Healthcare

Photo by Patrick Tomasso on Unsplash

Yesterday, I had to get a prescription filled. I went to the pharmacy, and they told me that I was no longer covered by my insurance. I was confused, but it wasn’t the woman at the pharmacy’s fault, so I went home to straighten things out. I called the insurance company. After navigating a long menu and being on hold for about ten minutes, I got to speak with someone. She told me that my insurance had expired on 12/31; I’d been uninsured for ten days. I was surprised and asked why I hadn’t been notified that my coverage was being terminated. She checked my account and said that nothing had come by mail because I chose paperless when I signed up. (I thought that was the socially responsible thing to do.) She then speculated that they had sent an email, but it probably got caught in my spam filter and I never opened it. I said I would like to re-enroll. She told me that she couldn’t help me with that.

I get my insurance through the Affordable Care Act. One of the quirks of the ACA is that people don’t enroll for policies with the companies that will cover them. People enroll through the exchanges. So, the customer support person was nice enough to give me the number for the exchange. After another long menu and moderate hold, I was connected to the exchange’s customer support person. I explained what had happened and that I needed coverage. She was happy to help. She needed lots of information from me, that part of the call alone took about forty-five minutes. I’m not sure why they didn’t already have all of my info considering I did this a year and a half ago, but they needed it again. I qualified for the same exact plan I had that had expired ten days before.

So, I explained to her that I had a prescription waiting for me at the pharmacy and I wanted to make sure I was all set to go get it. She said probably. She explained that the enrollment should be effective immediately, but it normally takes 7-10 days to get the insurance card with the ID numbers and everything else. I asked if she could give me the number, I could write it down, and take it to the pharmacy. Unfortunately, that is all handled by the insurance company, not the exchange. So, she couldn’t help. But she did give me the phone number to call at the insurance company.

Back at the insurance company, the menu went faster because I remembered the number I’d pressed last time. The hold time was about the same. When I got someone, I explained everything and asked if I could get my number so I could get my prescription. She said that it was no problem, and she gave me the number. She did warn me that it was still processing in her system, but if the pharmacy gave me a hard time that I could call back.

I went back to the pharmacy, went to the desk, explained what had happened, and gave them my new number. They told me that the number didn’t match my info. I told them about what the insurance company said about it still processing, but they didn’t think that was the issue. So, I called the insurance company back. I had the wrong number. I had probably copied it down wrong. She gave me the correct number. (Which, it turns out, is the same ID number as I had before my insurance expired.) I gave that to the pharmacy. Then, they said they had to change the label on the prescription, and it would be about ten minutes. Ten minutes later, I got my medication and left.

If you’ve made it this far, you’re probably wondering why I’m telling you this story. What should have been a five-minute errand took a few hours, but that isn’t unusual enough to be exciting. It turns out, that’s exactly why I’m telling this story. I realized, one of the times I was on hold, that this is the American Healthcare system working exactly as it was designed to work. The metaphor “well-oiled machine” could have been invented to describe my three-hour journey to pick up a prescription. That struck me as significant.

When it comes to insurance, I’m operating from a place of privilege. I worked in the industry for over a decade. I understand it in theory and in practice. I speak the language. But that didn’t help because it is supposed to be wildly, extravagantly inefficient. In the business world (and, at the moment, everything from childcare and supply chains to higher education counts as the business world), every point of friction is a way to make money for someone. I dealt with at least four people in those three hours that wouldn’t have jobs in an efficient system. (I want to stress that every person I dealt with was kind, courteous, and competent.) It’s pretty crazy when you stop to think about it. So, I’m writing this in the hopes of getting some other people to stop and think about it. Then, we can all start talking about it. That’d be something.

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