your signature."

"Did anyone review these claims to make sure they were covered under the PLAN?"

"Of COURSE, Steve."

"So why do we have an $8,000 payment for chemotherapy for a pre-existing condition?"


"If we released it, it must be covered."

"It's not," says Paul.

"There must be some misunderstanding. It just can't be."

"How many of these other ones are not covered, I wonder," Paul says.

"I'll need to get with my team, and we can discuss this further on our 1:00 call. We've been working non-stop on our plan over the weekend and yesterday."

"I can't feel good about any plan," I say. "I can't feel good about anything you say to me when I see an $8,000 check cut in error."

"Steve, I am sure there's some misunderstanding," Marna says. She sounds more confident today. "I mean, are you SURE that's chemo? Maybe it's something else. Our people don't release claims for non-covered services. Were we slow? Yes. Do we have more work to do? Yes. But the complaints that you were getting were for NON-payment, not OVER-payment."

"That doesn't mean you can't make a mistake," Paul says.

"We're all prone to error. But I would be shocked if that was wrong."

"We'll call you at one," I say. We hang up.

Paul and I call the hospital and inquire about Libby's husband's bill, taking copious notes. Then we call Marna back.

"Marna, Steve and Paul."


"Marna, it was chemotherapy. You're fired."