Thursday, January 13, 2005

"Tag team, back again..."

Congratulations to Jake, who won the 100k contest and scored himself a Gmail account...

Also, let me take this opportunity to thank all my readers. This blog hit the 100,000 mark early Monday evening. Thanks to all of you for your support!

Finally, thanks for your words of encouragement over the past two days. As I have said to many of you, my comment boards were getting a bit "toxic" and something needed to be done. I'm feeling much better now ;-).


Tuesday, January 4.

Bonnie is standing in my doorway. "Steve, we've got a problem."

Whenever I hear her say that, I worry. Bonnie is very smart and resourceful, and whenever a problem crosses her desk, she makes it her business to take care of it. If she can't do so, it means it's something serious.

I look at her, eyebrows raised.

"I've been getting lots of complaints from employees about health claims not being paid. I tried to handle the first few myself, because sometimes they don't fill out the forms right, but I keep getting more and more..." She holds up an inch-thick stack of paper.

I work for a big insurance company, and now I have to waste time investigating health insurance issues? How annoying is that? Out of everything we do, this ought to be the easiest thing.

"So people are submitting claims, and they're being lost?" I ask. "Or paid late?"

"Going into a black hole," she says. "They're asking for the same information 2 and 3 times, and TLQ is taking months to process them, and then the employees get dunning notes from the doctors. And they're very rude on the phone, too."

"Get Paul in here, please," I say. Paul led the team that selected TLQ to process our claims. I'd say it's time to go with plan B.

I meet with Paul. He's well aware of what's going on and is already trying to work with TLQ to correct the issues. "I'm having trouble getting them to return my phone calls," he says.

"Give me the name of the president of the company."

"I think she's out of the country."

"I don't care."

I dial her number, and she picks up. "Marna, this is Steve. I'd like to meet with you....."

After I tell Dan Johnson about the problem, he wants to come to the meeting as well. THIS ought to be interesting.


Thursday, January 6.

Dan Johnson and I are at the TLQ offices. Their office suite is big and impressive, not at all what we would have expected from such an inefficient company.

Paul has a family emergency and is unable to be here. We chose not to reschedule.

"Now, when we walk in there, Steve, I want you to sit at the far end of the table, directly opposite from me," Dan says.

"Opposite from you?"

"All the way at the end of the table."

My organizational behavior professor in grad school was big on that kind of thing. "Meeting-room dynamics," he used to call them. I never put much stock in it.

A receptionist opens the door. Marna and an older-looking man are across from each other at the middle of the table. I take a seat at the far end. Everyone exchanges warm greetings.

"I suppose you know why we are here," I say. I like cutting to the chase. Most meetings could be very short if people did not ramble.

"We are an insurance company," I begin. "Our day is filled with a lot of difficult tasks. Like most people, we barely have enough time to do everything we need to. So it's extremely frustrating when my time, or anyone's time, is wasted on INSURANCE claims, of all things.

"When one or two people complain, maybe we could dismiss it. Improperly filled-out forms, lost paperwork, and so on."

"Let me take a step back," Marna says. "I need to assess-"

"And before I forget," I interrupt her. No way I'm letting her slow me down. That's just what she's trying to do. "I'm also getting complaints of rudeness. That's even less excusable than sitting on medical claims! I know that if my medical bill wasn't paid for three months, and then someone snapped at me, I'd be complaining too!"

"Our staff is-" she begins.

"SIXTY percent," I cut her off again. "SIXTY percent of my staff is on an HMO at this point. The only people on this plan are the more long-term people who didn't want to switch over. Out of courtesy to them, we're not forcing the issue. Do I have to force these 20-year employees onto a different plan just because we can't get claims paid?"

Of course not, but I'm making a point.

"No-" she begins.

"But yesterday takes the cake," I say. "I got THIS letter from an employee, threatening legal action. LEGAL action! He's going to SUE us, because YOU won't pay his claims!"

"May I see that?" she says.

"Perhaps you'd also like to see THIS," I say, raising my voice slightly, holding up the stack of unresolved issues, which is now well over an inch thick.

She leafs through the stack. Her face is ghastly white; she's muttering quietly to herself.

"We definitely have work to do," she says, finally. "I had a supervisor working with my claims group, and for whatever reason, he wasn't notifying us of the backlog..."

"Don't you, or someone else, get reports each week, or each month, of outstanding claims?!" Dan says, jabbing the hardwood table for emphasis: tak, tak, tak. It actually sounds quite loud in this suddenly very quiet room.

"It's somewhat informal," Marna says.

"INFORMAL?!" I say. "What does that mean, you pass each other in the hallway, shouting numbers back and forth?"

"There are laws regulating this sort of thing, you know," Dan says.

Marna is totally defeated. Her head lolls slowly to face me, then back to Dan, then back to me, like a prizefighter who is about to fall to the canvas. No matter which way she looks, one of us is staring at her. She's like a caged animal.

I guess meeting-room dynamics work after all, don't they?

"I need one week," Marna says. "Obviously, I'm not involved closely enough in what's happening down there, and I need to straighten some things out. I'll put a team together and strategize, and...."

"Make it three days," Dan says.

Her head slides to the left, slowly.

"This is our credibility on the line here," I say. "Some of these long-term employees, they love to criticize. They love to write long letters to CEO's and boards of directors. And long letters lead to meetings, and meetings lead to wasted time."

I'm not as concerned about that as I appear to be. But I need to drive my point home with authority.

"I am hearing you," she says. She looks close to tears.

"Three days!" Dan says. "I need to hear back from you with a plan in THREE. DAYS. Or we'll hire another firm effective February 1."

"But our contract is-"

"I'm sure there's a way out of the contract somewhere in here," I say, grabbing the stack of complaints and shaking it.

"I....I'll be back to you in three days," Marna says.

Dan and I get up and show ourselves out.

I look at my watch. The whole meeting took a little over a half-hour.