Monday, April 13, 2009

You think this blog is about you....

Last Friday morning would have been such a waste of time had it not been for one's man's confusing comments. You see, there was this guy on the phone with me who was (surprise!) pissed off that our company didn't pay for a claim of his. We'll call him Ed since that is the simplest of names for the simplest of minds I was dealing. Good old Ed had a claim for an orthopedic surgeon that treated him while he had a stay at a hospital. This surgeon was not in his network, which means that despite his deductible being met, Ed had to eat up that charges all by his lonesome. It was a tough break, but completely within the guidelines of his plan. Ed didn't see to think that is was quite right. He had many interesting supporting arguments.

One was that he “hired” our company to pay his claims. Yep, “hired” was the word he used. As if it made logical sense to him that one could give someone $X.XX and they would decide to turn around and pay $XXX.XX out on claims on their behalf. Somewhere in his thick skull, it was not resonating with him that no business model is designed to spend more money than they bring in. I pointed out the policy guidelines and hoped shit for brains would just shut up and get back to beating his wife and children. Nope. That didn't do it. He had other ideas in store for me. For instance, I was not aware that he hired ME personally to negotiate all his claims for him whenever they came in. Fuck, that was news to me. I probably should be getting a pay raise if I am supposed to be doing all this negotiating. Ed was mistaken again as we only negotiate with contracted network providers and not with anyone out of network, especially after the fact. Essentially this was a tough break and the guy should just deal with it by drinking his worries away.

Well, Ed wasn't going to settle for just drinking anything away. Not that he didn't drink anything. I am wagering to bet that Ed smelled like a hobo who broke into a medicine cabinet. He had other ideas. Fantastic and ridiculous ideas. He then went on to ask me why our company went ahead and hired him an out of network surgeon. I had to remind him that we were not there with him calling the shots when he chose where he would be treated. I kindly reminded him that technically, he hired the guy who worked on his leg. He didn't take kindly to that. Probably because I was right. I wish I could apologize to his wife for the mark he inevitably left on the side of her face later that day because of this. You would think that Ed would realize that at this point he was defeated and perhaps he should just go out to the backyard and shoot some beer cans. Ed had yet another idea in him as whom to blame. He then asked, “Well, then why did the hospital hire an out of network provider?”

At this point, I probably should have said, “I don't know. Perhaps you should ask them”. But then out of courtesy and good will towards someone at the hospital, I defended the hospital by stating that they hire people based on credentials, not what insurance company they work with. All this did was get us back into a circle where he then insisted I should be negotiating rates for him. The real kicker here is that our friend Ed had his policy for 3 or 4 years by the time he had this big surgery. He had no issues paying a premium when he wasn't seeing any doctors for anything at all, not even preventive visits. For some reason, the guy suddenly thought he had the shittiest insurance in the world. I got the classic, “Well what do I have insurance for” comment. I loved that one. Seems to only come up after people go years without using their policy and then because they had never bothered to read the damn thing, they are suddenly appalled by it. They like to claim we are finding new ways to avoid their claim. Nope. We sure as hell are using the same ways to avoid paying your claims that we used 4 years ago before you started using your benefits. I decided to remind Ed what he was paying for. I pointed out the $20,000 he saved with contracted rates and coinsurance.

Oh, you were dead right if you just guessed that Ed had an answer for that one. He insisted that “everyone knows damn well that you can go to any doctor and they'll reduce the cost to a competitive rate”. This was another point where the perfect words were in my head and I should have said them.

“Go ahead. I hope that works out for you,” is what I wanted to say. I didn't though. At this point we had gone in circles and I was ready to give this ignorant jackass his appeal rights. In fact, I assumed he was getting tired of it himself. Then, when I thought he had played all his cards, the ace came out of his sleeve. Ed apparently had a new theory brewing. He had no problem sharing it with me.

“I wish that you could see right now the demons that I an envisioning while I am talking to you,” said Ed.

Verbatim, folks. Word for word, what he said to me. Demons. Bloody fucking demons. Just like an episode of “Buffy the Vampire Slayer”. Needless to say, he immediately impressed me with his ability to unleash such a surprise. Well, played, Ed. Bravo!

Now, at this point, I couldn't pay complete attention to what the man was bitching about. Some of it could have been real funny shit, but I was in deep thought at the moment. I couldn't help but wonder “How exactly did he see this demons?” Was he seeing them in the room with him? Perhaps he was imagining me with horns, a tail, and glowing eyes while wearing a headset. I opted to believe he meant the latter of the two.

He had me speechless upon this whopper of an accusation. This was another point where the perfect words were in my head, but I was not at liberty to say them. I should have though. Maybe they would have done some good and we could have gotten somewhere. I could have reached out to him through the phone with the simple utterance of the words, “The power of Christ compels thee”.

An exorcism could have done that man some good. However, I wouldn't want to be the one who would have dealt with him when he found out that his policy didn't cover it....

Speaking of ridiculousness, let's talk about those Brewers. Now I know that The Crew lost a couple big pieces of talent to free agency, mainly Sabbathia and Sheets, but we still expected them to have a fire lit under their asses. Okay, so maybe the offense has a fire under their ass. The boys have been hitting the best they can. Hell, they have put up some runs. Corey Hart has been solid knocking shit out of the park while Rickie Weeks is hoping to launch a career renaissance. Then there is the pitching.

Holy crap is there the pitching. The god awful pitching. It seems like the starters can't seem to keep their shit together long enough to give our guys a chance to take a lead. Their control is as solid as Lindsay Lohan is sober. A complete and utter joke. Someone on the jsonline comment board noted that Jeff Suppan is the most expensive batting practice pitcher in the league. That is true to an extent, but batting practice pitchers actually throw strikes. I would have pulled that guy as soon as Soriano made contact with that first pitch.

Regardless, The Crew has some problems to sort out.

By the time any of you read this, it will be 34 days until LAS VEGAS! As the days count down, the excitement grows more than I could have anticipated. However, along with the excitement grows a little anxiety. I don't want to deal with the nonsense that goes with the traveling portion of the trip. Now, I don't fear flying in any way at all. I just am not thrilled about the whole process of getting on the plane. Seems like a lot of shit could go wrong. How will I pack everything? Should I bring more than one suitcase? What about all those security checkpoints? I would prefer not to get a random strip search. Add to that the fact that we have a layover in Houston. Yeah, Houston. Not sure about that.

Random thoughts:

I had to restrain myself from buying half off Easter candy today. As much as I love those Reese's Eggs, I know better.

Job interview on Friday. I'll tell you more about it after it is done and over with.

I am quite fond of the newly formed Michael Scott Paper Company.

I bought some clothes this past weekend. Haven't done that in a while.

Mark Chmura is signing autographs at this year's Packers Draft Party. Yeah, that does amuse me. My brother thinks we should have him sign the police report.

Speaking of Packers, their schedule is released today.

Demon, he says!

I am so tired right now, but I haven't been able to sleep lately. I hope that mess figures itself out.

Saturday night was fun. It was a bachelor party of sorts for my good pal from work, David. We had several good laughs and even got into a discussion with a random girl in the bar about the bartender's chest. We assumed they were fake.

MLB: The Show 09 is addictive. I finally made the majors, however. We'll see how that works out. I sure as hell don't want to pull a Suppan.

Fast and Furious made more money this weekend? Thanks, America! Glad to see we have taste.

Alright, time for this demon to try sleep. Goodnight.

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