Bureaucratic Insanity

I’ve taken over the phone for my mother, whose is once again on hold, as she has been for at least 20 hours since Aug 12, including 3 or 4 hours today.  She bought a “deluxe rider” to her health insurance to cover vision care (among other things).  The insurance provider assures her she has the insurance, but she does not “show up in the system” at the health care provider for the vision benefit.  There are three parties to the problem: her health insurance provider, the organization that handles most of their vision insurance, and her health care provider organization.  At all three organizations, you can never direct dial back to the specific person you spent several hours with the last time, you have to start over with a new person and retrace the same steps multiple times.  Many times she has been assured that the problem is resolved and she will show up in the system in 24 hours, 48 hours, or a week.  Apart from the first visit, where she was shocked by her lack of coverage and had to pay a larger-than-expected copay at her optometrist, she’s been told she’s good to go twice, only to be told no on site after she has paid her neighbor to drive her to the office to get the glasses.  She is exhausted and near often tears with frustration.  Many different interpretations have been offered as to why the problem exists and what needs to be done to resolve it.   This week, while I’ve been listening on the speakerphone,  the phone people have been humane and sympathetic and willing to do a lot to resolve the problem, but even humanity seems to have limits when running up against an insane system.  According to today’s people — including a very helpful Sharon in Wichita who with her supervisor spent several hours yesterday and personally faxed a document to organization #2 and who today spent several hours in a multi-way conference call with the health care provider (even insurance company representatives have to wait on hold when they call each other!) — the problem is that most of the insurer’s customers are assigned to company #2 for vision benefits but my mother is in the 10% who were assigned directly to her health care provider.  This is why all the attempts to get her in the system at company #2 did not work.  At this point, I just spoke to a person at the health care provider’s patient services who says that she has been assured by Sharon that the benefit exists and is assigned to them, that she personally will be calling someone else (!) to get the information entered into the system, and that we should get a call from her or the optical department when this is done.  She also gave me her direct line phone number so I can follow up with her.   Now we will see if it works.