Let’s share a victory

Some of you might know that I’ve got serious knee trouble, for which I’m undergoing rather unpleasant but helpful physical therapy. We have GEHA as an insurance provider, and they contract with an outfit called Orthonet to review treatment programs and approve care. My PT set up a plan of eight visits, which seemed logical to me: let’s do this for a month and see where we are.

I soon got a letter from Orthonet: they approved only seven visits. This mystified me. What was the logic? I called GEHA, who basically said I’d have to call Orthonet. I did this. The minion could not provide a responsive answer to this question: “Okay. My PT says I need eight visits. Your case manager evidently disagrees, thinking seven are sufficient. Explain the logic, please. What about my case prompted this case manager, who–unlike my PT–has not actually seen either of my knees, to decide that seven were all that were necessary?”

Of course, the minion served up the standard vaguenesses and horse hockey that are designed to baffle, confuse and frustrate people into just giving up. Evidently that’s their job: to get people to give up and accept less care. I advised him that none of that had answered my question, and that if he couldn’t answer it, then I wanted to speak to the case manager. This evidently was a very irregular request: to speak to the actual individual who decided that his wisdom was superior to that of the medical professional. I insisted.

Somehow, they got a case manager–if not my own case manager–on the line. He spoke in the rapid “I’m way too busy for this sort of thing” tones of someone who also has the power to take action and needs not to be slathered in protracted conversation. I asked him the same question. He said it was a good one, and that he didn’t know why. Very quickly, he agreed to resubmit the review recommending the eighth visit. There was zero fight. I thanked him and the conversation ended, goal achieved.

Now let us deconstruct the reality of all this, because while it would seem I should be very happy with Orthonet for giving me what I wanted so quickly, that is really not so.

  • My PT recommended a course of treatment. The minion’s first response to my question had hinted that they basically always approved one less of whatever was requested.
  • As a reflex, on the logic that Orthonet is contracted by GEHA to save it GEHA money, they therefore approved one less visit. The average person, less obstinate or confrontational than myself, would simply accept the reduced care. One presumes that if my providers expected this, they’d request nine visits so that I’d get eight.
  • Orthonet’s first line of defense against pests of my ilk is to have their toll-free line answered by people with minimal power, whose work is to spout gobbledygook. Most people are nice and do not like to be confrontational, and also won’t ask such a blunt question; they also won’t insist on a real answer. This should get rid of most people. Money saved. They will get less care, of course, but that’s the whole idea.
  • If however one remains politely insistent (thus not giving the minion a valid excuse to hang up), one will be routed to someone with authentic power of decision. This person is extremely busy and will take the easiest route, which is to concede. Okay, we lost this one, but that’s okay, we expect to lose one out of twenty. Nineteen savings, one loss, duh, winning.

Why I’m not satisfied should be fairly obvious: in the first place, a lot of my time was wasted. In the second, the only logic in play was money-saving. If the physical therapist had asked for sixteen sessions, they’d have authorized perhaps fourteen or fifteen. Had the therapist requested four sessions, they’d authorize three. There was no medical value in play. So yeah, I won a victory of sorts.

Some situations are just designed to screw you. It’s not personal. They screw everyone.

A long time ago, in a small Washington county seat, I took my first driver’s test. I’d heard that everyone who went to this testing venue flunked the first time. It was so with me. For example, he directed me to parallel park in a space without markers and with a parked vehicle only on one side, and ordered me to treat the space as if there were a car behind. He could thus automatically fail me on that part, on the grounds that he could say that my parking effort required room that would not actually have been available. All he needed was to find a few other fails, and I’d have to come back later and pay for a new test. That was his racket: keeping his job by keeping testing volume and payments high. Of course, being sixteen, I didn’t really have options, which he also knew.

Our greatest social parasites are not those we support with our tax dollars. They are those who automatically put people to more trouble and expense than is necessary in the hope/belief/knowledge that most people will just swallow it. Some people wonder why I fight things like Facebook profiling, web trackers, debit cards and nearly anything Google comes up with. This is why. I can’t make anyone else fight it alongside me. I can only make sure that the fight with me–if only me–costs the other side something.

Well, that and I can make sure the world hears about this Orthonet outfit, and its actual impact.

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2 thoughts on “Let’s share a victory”

  1. I always feel sorry for the minions. They’re just earning a living defending policies in which they had no say.
    A small victory is still a victory.

    Like

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