Decisions and their consequences, part 2 -- a tale of two insurers
Why is a $14,000 emergency auto insurance claim easier to resolve than a routine $40 doctor’s office copayment?
In truth, I never figured that out. I share this that you might learn something from my tale of two insurers, starting with the vast, unforeseen consequences that may follow seemingly routine daily choices.
As you may recall from my last blog, this life lesson started on the dark, blistery evening of Jan. 7, 1999. I left work during an ice storm in hopes of making my church choir practice on time, only to end up in a nine-car pileup that broke my left foot and totaled my sparkling emerald green Plymouth Neon. Paramedics urged me to go to the hospital, but having written many articles on problems caused by unnecessary emergency room visits, I didn’t want to add to them. I feared this storm had already given Oklahoma City ERs more business than they needed, I believed my aching foot could wait until morning, and I refused to even consider an ambulance transport bill. My immediate concern was how to get home. That answer came in a ride offer from Christian strangers, friends of those who owned the car I hit. Reaching my apartment took them more than 40 miles out of their way, all under that raging storm, but they gladly met my need. Since I had no money, I had them stop at my dad’s house (just a few blocks from my apartment) so that I could borrow and give them $20 (which held far more value then than now).
As you might expect, sleep didn't come easy after more than two hours of sitting in the middle of a black-ice interstate, watching vehicle after vehicle ram my new car or waiting my turn to talk to patrolmen. My mind kept replaying those demolition derby memories through the midnight hours, enhanced by stabbing pains from my increasingly anguished foot. So I decided to seek what resolution I could. Pondering what positive steps I could take in the wee hours of that bitter night, I called State Farm, my auto insurer. My agent wasn't in, of course, but his 24-hour answering service met all my needs, starting my claim electronically in less than 15 minutes. I then rambled back to bed and eventually drifted away, aided by a Titanic-numbing cold pack bound to my swollen foot.
With the sun's rise, I found ice covering just about everything outdoors and some things in my apartment. Although State Farm's area claims office had closed due to the storm, my insurance agent opened promptly at 9 a.m. with knowledge (via internal emails) of my problem. Unimpeded by that harsh weather, State Farm's computer system had assigned my claim a number and adjuster who was already at work on my case.
Overjoyed, I turned my attention to that angry foot. My physician's office offered an 11 a.m. appointment, but I nixed that after recalling the 50-plus-mile roundtrip this required on those slick roads. My health plan suggested several clinics closer to home, but checking their availability showed most were either closed by that weather or no longer accepting my insurance. Only one nearby clinic met my needs. Its receptionist gladly scheduled my desired morning visit — until I revealed my injury came from an auto accident. That changed everything. Unless I could assure the clinic in writing that my auto coverage didn't include medical care, this attendant refused to take me. The reason? They feared my medical insurer (which was partially owned by the hospital chain operating this clinic!) would refuse to cover injuries suffered from my accident.
Their concern centered on liability — deciding which of my insurance policies (auto or medical) would have to pay my claim. A nine-car pileup could make that determination almost impossible to sort out. The clinic feared my reluctant insurers would try to postpone or shift responsibility, perhaps even refuse payment, leaving that office (and myself) holding the bill.
As a result, the clinic required assurances I would cover the debt myself in 30 days. That timetable was less than half the regular reimbursement schedule I've experienced from insurers, which the attendant admitted, but she would not bend. "It's just our policy," she said.
When I questioned that, the receptionist bucked me up to someone in the business office who, after trading calls, said the clinic would schedule me if:
I could provide a written document from my auto insurer verifying my policy did not include health coverage.
My medical insurer (an out-of-state firm that contracted a local provider for my health plan) immediately guaranteed this clinic over the phone that my claim would be covered.
I gave her my provider's 1-800 number, hoping this multi-state storm front hadn't shut their offices down as well. I then called my auto agent, who gladly printed the letter I required. Luckily for me, his office sat along my path to the doc. Not long after that I received a call from the clinic, which in less than 30 minutes had received assurances my claim would be paid. So my father — who always had my back — drove me in. The doctor x-rayed my rebellious foot, finding a crack in one small bone between my heel and toes. Thinking this would best heal on its own, he told me to wear heavy shoes and baby that foot a few weeks, then sent me home with a bottle of anti-inflammatory meds.
This all happened before noon.
I then received a call from my auto claims agent, who took my statement over the phone and told me not to worry, for my car would be inspected first thing next week. True to her word, that Monday the wreckage I'd once driven was tracked down, examined, and green-lighted for replacement. Four days later I received the keys for a brand new Plymouth Neon almost identical to what I'd lost. Its main differences:
A black paint job (and unpainted, black plastic bumper covers).
No Micro Machines USS Defiant hung from its rear view mirror. My oldest daughter had adorned my last car with her DS9 treasure, and felt sorely grieved that I had lost it.
Just that quick, this black roadster (for it was fun to drive) completed my auto claim (or so I thought). It cost me nothing, and my monthly fee never changed.
If only my medical issues flowed so well.
While this new doctor took me in and tended my wound best he could, I left with a stern reminder that my insurer had to pay them within 30 days. That month came and went, as did the next one, before that clinic's office manager phoned me at work to ask where their money was. I apologized and called my insurer's customer service rep, who projected his firm would get the check in the mail within a week. When I reminded him that they'd promised to pay within 30 days, he gently pointed out that they would be, since their firm only received the bill two weeks before my call. So I phoned the doctor’s office, explained the issue, and asked why it had taken so long to get the bill into the mail. But it hadn't, the manager said — their invoice had been sent the very day of my appointment.
Months later I learned what caused that discrepancy: a claims processor used by my insurer had sat on that invoice six weeks before forwarding it for payment. No one ever explained why.
Over this time, I learned that my auto claim also endured a long settlement battle – this one legal, between insurers. It somewhat paralleled what the doctor’s office had sought to avoid.
As often happens in car pileups, each impacted insurer naturally wants to pin liability where it belongs while avoiding liability whenever possible. Sorting through challenges in my case took at least a year, as I learned when one of the officials I’d spoken to in this odyssey (I can’t recall who) called to ask if I’d heard anything new. When I said "no" (a difficult admission by a newspaper reporter), he explained the main problem: the Oklahoma Highway Patrol's report on my accident remained unfinished.
That made sense to me, considering the chaos of that chill night. Who had means or proof to sort out how it all happened? Yet this, I was told, could pose two headaches for these insurers:
First, since my hit came early in the pileup, my insurer could face some liability for subsequent cars in the wreck if I was determined to be at fault.
Second, I'd owned my car less than a month when that crash occurred. That short time meant the insurer liable for my grief had to cover the total replacement price of my vehicle, with no depreciation. I was told every insurer resisted that.
The unfinished OHP report apparently left all this in legal limbo. Without it, the insurers had no one to officially explain what happened. Unless that changed, this informant suggested every insurer would probably agree to pay only its own client claims, leaving the uninsured to their own resources.
"Sometimes that's what's best," he said.
I never learned how this ended, for he never called me back, and neither did anyone else tied to this nightmare. But for years afterward, I reflected back on all the consequences I and others faced from my decision to drive on that icy night. And I thanked God no deaths resulted from this. That could have happened oh so easily.
Some readers may wonder whether the age of this tale lessens its value. Well, this wasn’t the only time a doctor’s office treated me this way.
Roughly a decade ago, while preparing to give a benefit concert for Tulsa's United Way, I felt symptoms of a flu bug or sinus infection. Seeking to keep my voice and mind bright and clear, I went to see a doctor under my company health plan. About 35 days later I received a call from that clinic’s business manager seeking to know why I had not yet paid for that visit. Surprised, I asked if they had filed a bill with my company’s insurer, which typically handled all claims within 90 days. She admitted they had, but still insisted I personally pay them, just in case my insurer did not come through.
Amused, I forwarded this complaint to my employer’s business manager, who called this stubborn executive with assurances our insurer would not let them down. That appeared to settle things, but when the next month rolled around, so did that persistent clinician. Since my insurer still had not paid my bill, she insisted I do it – as she’d demanded 30 days earlier.
Amused no longer, I arranged for a group phone call between myself, my employer’s business manager, a customer service rep for our insurer, and that irate bean counter. Our insurance spokesman reminded the clinic’s business manager that his firm paid our claims within 90 days, as that clinic had agreed when joining our health plan. After some hedging and fuming, that manager backed off and vowed to wait one more month. Since I never heard from her again, I assume that clinic got paid… but since I refused to ever see that doctor again, I’ll never really know.