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Health Care Despairia

How our small business wrestled excellent care from the jaws of the astonishingly absurd US health care system. Part 1: The descent.

It was late on the Wednesday before Thanksgiving when the message from one of our team members blinked into my Slack notifications:

“What’s this notice about our health care being canceled?”

If I were already eating Thanksgiving dinner, I’d have spat it out. That is not the holiday message one wants to see, but soon other reports and a call to our provider confirmed it: Our company plan was being canceled as of January 1, a mere six weeks away in the rush of the holiday season.

The reason was that our coverage had been gained through a deal with the Microsoft Alumni Association, which offered not just individual plans to members, but group plans to member-owned companies (and I was a member). Through Microsoft Alumni Association, we were able to access a Premera Blue Cross plan that deftly handled our multi-state footprint, but it was apparently too good to last. Microsoft Alumni Association was abruptly getting out of the health insurance business, notifying my employees before notifying me, and giving us a scant six holiday weeks to get new coverage lined up for everyone. (My rant mail to the association explaining the real world effects of dropping this bomb inside our company went unacknowledged, and in case you were wondering, no I am no longer a member).

Begin scramble mode. With our COO David Skinner leading the way, we found a broker willing to work with us on short notice. (As a 10-person firm at the time, our health insurance business wasn’t going to make anyone’s financial quarter.) Under the gun, we looked at a couple options and landed on one that looked like the right mix of costs and benefits. The provider: UnitedHealthcare.

Then things got really bad. UnitedHealthcare may work for some people; for us, it was a disaster. Out of a coverage pool of 10 people, within 3 months we had racked up 6 separate incidents of denial of coverage: Prescriptions denied at the counter. Coverage denied at the doctor’s office. Failure to find a specialist within 100 miles of a major metropolitan area. Incidents where helpful pharmacists revealed that the UnitedHealthcare price was twice the cash “off-insurance” price and thus suggested the employee pay out of pocket for the latter. The experience delivered the exact opposite of what insurance was supposed to provide.

It was a nightmare: A bureaucratic headache, a terrible “benefit” to be offering employees, and for some a distressing — even traumatic — complication to be thrown into the middle of the already-stressful situation of managing a health issue or crisis. We carved out a tremendous amount of time documenting the issues, cross-referencing the policy, pointing out why things should be covered, and escalating through our broker. Those of you who have been down the same path know what resulted: A lot of concerned noises, some activity, but zero positive outcomes. The broker pointed at UnitedHealthcare who pointed at the prescription provider who pointed at UnitedHealthcare, who pointed at the broker. Meanwhile, several employees simply started paying cash out of pocket for medical expenses because going to war with their health issue AND going to war with their own insurance provider simply both didn’t fit into the same day.

We gave it 3 more months to settle out, but with more incidents, more hours spent chasing the medical bureaucratic complex Merry-Go-Round with no results, and UnitedHealthcare becoming a morbid punchline at our company meetings, we said “enough.”

We set out to find a new health care provider. Again. But instead of six weeks to find one, we were going to take six months and leave no stone unturned.

We now knew directly that the terrain ahead was treacherous: a US healthcare system that was… well what was it? A realized dystopia? I’d call it more of a “despairia”: a system that by default preys on the sick, denies them care when they need it most, dares them at their weakest moment to do something about it, and counts on them eventually giving up the fight, all while cashing massive checks from captive corporate “customers” to fund the entire con.

We had been rudely awakened to that reality, but with six months to work with, we set out with a goal to navigate this stark landscape and return with the best possible coverage that our small company could afford, something that in these turbulent times would serve as a “safe harbor” that would underscore our commitment to our team and give them the space to focus on our clients’ problems, not our health insurer’s.

Sound daunting? It was, but (spoiler alert) we got there. Mostly. We also learned a ton along the way. More on that in the next post.


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