For those accustomed to data-driven posts, I apologize. This post is 99% personal experience. It represents my ongoing battle with Harvard Pilgrim Health Care to obtain coverage that I need at a price that I can afford.
This episode began when I received a notice dated 2/11/09 notifying me that the cost of my family coverage plan would increase from $1785.96 to $1929.68 per month, an 8% increase that would push my family’s cost to over $23,000 annually, considering the $25 copay per visit and the $15/$30/$50 tiered drug copay. As a solopreneur with two kids in college and predictable expenses with unpredictable cashflow, I felt that a win-win negotiation was in order. I printed information from a variety of Harvard Pilgrim policies on the Commonwealth Connector and called Harvard Pilgrim last Thursday to discuss my options.
I mentioned (see Gotcha: A surgeon dissects patient-centered care) my frustration with insurance company micromanagement of physical therapy (PT). I explained that a limit of 60 consecutive days of physical therapy did not work for me because a seizure sustained as a complication of chemotherapy for lymphoma in 1981 resulted in compression fractures of my spine, chronic pain, and limitation of motion. Knowing that I would have to pay full price for PT after 2 months despite paying out nearly $23,000 in premiums did not buy me peace of mind. I stressed that nobody in my family smokes cigarettes, has high blood pressure, or is obese. Other than my spine issues, we have no chronic conditions.
I asked, “What can we do to reach a mutually beneficial outcome?” You would have thought that I was asking for permission to desecrate the American flag.
“We can’t change PT coverage,” she protested.
“Nonsense,” I replied (I confess that I used a different compound word that had the same number of letters; it just came out in the heat of the moment). “If a human being can write an arbitrary, capricious rule that has more to do with managing cost than managing care, a human being can promote wellness by changing that arbitrary and capricious rule! Why aren’t there limits to spine surgery or MRI scans that cost a lot more than PT?”
I continued, “I know that you can’t change the rule, nor do I expect you to. All that I ask is that you convey my request to the people at the top of your organization that make the rules. I want you to know that I want to stay with Harvard Pilgrim if we can find a way to accommodate my family’s needs.”
She thanked me for my comments, and we hung up.
The tragedy of the conversation is that (to paraphrase Jerry Maguire) she could have had me at hello. Perhaps I am naive to think that a mere surgeon/MBA/author-blogger could have a mutual dialogue with a company that reported operating income of $22.6 million on revenue of $2.6 billion for 2008. Net income for 2008 was $48.1 million. As of December 31, 2008, total membership for Harvard Pilgrim was 1,068,000, an increase of 38,000 members from 2007.
I am not suggesting that Harvard Pilgrim is a bad company. I know that it is ranked number 1 in New England by a variety of measures. I learned in business school that the definition of a good customer is someone who keeps a company in touch with the marketplace. I know from having traveled over 500,000 miles in the last 6 years to over 40 states in the US that many of us in the middle class are feeling squeezed and we’re not gonna take it anymore.
In a memorandum to the heads of all Executive Departments and Agencies dated February 27, 2009, President Obama wrote that government should be transparent, participatory, and collaborative. Shouldn’t these principles apply to healthcare insurance companies as well? If we want better healthcare outcomes, we all need to work more interdependently.
As I wrote in Facilitating Physician Engagement, it took years of meetings of healthcare professionals at the Pittsburgh Regional Health Initiative before questions shifted from the accusatory, “Why don’t you…?” to a more systems-based reflection, “What if we…?” (“Socioeconomic Issues Affecting Healthcare Collaboration, p.48, in Cohn KH. Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives, Chicago: Health Administration Press, 2006).
What do you think?
- What would you like to say to your healthcare insurance company
- How can citizens who are not part of big companies promote a more patient-friendly wellness agenda
- Is now the right time raise these issues
As always, I welcome your input to improve healthcare collaboration.
Kenneth H. Cohn
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