Friday, 1 January 2010

Dealing with US Insurance and Banking Bureaucracy

I may have mentioned in earlier posts my sense of desperation at the level of debate in the US about health care reform. Dealing with the insurance bureaucracy has been a real eye-opener to at least one source of the very high cost of health care here. Many Americans seem unaware how far from world's best practice they are here.

Through Barry's job at Berkeley, we are entitled to medical coverage, and as we went through quite a process in 2008 to choose an insurer and a plan, we decided to stay with the same supplier when we returned in 2009. It seemed to me (this is from memory) that what we are paying for the two of us, on top of the University contribution, which Barry thinks is abut 80% of the cost of the coverage, is considerably more than half of what we pay in total for our top private hospital and medical coverage, including all ancillaries (chiropractic, dental, optical, massage, CPAP machine, orthotics etc) in Australia.

It took months for them to get our address correct and send us our cards, though they had other details they could only have got from the very forms we filled out our first full day in Berkeley in the History Department at the University, and the money was certainly being debited from Barry's pay. It seems that some details on the forms go through Payroll, others through the part of the HR Department that deals with the insurers - many players handle the pieces of paper at Berkeley, then many more handle them at the insurer. When calling with an enquiry, the people we spoke to often said they weren't authorised to deal with that piece of information (for example level of coverage, name of our doctor, or even our address), and we had to call another department. I wonder who sold them their computer systems! In fact I sometimes wonder whether they even have them. The first doctors we were assigned to in 2008, far from being the ones we had nominated on our forms and who worked at the University Medical Centre, were in South San Francisco, about 30 miles from Berkeley where we lived and Barry worked. At least this time we got the doctors we nominated, close to campus. Both of us had minor problems (Barry had hurt his wrist and my left arm was not working properly) and as they were not improving we each eventually saw a doctor, had X-Rays etc.

Making my appointment was not easy, but as Barry had pioneered the process a couple of weeks earlier and offered his wisdom, it only took me 3 phone calls to get an appointment! There was a myriad of forms to fill out, and rather a long wait, but the doctor was extremely thorough and referred me for an X-Ray and (based on the outcome of the X-Ray), diagnosed the problem and referred me for physiotherapy. I saw the physio 5 or 6 times, it was easy getting appointments in advance, and he was very good, doing some manipulation and a lot of laser treatments as well as teaching me a variety of exercises. Now if I only did the exercises he prescribed regularly, the pinched nerve in my neck would be improving faster.

Once I got to the practitioner, I think the treatment was very professional, very thorough, and very good. But from my observations while waiting in the office at the physio (never for long), each patient seemed to have trouble over their insurance, and the receptionist and the physios were forever on the phone to insurers or doctors, chasing faxes about coverage etc. The co-payment of $15 per visit seemed about the same level as it is in effect at home, though we don't call it that, and that is all I had to pay, as under the insurance scheme the insurer picks up the rest of the bill, rather like bulk billing.

There is no doubt that enormous amounts of money could be saved by having better systems, perhaps standardising systems and practices, multi-skilling the people who answer phones or having a single case manager for all aspects of a person's treatment.

So much for health insurance bureaucracy. We also have a bank account with Bank of America - one that was established originally about 25 years ago when we were in San Diego for a sabbatical. We started using it as our main account in Berkeley last year, and the change of address seemed to work OK, though they never managed to print any new cheques for us (and it is hard to get by in the US without using cheques. Having transitioned away from paper-based to electronic banking years ago at home, it irks me that so much still depends on cheques. Interestingly, when you deposit a cheque in the ATM, you have to scan the cheque rather than put it in a deposit envelope, then it offers you a form of receipt with a scanned copy of the deposited cheque, but sometimes the ATM can't read the numbers on the cheque so you have to key it in anyway.) People seem to use cheques for trivial amounts of money, and often credit or debit cards also - you don't see so many notices in stores saying minimum expenditure $10 for a card transaction, whereas at home for low value transactions I have the sense we use cash more. Perhaps merchants in the US don't have to pay the banks such high transaction fees for card transactions (I assume this is why they Australian merchants don't like to take cards for low value transactions where the fees eat up their profit) - there is a lot less EFTPOS and more credit card use.

But this year, though the Bank recorded our change of address and at our request printed some new cheques with this address on them, and mailed them to us at this address, they still had our address from last year as our account address. This meant that the only way I could get a credit card transaction to work when paying for something over the Web was to use last year's zip code rather than this year's. Very peculiar, and it wasn't until I enquired about this that the third person I spoke to (after being on hold for ages at the start of the call and between each person), checked the home address on a different system than the one that issues the cheques!

Then Barry got a new debit card in the mail, with a letter saying his old number may have been compromised by some scam. But he could not activate this new card, because they seemed not to recognise Barry's date of birth as correct, as he discovered when he went down to the local branch and spoke to a person there about it. His date of birth has of course not changed in the 25 years he has held the account, so it seems odd no-one had noticed! And within a week or two of getting this sorted out, another 3 new debit cards arrived in the mail, with no explanation at all this time. Rather than once again engage in the telephone marathon, he went to the branch and cut them all up!

Then I had a further refusal of my card over the web, and again it required talking to a number of agents on the phone before one of them had the authority to tell me what had happened (I had apparently inadvertently selected the wrong month for my date-of-birth in this transaction). It seems many different aspects of transactions are managed using different computer systems which don't talk to each other, and the California-based accounts are on different systems to accounts held in other states or transactions done in other states, so no-one has the complete picture. I have not been a great fan of the Australian banks, and was especially peeved years ago when the Commonwealth Bank took over State Bank of Victoria, which had been my bank, and retired the latter's far better (from a consumer point of view) systems in favour of using their own legacy systems, but with this experience behind me I am a lot more appreciative of the relative efficiency of the Australian Banking system now!

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