Demons and the Repetition Compulsion

“Well, you may have a point there, Elie, about the faces of the demons we fight,” said the skeleton of my father.  My father, during his life, was always silent about the particular demons he was up against, although he made mention of the demons every one of us must grapple with.

That mad, but brilliant, classmate of mine in law school told me about the “Repetition Compulsion.”   It is a compulsive need to relive, and re-litigate, painful personal transactions of the past.   You find yourself drawn to types who have some salient aspects of the people who bludgeoned you early on.  As you were my bludgeoner-in-chief, it’s not surprising I found myself in close contact with people who exhibited your most personal traits. 

“So these people were brilliant,” said the skeleton.  

Brilliant assholes, pinched and needy, bent on ‘winning’ at any cost.  Worthy adversaries, until they were not.  

“Youch!” said the skeleton.  

I’ve got to be honest here, dad.  It’s all I can do, particularly in a world like ours, where the media increasingly gives equal weight to the comments of the studious and thoughtful and to the careless stylings of talking, shit-smeared assholes.  

“Well, talking, shit-smeared assholes tend to rule, Elie,” said the skeleton.  “It’s a matter of opinion anyway, who is smart and who a shit-smeared asshole.  One man’s shit-smeared asshole is another man’s no bullshit, straight shooting president.  Ask the 39% if you don’t believe me.”  

Granted.  I think of the long struggle with my good friend Friedman. Implacably unhappy fellow, aggressively so, actually.   I don’t know that he was beaten as you were, physically, but he emerged from childhood with serious and stubborn wounds.  He was a guy who felt he could never win, I suppose, so everything in his life was a contest and he had to prevail.  He pursued these little victories reflexively, he always had to negotiate and get the best of every interaction.  The story arc of every transaction with people he met was identical– high hopes, betrayal, sullen, smoldering anger he would not admit was anger.  It wearied me to death, slowly, over decades.  Nothing could ever be good enough for an unhappy soul like that.   He was eternally seeking some impossible ideal of perfection, eternally disappointed, betrayed over and over and over.  

“Sounds familiar,” said the skeleton.  

Yeah.  Anyway, in the end, he was reduced to silence.  It took me many years, I had my own wounds to deal with, but finally I boiled his insoluble misery down to a single issue.  To my grim gratification he was speechless, didn’t have a word to say in defense of his indefensible world view, the things he expected from his friends, the impossible burdens he tried to make them carry.  We sat in a Florida diner, a deluge pelting down outside, and he just looked at me, very hurt and not a little bit angry.   That’s the expression of one of my demons, irrational disapproval that needs not so much as a whiff of a justification.

“Well, you always said you were not sorry you went to law school, though law was the wrong line of work for you and you are still deep in debt for loans for the tuition, it did teach you to organize your arguments,” said the skeleton.  “I realized I was over my head during that last one in the den, where I fought you desperately, knowing I was completely fucked.”    

It’s another argument for the people can change position.  If not change, we can refine our talents, anyway.  

“I won’t argue that,” said the skeleton.  “What other demons you got, besides Friedman?”  

Well, there was an angry woman I stayed friends with for decades.  Very smart, great sense of humor, talented, but terminally angry and never satisfied, always feeling she was on the short end of things.  Whipped her feckless, out-gunned husband mercilessly every time we had dinner with them.  In the end, she turned her anger against me.  When I responded with a long note about how hurt I was by an email she sent chiding me for self-pity and depression, I never heard from her again.  It’s like she was waiting for me to tell her I was done with her, as if she’d been waiting for years for me to confirm that she was unworthy of friendship.  Maybe she had been waiting, biding her time for a moment of weakness on my part.   It would have been an easy matter, if she hadn’t meant to hurt me, to have simply apologized for a harsh, arguably cruel, email.  She was apparently incapable of it.  Or maybe she thought I didn’t deserve an apology, that I was an unredeemed asshole.  In any case, her face, bored and superior, is up there when I picture my demons.  

“I can see that,” said the skeleton.  “It’s hard to explain to those who go along to get along, but there comes a point where a trusted friend reveals a face that you cannot unsee.”  

My mad friend Andy’s smug face comes to mind.  

“A face only a mother could resist smacking, although not my mother,” said the skeleton.  “Well, as I understand it, the thing with Andy was his self-hatred, his deep feeling of unworthiness.  I don’t know, truly, how you emerged from your war-zone childhood with so little self-hatred, but for those of us who are consumed by it, I assure you, there is nothing more painful.”  

I can dig it.  It goes to Groucho’s ‘I’d never join a club that would have somebody like me as a member.’    The capacity to be witty is one thing, and I always enjoyed Andy’s wit, the capacity to have insight, and act on it with integrity, is quite a different thing.  

“Don’t pat yourself on the back too hard, Elie,” said the skeleton.  “One man’s insight is another man’s… eh, you show me a man who finds himself insightful I’ll show you a man…. what does Sekhnet always tell you?  Put a bushel over that light of yours.   It’s unseemly to speak of yourself as insightful, talented, intelligent.”  

Fine, I get that.  The only insight I really cherish is the one I picked up as a kid at that finishing school for anti-Semites you sent me to.  Hillel’s statement of the Golden Rule.  What is hateful to you, do not do to someone else.   I consciously try to live by that.   I don’t claim to have ever had any insight remotely comparable.  I’m just laying out a few particular, identifiable demons here, dad.  The faces attached.  

“Well, I get that.  Andy had the best demonic last word, delivered to you by a third party.  He made it known that he knew he owed you an apology, but that he was ‘too stingy’ to give it.   The mark of a… what is that hideous word you like to use on such occasions, a true cunt, in the unredeemed sense of the word.”  

True dat, dad.  I admit that I was wrong, that I hurt you, that my subsequent attack on you was unfair, that I owe you an apology but… nah… not to you. I’m too stingy.  Let that be the last word on our long friendship.  

“Talk about a shit-smeared asshole,” said the skeleton, suddenly distracted, sinking back into his grave without so much as an adios.

Adios, padre.

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You sound a bit… insane, sir

I am scheduled to have the first of two five hour infusions of a drug called Rituximab on Friday.  This drug is usually used for lymphoma patients, as far as I can tell, after a visit to the manufacturer’s website.  Nephrologists have recently found Rituximab is often helpful in curing the kidney disease I have, membranous nephropathy.  I am resigned to being hooked up to a slow dripping bag of this miracle drug, which seems to have a fraction of the side-effects of the steroid-based chemo regime I was being pressured into a few months back.   My current nephrologist recommended three vaccines before I start, as the Rituximab will suppress my immune system.  

I had a flu shot, and a pneumonia shot.  I’ve spent the last ten days or so trying to get the third — an immunization against shingles.  From everything I’ve heard, shingles is something to be avoided.    I am prone to skin troubles, I am over sixty, I have an auto-immune disease, had chicken pox:  I am a good candidate for this potential side effect of the immunosuppressive regime.  

My primary care doctor, for whatever bureaucratic reason, could not order the pneumonia and shingles vaccines.  He gave me a prescription to fill.  The pneumonia vaccine was easy to find, the shingles vaccine, not easy.  I have been to seven pharmacies so far.  My local pharmacy, for whatever reason, could not order the vaccine.  Two chain pharmacies had the vaccine, RiteAid ordered and quickly procured it, and DuaneReade had it in stock, but they do not accept my insurance.    

It costs about $300, if I wanted to plunk down my credit card.   Four pharmacies that accept my insurance, CVS branches, did not have the shingles vaccine. The CVS closest to my apartment has been waiting months for it to come in. The pharmacist at the last place, the one that had the vaccine, but doesn’t accept my health insurance, suggested I call Healthfirst, the corporate gatekeeper of my health care.

It was not a terrible suggestion, but past experience whispers now that I should not have made the call.   For one thing, the inviolable policies of corporations are not something mere mortals can question, let alone contest. For another, there is the psychological angle — I cannot separate the practices of one homicidal legally-created psychopath from those of another homicidal legally-created psychopath, and I hate them all.  

“Homicidal” sounds so judgmental, I know, but do the math.  I live in the USA, where tens of thousands die every year for lack of affordable access to adequate health care.  It’s a cost of doing business here in the Land of the Free and the Home of the Bankrupted by Cancer.  We don’t bat an eye about the annual preventable deaths, more than tenfold the death toll of September 11, 2001, every year.  We have reality TV, social media, a big American Dream, evil people to hate– so people die here, like the tens of thousands of Americans who died of oxycodone and heroin overdoses last year, what’s your point?  Your little problem?  Fuck you, asshole.  Get a better life, make enough money to buy whatever you want, including good health care, and shut the fuck up about ‘injustice’, boner breath.

In fairness, and we should always strive to be fair, insurance companies do not make money paying out claims, the profit is in paying out as little as possible.   In a nation that was not insane, stoned beyond reason on “free market” kool-aid, it would not be a patient’s problem to figure out how to get a needed inoculation paid for by the insurance company he pays a premium to every month.  

My trouble is that I can’t separate the frustration and the indignity from the injustice any more.  I get angry, though I control my language, and I cannot help but remind the helpless representative, reduced to meaningless apologies, that she works for a corporation, something we pretend is a “person”, but is the kind of person incapable of conscience, empathy or anything but naked self-interest.   This does not sit well with some of the reps.   They are not being paid enough to listen to this kind of shit from someone who is angry that he has to keep calling a murderous psychopath for help with healthcare.  Murderous psychopaths do not give a fuck, what kind of idiot does not know that?  What kind of moron tries to argue with representatives of an artificial “person” who is also, by definition, a murderous psychopath?

By the end of yesterday’s marathon 40 minute chat with an excessively polite woman named Ilene, the obstacles escalated considerably.  Not only, did she inform me, (after two long holds for consults on how to deal with an insane raging asshole, and a sickeningly articulate one), would Healthfirst not pay for a shingles vaccine administered in a pharmacy, assuming I could even find the drug anywhere, the shot must be given by your doctor, in his office, after he receives pre-authorization from Healthfirst.   

As for how long that pre-authorization might take, nobody has any idea. Could be fast, could be very slow.  Ilene, after all, is on the membership side of Healthfirst’s corporate brain.  Pre-authorizations come from the provider side.  These two sides have no way to communicate with each other.  I have experienced this before.  It was a kind of last straw yesterday.  I remarked that it was handy, for an artificial “person” without conscience,  to have a divided corporate brain that could not communicate between the halves in order to answer a simple question.  Before I could utter a stream of horrible curses nobody would be able to unhear, I thanked Ilene in an acid tone and wished her a good day.

The pharmacist in Sekhnetville, who has ordered the vaccine, assured me that they give shots to Healthcare customers all the time, that it should be no problem, once the vaccine comes in, to shoot me up right there.  In hindsight, I suspect that Ilene, being a polite and hardworking girl, probably from the mid-west, had found a way to tell an insane asshole to go fucking fuck himself, in the politest, most vicious possible terms.

The latest call to the pharmacist in Sekhnetville, who promised the vaccine would be in today, revealed that… oops, the manufacturer does not seem to be currently shipping the vaccine.   It appears to be on back order.  Could be weeks, or even months.  So, sorry.   Have a very nice day.  Unexplained is why RiteAid was able to procure the drug within a couple of days, or why the shot was available at DuaneReade.

Looks like I’d better reach for my credit card and just have the fucking shot at one of the “out-of-plan” pharmacies that currently have the shit.

USA! USA!!!!  Nice work, Barack, rocking that big, lucrative corporate boat as gently as possible while making some small, long-overdue improvements for more folks who couldn’t previously afford health care.  Good luck with your book sales and paid speaking tours, my man.

 

 

 

A Marker for my father

My father’s grave is marked with a large tombstone that notes, in an ancient tongue, that he was an intelligent and modest man.   His father’s grave, in the low-rent section of the same small town cemetery, where the tomb stones are jammed together like a mouthful of crooked teeth, is marked by an epitaph calling him straight and simple.  There are no other grave stones, going further back than that.  The Nazis simply didn’t give the Jews they killed such amenities.    

“Well, look, Elie, I don’t blame you for being disgusted, and angry,” said the skeleton of my father, “though I think we can safely throw these paragraphs into the circular file.   You are talking statistics again, a few handfuls of terrified, powerless Jews run into the swamp to drown, shot in the head.  They happen to be our people, fair enough, but, I mean, what is your point, really?”    

When I said “fuck Hitler” a few weeks back, this is part of what I was talking about.  

“Well, I’m sure the corpse of that psychopath is twitching in rage at your disrespect, Elie,” said the skeleton.  “In your fucking face, Hitler!”  

Fuck Hitler, dad.  In all his forms.  Hitler was a rock star of genocide, as charismatic as Elvis, to those who loved him.   We have always had these types among us, they tap into that rage we all feel sometimes, transform it into an irrational movement, capable of the worst mob violence.   When I used to rail against the aptly named Dick Cheney I was walking a mine field.  I had to be careful not to make any Nazi references, because, of course, Cheney never set up a system of death camps, didn’t even make any racial laws.  Killed a lot of people, sure, but not in the organized, systematic way Hitler’s folks did.  The comparison was unfair, even I realized that, even as he oversaw the torture and deaths of perhaps a million people in his borderless, trillion dollar, permanent war against Terror.    

“The pundits still call it that, ‘The War on Terror’, just goes to show — the power of branding,” said the skeleton.    

Yes.  So in the time I have left I suppose I want to testify.  I want to stand against the bullshit that is force fed to us by the marketing geniuses, by those who make big bucks to make atrocities sound benign, to keep the wheels of the war and oil industries humming.  

“That’s a big job, Elie.  Those types have already won,” said the skeleton.  “And besides, what do you really hope to gain?  You don’t even know the names of any of Pop’s large family, Grandma’s.  You have three siblings of my mother, Chaski, Volbear and Yuddle, just their names and no trace of the hamlet they lived and died in.  On my father’s side, just like him, a complete blank, two eyes, a nose and a mouth, in Eli’s immortal phrase.   That’s all you have, that and the area that 3/4 of them lived in,  where they all died horrible deaths.   At least they were spared being forced into cattle cars and railroaded off to slave labor and brutal living deaths, until their actual deaths.”  

You’re right, dad. Some days, it’s just too big a job to even contemplate.  I need to find a fucking chain pharmacy that has the shingles vaccine, before I start my immunosuppressive therapy in a few days.   Shouldn’t be this hard, I’ve been to several pharmacies already, one hurdle after another– now apparently it has to be a CVS that has the vaccine in stock.  Should not be this fucking hard, “should”, of course, being a word one shouldn’t use in a nation that places corporate personhood over the personhood of humans.   Give Hitler some credit for that, he showed how it could be done.  

“All roads lead back to Hitler with you,” said the skeleton.  

Yeah.  And there’s a freshly painted sign on that road, I painted it myself.  It says “fuck Hitler.”    

“Sieg Heil, man,” said the skeleton, listlessly lifting an arm in the Hitler salute.

Food is Love — (note)

“So, if food isn’t love, what is food?” said the skeleton.

Look, fine, if you’re eating, and you see somebody who is starving, and you give them your food– food is love.   Nothing really more to the point you can do in that moment to express love.  Preparing a delicious meal for your loved ones, I’d say in that case the food is love.   Patiently spooning soup into the mouth of a weak, sick person– love.  Stuffing an overfed dog with steak?   I’m sorry, that just seems the wrong example.

“Well, maybe it’s a lot for me to expect you to understand, never having been hungry yourself,” said the skeleton.   

As you recall, my sister and I were pampered little middle class bastards.  It was a beautiful and horrible arrangement for you.  You could point to your virtue in never letting us know hunger or any kind of material want, and at the same time, you could be bitter because we had so little appreciation of the things we learned to take for granted.  You remember what you used to tell me when I thanked you as we came out of a restaurant?   

“You never have to thank me for food,” said the skeleton.

Food was many things when we grew up, few of them healthy.  Overeating was the norm, and eating in anger.  Literally, eating to choke down feelings. I recall you equated being able to put away a large quantity of food with manhood.

“Well, I saw that in the army,” said the skeleton.

I recall how proud you seemed to be when I downed maybe a half dozen hot dogs at the end of the Wading River Fourth of July parade.  I must have been eight or so.  The volunteer fire department had a big pot of free hot dogs and I kept going back.  The fireman would dip a long fork into the steaming water and pull out another one, put mustard on it, hand it to me.  I remember your smile, and your pride, at how many I ate.

Food, perversely, was also held up, mostly by mom, as a sign of personal bravery, a daring willingness to try things that looked and smelled repellant. She was not consistent with this in her own eating, but she always praised my sister, who was more apt to try new foods than I was.  “Your sister is a trooper,” mom would say, as my sister put something disgusting in her mouth.   

“Well, you had the last laugh on that one, didn’t you?” said the skeleton. 

We went for sushi after you died and I ordered eel.  Mom was horrified.  I got to chide her for not being a trooper.  Quite delicious, the way the Japanese prepare it, though I don’t know if, even at the height of my omnivore days, I’d have tried it boiled in a creamy sauce with onions.   

“Well, on the other hand, you were never trooper enough to try herring, Elie,” said my father.   As he said it I felt a sick feeling in my stomach.  Man, that stuff looks and smells disgusting.  Even my sister was not trooper enough to try herring.

 

 

 

Attachments for the letter to the A.G.

Attachments to this letter.

#1  The NYS Health insurance Consumer helpline cul du sac

In an attempt to resolve problems with my health insurance I contacted a circuit of government agencies in vain last December.  Here is a summary of that healthcare consumer help cul du sac:

The NYS Department of Financial Services helpline (from dfs.ny.gov) referred me initially to the US Department of Health and Human Services (877-696-6775) which, supposedly, connected me to NYS Health and Human Services, although to an incorrect branch of that agency, the pertinent branch apparently having been merged into the NYS Department of Financial Services which took over all functions of the former NYS Insurance Department as well as oversight of banking and several other discrete and seemingly unrelated areas.  (When I called this number today, it gave me an option, unavailable last time, to press 6 for “consumer problems with the ACA”, and offered a call back in five business days from a representative.)

The New York State Insurance Department, along with other agencies related to healthcare in New York State, was merged into the Department of Financial Services when New York adopted the Patient Protection and Affordable Care Act (“PPACA”).  The New York State Department of Financial Services, it turns out, does not hear consumer fraud complaints against health insurance companies.

I entered this administrative cul du sac in December 2016 after Empire Blue Cross “Health Plus” sent me to two in-network providers for needed medical services, a cardiologist (for follow-up care after a hospitalization for cardiac issues) and a physical therapy facility.  Neither provided me with any service. 

The fraud investigator I eventually spoke to at the NYS Department of Financial Services, at the end of a long chain of calls, could not find a word other than ‘fraud’ to describe the facts I set forth, but urged me to call the NY State Department of Financial Services Consumer Services Hotline.  He assured me that they were the specialists in the area of health insurance.  The recorded menu at the hotline, which I recognized from my first call hours earlier, offers no option for resolving issues with insurance companies of any kind.  

On my original call to the Department of Financial Services, a long wait to speak to a representative yielded the number of the proper federal agency to contact.   Calls to the U.S Department of Health and Human Services are robotically routed to a NY State number that is, sadly, the office of Temporary and Disability Assistance, where a helpful party connects you to a fraud hotline, which turns out to be at the office of the Medicaid Inspector General, where the office of legal affairs is also sympathetic, but unable to help, and so forth.

#2 Permissible grounds for routine denials of purchased healthcare benefits in NYS and limited “appeal” of denials available to New Yorkers

More ominous than the many billing irregularities consumers are left to resolve with the billing parties, a patient can be denied needed medical service without explanation.  Permissible corporate reasons for denying service are things like incorrect site-specific provider NPI number and improper CPT pre-authorization codes.  These valid grounds for denial are unrelated to an individual consumer’s MOOP, which comes into play more for billing.  There is nobody in New York State a patient can appeal these denials of service to, except to the insurance company itself.  

Immediately before I was diagnosed with a serious kidney disease, in January 2017, I attempted to resolve some issues I’d been having with my then insurance provider, Empire Blue Cross. This was before I switched to Healthfirst, which has a series of nephrologists I’d been referred to, listed as ‘in network” who, it turned out, were not.   Here is the slightly overwrought grievance I wrote when I was a customer of Anthem/Empire.  It reflects the frustration of someone caught in this ‘regulatory’ vacuum:

Grievances – Anthem/Empire Blue Cross Blue Shield “Health Plus”

Grievance 1:  lack of internal complaint procedure for aggrieved customers

After being chided by an Empire representative for never filing a written complaint about any of the grievances detailed below, I attempted to do so on-line.  Logged in automatically under my former bronze plan ID there was an on-line complaint form, easily located.  I was unable to update my member ID info.  A web support representative at Empire walked me through changing the new log-in.  On the website for the “Essential” plan there is no complaint form.

I was also told by web-support/claims representative Laurisha that there is no internal mailing address for submitting a written complaint to Empire and that company policy was not to divulge the name or contact information of company executives.   The rep told me she could take my complaint orally over the phone.   I decided to try my luck with the original claims person I’d just spoken to for an hour.  Nobody was able to connect me to her.

Someone at claims found this answer for me, while looking for the physical mailing address to send a complaint directly to Anthem/Empire.  He told me it was printed in red, as I will reproduce it here:

Essential Plan members do not have a right to file complaint appeal (sic).  If they need assistance filing a grievance or appeal, they may also contact the state independent consumer assistance program at:  Community Health Advocates, 105 E. 22nd Street, NY NY 10010 or 888-614-5400 or email at cha@cssny.org

source:  Anthem’s National Contact Center Document under NY market tab for “Essential” plan updated as of 12-14-16 at 7:56 a.m.

Grievance 2:   unresolvable bill

8/17/16 I went to Madison Avenue Radiology for an x-ray and two sonograms.  I had referrals for all of them.  I got a bill from Madison Avenue for $1,324 for one of the sonograms.   

On 10/19/16 I spoke to a representative at Empire who spoke to the provider, to a person she told me was named Daniel.   I then spoke to Daniel who agreed the $1,342 had been billed in error and told me I’d receive a corrected invoice for the $25 co-pay.  

The next invoice I had, in December, was a third notice from Madison Avenue Radiology that I owed $1,342.  This time Ty at Empire told me she called the provider, who denied ever speaking with me, and that I owed the entire amount, for reasons I could find in the Essential Plan handbook she offered to send me.  She herself did not know the reason a kidney sonogram was covered and a pelvic sonogram was not.  She told me I was responsible to pay the $1,342.  When I asked to speak to a supervisor she told me no supervisor was available.  

(Months later this bill was eventually reduced to a $25 copay)

Grievance 3:   fraudulent referral to cardiologist

I was referred, by Empire, to a cardiologist named David Sahar.  I was given his site-specific NPI number to see him at his 3050 Corlear Avenue office, I sent front and back of my insurance card to his receptionist who confirmed that we were good to go for a December 15 follow-up to my November 18 Emergency Room visit/hospitalization.   Ten minutes into the consultation the nurse who was interviewing me was called away and when she returned she told me Empire had refused to cover the visit. The doctor explained he could not risk not being paid by Empire.

Grievance 4:   fraudulent referral to physical therapy

I was referred by Empire to a facility to continue the Physical Therapy I had begun on 11/1/16 at a facility that treated me once and then informed me that they do not accept the Empire Essential Plan.  I made several calls to Empire to find out how to get them in network, as Empire told me they could enroll by calling 800-454-3730.  After a few weeks calling the PT facility and Empire I gave up.   I requested an in-network PT provider and Empire sent me to an address that turned out to be a nursing home.  It did not offer PT to outpatients.

Grievance 5:   incorrect information; false promises of help from customer service

I called on 12/30/16 in an attempt to resolve these issues, the bill and the two denials of coverage from providers I’d been referred to by Empire. I was told by Joan that the “service not covered” code came up at the cardiologist’s because, likely, an incorrect CPT number had been called in, or possibly the doctor’s office had failed to obtain a prior authorization from Empire’s medical management office, both the fault of the doctor’s office. Empire, I was told, had done nothing wrong.   Joan had no explanation for why I was sent to a nursing home for PT or why the kidney sonogram had been covered and the other one not covered.   She offered to send me the handbook so that I could read it and find out for myself why one body part is covered and another is exempt from coverage for the same diagnostic procedure.  

Joan transferred me to someone who said she was a supervisor.  She identified herself as Julie, at the New York Call Center, assured me she was the only Julie there and that I’d have no trouble finding her.  She noted that I’d never filed a formal complaint about any of these issues and promised to research and get back to me with the answers on Tuesday, 1/3/17 when the office reopened.   Regarding the PT, she gave me a number for a third party vendor called Orthonet.  She incorrectly informed me that they could answer any and all PT-related questions.  When I called Orthonet the receptionist there told me Orthonet’s only role is to authorize services for PT once a provider makes a request to treat a patient.  

When I got no call from Julie at the NY Call Center I attempted to reach her.  Ashanti D, user ID AF09740, was very helpful, even giving me the conversation reference number I52146704.   She told me that without a last initial or employee ID number it would be impossible to look Julie up.  The NY Call Center could not be reached directly by Empire customers, it was an internal number and Ashanti looked it up and transferred me to it.  After a long hold the phone rang three times, then the line went dead.

Grievance 6:  improper billing practices

I received confirmation of my payment for December and January two weeks before this arrived:

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Grievance 7:  instead of promised return call, customer service survey

Attempted Customer Happiness surveys asking about each of these “customer service” experiences, by telephone and email.

To show that the corporation is not without a certain sardonic sense of humor, I had a solicitation call from an Empire representative, on 1/4/17, thanking me for my business and offering her assistance in renewing me with Empire so there would be no interruption of insurance for my health care.     

#3 The New York State of Health Marketplace

Errors are not easy to resolve at the New York State of Health (”NYSOH”). Answers to routine questions vary from representative to representative. There is a wait of several months to have even the most simple mathematical mistake by the NYSOH corrected, and one must go through a quasi-legal appeal process before NYSOH will correct its error.  Attached is a recent decision by a hearing officer that ordered NYSOH to correct an easily detectable mathematical error they had committed months earlier.   

Note that any employee of NYSOH could have used the online calculator on their website to instantly verify their error, generated automatically by their website (it is easy to instantly lose insurance coverage at NYSOH, hard to regain it), a mistake that took months to have corrected and resulted in the customer being forced to overpay by almost 100% until they did.

Compounding the aggravation of resolving problems with NYSOH is the policy of its director, Donna Frescatore. Representatives are specifically instructed not to divulge the director’s identity or any way of reaching her office. I have confirmed this policy many times, with many different NYSOH representatives.

#4 Common healthcare billing irregularities in New York State

The PPACA, whose primary drafter, Liz Fowler, went back to work in the health industry after her legislative work was done, apparently contains no provision that the cost of a medical service must be divulged to the patient before the medical service is performed.  

The doctor’s office or hospital cannot tell you the fee until the insurance company sends them a statement.  The insurance company cannot predict the fee until they get the provider’s bill.  The insurance company then eventually sends the patient an Explanation of Benefits, (“EOB”), detailing all charges, payments made and the patient’s responsibility for whatever part of the negotiated rate insurance has not paid.   It is like eating at a restaurant with no prices on the menu, and being sent a bill for the meal weeks later.  Except, of course, that it is not a meal at a restaurant, it is often a matter of life or death, or, at least, of health-related stress.

My kidney biopsy, for example, may cost the patient anywhere between zero and many thousands of dollars.  Simply no way to determine the cost prior to delivery of the service, under current law.  I had the procedure on May 26, I got the most recent EOB related to the procedure on September 28.  In the intervening four months, I got many bills from the hospital.

Though there is probably nothing your office can do about this particular practice, I offer it as an illustration of the scope of the challenges facing New York healthcare consumers.  I provide the following letter to the CEO of Healthfirst as a snapshot of the general billing madness under our current ‘regulatory’ scheme.   

Pat Wang
CEO  
Healthfirst
100 Church Street
New York, NY 10007

pwang@healthfirst.org

September 26, 2017

Dr. Ms. Wang:

I appreciate that you allow your reps to give out your contact information to customers who can’t otherwise resolve issues with your staff.   This encourages me to think that you might be helpful in resolving an aggravating billing situation that has been ongoing for months.    I applaud your willingness to be contacted, it shows integrity and is in stark contrast to the policy of Donna Frescatore, director of the “New York State of Health” (NYSOH) ordering her reps not to divulge her name to callers.

I request a corrected bill and an accounting showing my remaining credit toward premium payments.  The credit situation is described below.

During an August 25th call to Healthfirst to try to resolve the issue of incorrect bills being sent to me, my “case” was assigned an “escalation number” (347-79-923).  I was promised an accounting, showing payment history and current credit toward future premiums.   I received instead a notice, dated September 8 and signed by Christopher A. DiMarco, threatening me with cancellation of my health insurance for a claimed past due balance of $28.   

On September 19 I called Healthfirst and was assured that credit had been applied and my September premium paid in full.  I was also informed during that call that “finance” had included no notes on my account.   I could not be sent a simple receipt for payment or anything indicating my remaining credit.  I was assured by an extremely sympathetic rep that my account was paid through October, with credit remaining toward November’s premium.

Attached is the invoice I received on September 25.   It seeks payment of $482 for October (plus a past due amount), nonpayment of which will result in losing my health insurance (as I begin treatments for kidney disease and skin cancer).   It has been mailed to me in error.   I have a credit of several hundred dollars due to overpayments made as a result of NYSOH’s error.   NYSOH incorrectly denied my subsidy for 2017.   It took months, and a ruling by a hearing officer, before NYSOH was ordered to retroactively restore the subsidy, about fifty percent of the premium.  

As a result of NYSOH’s error, I was required to pay Healthfirst the full premium from February through June.  When I got a bill for July, I called Healthfirst and learned that a credit had been applied for my overpayment.  After payment of July’s premium the rep calculated my remaining credit at $876.

Since then it has been a health insurance headache every month.  In another context, it would be tempting to characterize the attached invoice demanding payment for a premium I have already paid as an attempt at fraud.  I am sure it was sent to me in error.    Please have somebody update my account and send me an accurate statement of my payments and remaining credit.

(invoice attached here)

Thanks,

 

A short time later, after a call from one of Ms. Wang’s assistants, I got a corrected bill that demanded payment of -$183 on or before October 1.

Food is love

My father had a very sentimental side, the flip-side to his often brutal roughness.   One night at dinner he was feeding Sassy, the overweight Cairn Terrier, from his plate.   Toto from the Wizard of Oz was a Cairn Terrier and after visiting with dogs at the Westminster Dog Show we’d chosen a Cairn after Winnie, a great West Highland White Terrier went on to her reward.   Sassy was the daughter of Dodie.  Dodie had been a great, spirited little dog and the only one of our dogs (all female) to ever have been mated.   A breeder brought a randy male Cairn around at some point (or perhaps we brought Dodi somewhere, I have no recollection) and a few months later Dodi gave birth to three little Cairn pups.  My sister and I were shocked at how savage Dodi suddenly became when we started to approach her adorable sleeping mice newborns in their nest in a big cardboard box.   

The pups were very cute, and sadly, we were resigned to them all leaving for other homes.   Brer, our favorite, was chosen first, some people came by and bought him immediately.  Then the little female went.  The other, large, flat-backed and paranoid, never found a home.  We wound up keeping her.  My mother named her Sassy.  There was rarely an animal less sassy.   Unlike our other dogs, who slept out in the open and were always happy to interact, Sassy spent much of her time squashed under a bed or couch.    She was heavy and naturally suspicious, frightened, it seemed.   

I have thought of Sassy’s withdrawn paranoia over the years, in the context of nature vs. nurture.  We were there when she was born.  Her two siblings were playful, spirited little dogs.  None of the three had any experience that would make them distrust humans.  But Sassy, when she was not eating, was finding a place to flatten herself and hide.  She often skulked when she was not hiding, as though fearful to be out in the open, and gave the appearance of a giant, furry cockroach.   She was heavy, and sometimes, when it was necessary to pick her up for some reason, her eyes would roll in terror.  To complete the depressing picture, Sassy’s mother, Dodi, a very cool little dog, suddenly took ill a few years after Sassy was born, and died in what should have been the prime of her dog life.

My father doted on Sassy the sad sack.   One night when he was feeding the overweight dog from his plate I snarled at him to stop it.   I was a teenager who frequently snarled at my father at this point.   Our relationship, in fact, was mostly snarling.  A mutual snarling society, so to speak.  It took very little by that time for one of us to begin attacking the other.   The accumulated grievances weighed heavily on each of us, waiting for the next small flash point.  I was disgusted that he was stuffing this overweight dog with scraps of steak from his plate.  My father’s response was unexpected.   

“Food is love,” my father said gently.  I replied harshly that love is love and food is food.  He was uncharacteristically unfazed by my harshness and went on to talk about how sharing food has always been a sign of love between creatures.   He quoted some writer about it.   I snarled some more and left the table in disgust, my regular way of leaving the loving dinner table.   

For the last few years of Sassy’s life, my father injected the diabetic dog with insulin.   Sassy appeared not to object as my father made a tent of the skin on her back and slid in the thin needle.   He did this every night, and it extended Sassy’s sad life by several years.   She lived to be fairly old, as I recall.