Narrating Medicine: When The Insurance Company Brings A Therapist To Tears

On a bright spring morning in late May, I force myself to sit down and make the dreaded call.

It is to a national health plan that covers the psychotherapy benefit for many of my patients. Let's call it Community Allied Services For Health, for the fitting acronym "CASH."

The company’s automated telephone system instructs me to press "1" to reach the claims department. When I do, Mary, a customer service representative, answers. I patiently explain that CASH paid my April claims incorrectly, sending me $7 less per session than the contracted rate.

"It will take 30 to 45 days to correct," Mary says curtly.

"OK. Please fix the problem,” I plead into the phone.

The day after our July Fourth barbecue, a letter from CASH arrives in the mail. I quickly rip it open. It does not mention the April rate I'd called about.  I see that the plan has made another mistake, now reducing my fee for the May claims. My neck muscles tighten into a hard knot.

I realize that $7 is not much in the scheme of things. Nothing, really, and it won’t break my budget. My patients' dilemmas — John’s struggle with alcohol addiction and Susan’s recent cancer diagnosis — dwarf my insurance company problem and make me embarrassed to be so overwrought.

Nonetheless, the insurer's unwillingness to listen to me and follow through on its promises makes me crazy. Maybe it is my pride. But rather than feeling like a competent psychologist, I feel like the lowly kitchen maid begging her master for her meager wages.

At dinner the next day with my sister, a physical therapist, I express my frustration, and she corroborates my reaction.

"The insurance companies just try to wear you down," she whispers. "Don’t give up the fights; eventually, you will get paid."

On a sweltering July 7, I urge myself to call the company again. Sweat trickles down my face. Finally, I pick up the phone and dial the Network Management Department. I muffle the irritation in my voice when I speak to Jane, another representative. She agrees to email her supervisor — let's call her "Ms. Smith" — about my problem. Before helplessness overtakes me, I wrest Smith’s phone number from a reluctant Jane, who abruptly hangs up.

I make several calls to Smith, each time ending up marooned in her voicemail. Finally, I block my phone number. She picks up. In her singsongy voice — was she my mean kindergarten teacher in a previous life? — Smith admits that she doesn’t know how to correct the problem. She will speak to her boss, whom we'll call "Mr. Brown." I finagle Brown’s phone number out of Smith before she cuts off my call. Despite this small triumph, tears of frustration well up in my eyes.

My husband gently asks me, "Is the money worth it?"

"No," I would say, if I were thinking rationally. But I’m way beyond that now. I go into my study and close the door. Why does this get to me so? Perhaps I have just been my own boss for too long. But in any case, the high-handed way that the insurers treat me — and other providers, and patients, too — drives me mad.

On July 20, I dial Mr. Brown. I attempt to leave a polite message for him, but even I can hear the anger in my voice. I inform him that Ms. Smith does not know how to fix the incorrectly processed claims. When Brown does not return my call, I feel like a little girl tugging at my busy mother’s sleeve. Why won’t anyone listen to me?

On Aug. 1, I see a large envelope from CASH lying at the bottom of my mailbox. I tear it open. I see that the insurance plan has reprocessed all my 2016 claims; every claim I submitted this year — not just April and May — has now been paid at the lower, erroneous rate.

I start to sob. I can’t help it.

In the middle of August, I receive ten letters from CASH. I open the first one. The letter informs me that the insurance company has overpaid me, and they are requesting their money back. I shove the remaining nine unopened letters in the junk mail drawer, wondering how much more frustration I can take.

I awaken in the middle of the night and plan my strategy. I consider turning away new CASH patients. But in my current caseload, I have 10 patients covered by this insurance plan. I imagine looking at the bereft face of a 50-year-old, newly divorced woman when I tell her that she will either have to pay me out of her pocket or find another therapist. She lived with a philandering husband for many years. Am I going to turn out to be unfaithful, too?

"Then soldier on," advises my English husband, whose parents survived the bombing of London during World War II. His war metaphor turns out to be right on target: On Aug. 20, Ms. Smith calls to tell me that she has sent my claim problem to “Escalation.”

Three days later, Tanya, from “Escalation,” calls. She sees that the 2016 reimbursement rate has been reduced, but she doesn’t know why. Tanya tells me that she will email Mr. Brown — oh no, we are back in Network Management — to find out the correct figure.

At the end of each call I have made to CASH, the automated system requests that I stay on the line to “complete a brief satisfaction survey.”

“Thanks for asking about my opinion,” I might have said, if I hadn’t already slammed down the phone. “Let me sum it up for you: The countless hours I spent trying to correct the claim problem has destroyed my confidence in your organization.”

I notice my energy flagging — battle fatigue. Then I imagine myself as a knight in armor standing up for maltreated, disgruntled providers and patients everywhere.

“Get back on that horse,” I order myself. “Start the battle again.”

Ellen Holtzman is a writer and psychologist who practices in Wakefield, Massachusetts.