Tuesday, June 26, 2012
June 26, 2012: Insurance Claims
[As summer gets underway, this week’s series will be on American Studies topics connected to summer jobs I’ve worked. Your experiences, thoughts, and job stories—good, bad, or ugly—very welcome in comments, and for another crowd-sourced post this weekend!]
On the worst and the best of what I learned in my summer working in—or at least near—the health insurance industry.
Nostalgia is a dangerous thing for a variety for reasons, and certainly that can be the case when it comes to American Studies. It can be easy, for example, for those of us who bemoan the increasingly corporatized and for-profit state of so much of 21st century American society to hearken to an earlier, more communal moment, when profits seem to have not so consistently been prioritized above people. Yet the truth is likely significantly more complicated—that profits and people have always been competitors, that every industry and aspect of society has been driven by both selfish and selfless forces since its origin points. Certainly the origins of health insurance in America, which began in many ways in the early 20th century, contains both sides: Progressive reformers argued for the need for national insurance plans in order to protect all Americans from increasing medical costs (in new, technologically advanced hospitals); while the newly formed American Medical Association and other physicians’ groups critiqued such ideas as impractical and pushed for very different, more profit-based narratives of insurance.
That history is important to remember, and not to idealize or be nostalgic about. As is, to cite a very salient second example, the history of Harry Truman’s proposal for a nationalized health plan, and the significant pushback he and that proposal received (being called a Communist, for example). These issues and problems, and the social and political debates they produce, are not at all new. Yet I also feel that they may have gotten even worse in recent decades—and I had a chance to experience some of the worst aspects of the health insurance industry in the summer after my freshman year in college, when I worked for a few months for the University of Virginia’s Health Services Foundation. My job was to follow up on insurance claims for UVa patients that had been denied or otherwise not paid, and to try to find out why and help get the issues resolved if possible. And while this is purely anecdotal, I was told by one of my colleagues, who was also a former claims servicer for a major insurance company, that the company’s policy when he worked there was for the servicers to throw out every claim the first time they received it, since at least some of the patients would not follow up a second time. I don’t know if he was telling the truth—but what he said rang true for so much of what I did experience at that job, and so much of what I have seen and learned about insurance companies in general. Which is, in and of itself, a pretty strong indictment of those companies and the system they’re a part of.
Yet that’s not all I saw and learned in that summer of work. After all, my own role, and the role of all those who were doing the job around me (including that former claims servicer), was indeed in the most communal and positive spirit of what health insurance can and should mean: looking out for those patients, trying to help them get the coverage (and the health care) that they need and deserve, making sure that they weren’t fighting that fight on their own. And to be very clear, I felt the same from all of the insurance company employees with whom I spoke, many of whom I talked to nearly every day; they too saw their jobs (whatever their companies might be telling them!) as working with people like me, trying to resolve things for these patients (not ignoring the company’s interests, but neither treating the patients as simply secondary to those interests), working to make the system work more consistently. Idealizing people can be as reductive or dangerous as idealizing the past, I know—but there’s no question that the vast majority of the people I encountered that summer had their hearts and goals in the right places. If we’re going to reform a system—as the Progressives well knew—it’s pretty important to remember the best of what people are and can be, as well as the worst of what those systems can include.
Next summer job connection tomorrow,
PS. What do you think? Experiences and ideas you’d highlight for the weekend’s post?