Proctered and Gambled

I have fierce brand loyalty where toiletries are concerned. Though Mrs. Gerbil thinks I am unnecessarily finicky about such things, I simply will not settle for store-brand skin care, dental care, or feminine hygiene products. But for all my desire to cut costs wherever and whenever possible, I am a creature of habit, and a lot of times the store brand just isn't the same.

A lot of my favorite toiletries are made by Procter and Gamble, and I've been using the same P&G products since high school (i.e., half my life). Consistency may be the hobgoblin of little minds, but for me it's a source of warmth and fuzziness. So if my beloved products aren't up to snuff, you bet your bippy I'll be upset. And what do I do when I'm upset? I rectify stuff.

Many moons ago, I called P&G about cat food cans that wouldn't open, and for my troubles I (or rather, the cat) was rewarded with eighteen vouchers, each good for one free case of cat food. That is a whole freaking lot of cat food.

Several weeks ago I restocked our supply of nice, lotiony Puffs tissues. Tissues with lotion in them aren't good for wiping up spills or cleaning one's glasses, but they sure are good for protecting my sensitive little schnozz. Imagine my unpleasant surprise when I discovered that one of the boxes was full of coarse tissues! The P&G representative asked whether the tissues contained the proper amount of lotion, "because sometimes the lotion doesn't get on them." Oh, they were lotiony, all right. And mysteriously scratchy. For my troubles, P&G sent me a voucher for three replacement boxes of Puffs.

Recently I bought some more of my favorite unscented Secret deodorant. At about the same time, I noticed the smell of tropical fruit every time I went to nurse Tovah. None of us uses any products that smell like tropical fruit, so I was completely at a loss for whence this smell was coming. Then one morning I figured it out: it was my supposedly unscented Secret. WTF? (At least it wasn't phantom chai.) My sensitive little schnozz did not appreciate the bait and switch, but I feared I might get myself blacklisted with P&G's customer service. I know I'm in their computer system, because despite my careful spelling-out of my name each time I call, they always address mail to me with the same misspelling.

Not surprisingly, my need to rectify things won out, and I called P&G about my disturbingly fruity unscented deodorant. The representative was all apologetic, especially when I alluded to my sensitive little schnozz.

Well, today I received my replacement vouchers, with a predictably misspelled address label. I'm pretty certain I've been blacklisted. P&G thanked me for being a valued customer by enclosing a sample of heavily scented laundry detergent.

Support single-payer healthcare!

A cute video from my aunt's colleague's family:

Loyalty and algebra

Although we don't really live in a real neighborhood these days, we are right across the street from a whole bunch of useful things. These include the cheapest gas station in South Hadley, Dunkin' Donuts, a Chinese restaurant, a Greek and pizza restaurant, a drycleaner, Friendly's, a hardware store, and a grocery store. (Oh, and there's an armed services recruiting office, too, but that's not so useful for us. After all, Tovah's too young to enlist, and we're too gay.)

The grocery store is a Big Y, and unfortunately its convenience factor is offset by its prices. Mrs. Gerbil is in charge of most of the grocery shopping around here, and she prefers the PriceRite a few miles away. But when the PriceRite doesn't have what we need, or when we just can't be bothered to drive or bike out there for a few items, we just go across the street.

The Big Y, unlike the PriceRite, has a loyalty program. There is your standard savings card, but there are also these little coins that you sometimes get at the register. The coins grant you discounts on items we never buy (like pre-fab frozen bagel pizza bites, ice cream cakes, and steak). There are silver, gold, red, and blue coins; silver coins get you the smallest discounts and of course are handed out at greatest frequency, usually in pairs. We have about three dozen silver coins, and needless to say, this is all kind of annoying.



I perused the rewards flyer the other day and discovered that a silver coin will get you a free small cup of coffee. Mrs. Gerbil is a coffee fiend, so I suggested that instead of making coffee twice a day, she should take a coin across the street and get some free coffee. On Thursday I tried this arrangement out for myself. The decaf was pretty good; but I hadn't realized that even if you pay for a purchase entirely with silver Big Y coins, you still tend to get a pair of silver coins at the register.

Let x equal the number of coins with which we started out. Despite my efforts to turn coins into coffee, we now had x+1 coins.



On Friday morning, Mrs. Gerbil and her mother (who's enjoying her grandma time immensely) went across the street for coffee for all three of us. They returned with two regulars, one decaf, and (argh!) two more silver coins. After four free cups of coffee, our coin collection had achieved homeostasis, with (x+1)-3+2 coins... otherwise known as x coins.



Mrs. Gerbil and her mother went back across the street for more coffee on Friday afternoon. They returned with two regulars, one decaf, and (praise the Lord!) not a single silver coin. Seven free cups of coffee later, we possessed x-3 coins.

This morning, Mrs. Gerbil brought back three more free cups of coffee (two regulars and one decaf, of course)... and two more infernal silver coins. This brought us to nine free cups of coffee but (x-3)-3+1, or x-5, coins.



Secondary school students often complain that algebra isn't useful in the real world. Perhaps the powers that be at the Big Y are counting (ha ha) on its customers remembering the pain of algebra rather than its methods. But in any case, hey, small cups of Big Y coffee are the gift that keeps on giving.

Can you hear me now?

A few weeks after we moved, I decided it was high time to get myself a local cell phone number. It seemed silly to continue using my old phone number, for three reasons. First, it would be a long-distance call from any land line in these parts. Second, on account of the three-hour time difference, I was getting wrong-number calls at 2 or 3 in the morning. Third, even moving 3000 miles away did not make the pharmacy calls stop.

So I called Verizon and requested a new number. I'd changed my number once before, upon moving to California from Ohio, and it had been a very easy process... until I received a bill with an early termination fee on it. It turned out that Verizon's California operations are completely separate from their operations anywhere else. So Verizon's everywhere-but-California office tried to charge me $175 because they were not told by Verizon's California office that I hadn't, in fact, jumped ship. Fortunately, it only took one phone call to straighten that one out.

(It seems many telecommunications companies have separate offices for California-based services. When I signed us up for land line service in California with SBC, they tried to screw us over with this very bizarre method of "credit establishment," which amounted to giving us about 7 calendar days to pay our first couple of bills and then slowly lengthening the payment timeframe. This seemed like a trap, so I called to complain. I pointed out also that I'd had SBC service in Ohio for four years and had never once been late with a payment--hadn't I already demonstrated myself as a good customer? The representative told me that SBC's California office does not have access to records for SBC's operations in any other state. I tried to enlist the help of the California Public Utilities Commission, but apparently this backwards billing method is perfectly legal in California. Your guess is as good as mine.)

Getting my Massachusetts cell phone number was also very easy--almost too easy. Then I got my first bill and noticed that not only did I have late fees for January (a month for which I'd never actually received a bill) but I was being assessed California state and local taxes on my new Massachusetts number. Naturally, I called to rectify the situation. I got the late fee erased after much convincing of the reluctant representative that, during my 6 years with Verizon, I'd never once been late with a payment, and furthermore I'd never been billed for January anyway. She made me acknowledge at least three times that they could only waive the late fee once, whereupon I reminded her each time that I would have happily paid on time, just as I'd happily been doing for six years, if I'd actually received a bill in January.

The matter of the taxes was a little more complex. It seems that when I had called to notify them of my new mailing address--prior to getting my new number--whoever took the call had not also updated the primary location where my phone was being used. So their computer system thought I was receiving mail in Massachusetts but using my phone in California. (Huh?) The person who helped me fix this was very thorough and not the least bit reluctant. I like it when that happens.



I thought all was well until Mrs. Gerbil called me from home yesterday and found that she had to dial 1 and the area code to get through. We do not live in an area with 10-digit dialing. In fact, the entire western half of Massachusetts has the same area code, so local people look at you funny if you give your phone number as 10 digits instead of 7. My new cell number was supposed to be a South Hadley cell number, but it obviously was outside our local calling area. Our local calling area is pretty big, but it's definitely not the entire western half of Massachusetts. What gives?

So I called Verizon and asked where my new number was based. Imagine my surprise when I found out that it was based in Huntington--which is forty-five minutes away! I wasn't all that attached to my new number, and it seemed silly to keep a non-local number that I'd received when I'd asked for a local number, so I asked for a number that was really and truly local. This time I looked the exchange up in the phone book just to make sure. The representative magnanimously volunteered to waive the $10 new-number charge. It all seemed too easy. But we'll see when the bill comes.

That is, if it comes.

Blessings and curses

This shouldn't be a surprise to anyone, but western Massachusetts has a much more reasonable cost of living than does the Bay Area. For example, I bought a gallon of store-brand skim milk the other day at Stop & Shop for $3.69. A month ago we were buying store-brand skim milk from Safeway for $4.59 per gallon. (The gerb demands a lot of milk these days, so milk prices make me a lot happier than they probably ought to.)

The Commonwealth of Massachusetts is also a lot more concerned about health insurance than is the State of California. California's approach seems to be "let's wait until something goes horribly wrong, then get medieval on some asses" (as in the Blue Cross recission fiasco). Massachusetts' approach, by contrast, seems to be "let's see how much ass-medievalizing we can prevent." Recent legislation requires pretty much every resident to have his or her own health insurance--with steep monthly fines to deter potential law-breakers. Most employers are required to provide at least some kind of health benefit. There is even a state agency, the Commonwealth Connector, via which one can obtain insurance if one can't get anything through one's employer.

Unfortunately, the requirements placed on employers are pretty vague in terms of what constitutes minimum coverage. Mrs. Gerbil (who has found part-time work) and I (with the promise of temp work) have both been offered extraordinarily crappy coverage through our new respective employers. The plan which I've been offered has a very low maximum annual inpatient benefit which stands an excellent chance of being exhausted by the birth of the gerb--assuming, of course, no complications. The outpatient benefit doesn't cover preventive care, and the plan certainly doesn't cover mental health treatment.

Mrs. Gerbil has a choice of three coverage levels, two of which will only pay for 5 outpatient doctor's visits and 3 emergency room visits (presumably excluding ER services that lead to inpatient admission) per year. WTF? Now, I'm all for getting people hooked up with outpatient providers instead of using the ER for primary care, but if you've used up your five (again, WTF?) outpatient visits and you get a sinus infection, the only way to get the treatment covered seems to be to go to the ER. ('Course, the ER deductible might be more than the out-of-pocket cost of an office visit...) Again, there's no coverage for mental health treatment, and maternity care is subject to the same limits as other conditions.

My stint as a managed-care monkey gave me a very solid lesson in what sorts of questions one should ask about benefit design. However, it also taught me what constitutes a reasonable coverage limit. Naturally, I decided to call both of these insurance companies and press them a little on what exactly they cover and exclude.

First I called the plan I was offered. I waited on hold a long, long time and was eventually bumped into voicemail. The outgoing message promised a call back within 24 hours. I was not surprised when 26 hours went by with no call back, so I waited on hold some more and finally spoke to a very nice representative who really knew her stuff. She informed me that prenatal care is not considered preventive care (after all, pregnancy is a sickness), and therefore it is covered. She explained the various components of the inpatient benefit, the process by which one obtains reimbursement for prescriptions, and how to get documentation of prior coverage so as to be exempt from the pre-existing condition clause.

Verdict: plan sucks, but not as much as it could.

Then I called the plan Mrs. Gerbil was offered. I asked whether the outpatient visit limit also applied to prenatal care. The representative confirmed that it did. "That's amazing," I said, "and not in a good way. I'm in my third trimester, and even with a perfectly normal pregnancy I have to go to the midwife every two weeks!" The representative made an ambiguous little noise. I decided not to tell her that once I reach nine months, I'll have to go every single week. Instead I asked whether well-baby care and immunizations are covered, and if so, are those also limited to five visits. The answers: yes and yes. (The American Academy of Pediatrics' recommendations include no fewer than seven well-baby visits in the first year of life.)

Then I posed a more complicated question. Massachusetts has a fairly extensive mental health parity law. This plan has no mental health coverage whatsoever, so how is it exempt? The representative put me on hold, which I knew to mean that she had to ask her supervisor. When she came back on the line, she said that her supervisor (ha! I was right) told her it is because of the "delivery state." It didn't sound like the representative really understood this herself, but I happen to know from my all-too-recent managed-care-monkey days that exemption from parity laws depends on the state where the policy is written (and not where the patient lives) and how it is funded. (I swear, I wasn't trying to fake her out or anything! I just wanted to know!)

Verdict: plan sucks far more than expected.

And this, my friends, is reason #392 why I support universal health care.

Playing telephone

First, some ketchup: Day Five of our cross-country drive took us to my parents' house in good old Newtown, PA; and Day Six took us to our new home in South Hadley, MA. We've been here since January 13, but we only just got the internet to come into the house this morning. Thus, my lapse in blogging. Sorry about that. (In any event, there wasn't anything funny on Day Five except my parents; and by the time we actually made it to our new abode, we were too tired to consider anything funny.)

So, yes, the internet now successfully comes into the house. The telephone, however, does not. Verizon was supposed to have connected our new phone number on January 11, such that it would work when we arrived a few days later.

It did not.

Well, that's not entirely true. We plugged a phone into the jack and got a dial tone.

When we moved to Berkeley, we discovered that we had a dial tone but no ability to receive calls, as some other number was coming into the house instead of the one we'd ordered. Amazingly, SBC was able to fix the problem within 48 hours. What had apparently happened was that the previous tenants had not disconnected their phone service (which was with another company), so SBC had to send someone up the pole to unplug the line and plug it in again. And voila, we had our rightful phone number.

Having learned well from this experience, I called my cell phone from our newly-plugged-in Massachusetts phone to see what number came up on the caller ID. And lo, it was not our phone number.

So I called Verizon on the 14th and asked them please to hook up our phone which was supposed to have been hooked up on the 11th. I was assured that this would be done by the end of the business day.

It was not.

I called again on the 15th and asked them please to hook up our phone. The representative said that there was defective wiring outside the house, and that it would be corrected either by the end of the week or by February 8. I expressed my frustration that (1) our service had not been connected as scheduled and (2) no one had contacted me to inform me of any problems, when I'd provided my cell phone number for exactly this reason upon placing the order. I made the representative promise me that we would not be charged for phone service until it actually worked. Then I asked what we were supposed to do about all the people (read: potential employers) to whom we'd given our non-working number. The representative offered us a voice mailbox.

"I hope we don't have to pay for that either," I said. The representative thought for a moment and then agreed that we would not be charged for voicemail. Score!

By the end of last week, we still did not have a working phone line. So I called Verizon again. I was told that there was a problem with the outside line--more specifically, that there was no line coming into the house.

"That's interesting," I said, "because every call I've made about this issue has been from a phone that is plugged into a jack in my kitchen."

(This is oddly similar to a situation frequently encountered by Childhood Friend J, who used to work for the phone company in Wisconsin. The difference is that his callers would call him to say their phones weren't working at all--then inform him that the number they were calling from was the one that was out of service.)

I was assured that there was, indeed, a problem outside the house, and that someone would fix it as soon as possible. I was also offered a rather condescending explanation of "how phone lines work," which I politely (okay, semi-politely) declined.

Yesterday, we were very excited to see a Verizon guy up the pole that serves our house. Oh, frabjous day! Calloo, callay! But alas, by evening we still did not have our phone. So I called Verizon again. Verizon said that the number that was coming to our house used to belong to the animal hospital across the street. The animal hospital had since switched carriers and phone numbers, but through the miracle of crossed lines, we somehow wound up with their old number. Verizon also said that the pole-climber had indeed found a working line up there, which could be routed to our house once another technician could come to unplug some wires in our network interface box and then plug them back in again. Verizon promised that this would be done by 11am today. Verizon also promised that I would get "more confirmation calls than I probably wanted" today, not just from the repair department but also from our case manager.

I feel a little weird being case-managed by the phone company.

Needless to say, by 2pm today no one had gone near our network interface box. I called Verizon again and, after initially being told that there was no work order on file for today, was promised that "someone will be out by the end of the day today." It's now well after dark, and not only does our phone still not work, but I haven't received any of these fabled multiple confirmation calls.

I'd call our case manager (again, being case-managed by the phone company? totally weird) but I have no way to get in touch with her.

Verizon must be taking lessons from the Department of Mental Health.

HIPAA and the Good Samaritan

I received a call the other day from a man who said he'd found a wallet with an insurance card inside it. On the insurance card was a phone number, and when he called it, he got me. He wanted to return the wallet (and the money and credit cards inside) to its owner, and he requested the member's phone number for this purpose.

Unfortunately, there was nothing I could do to help this kind man. HIPAA prevented me from acknowledging even that the wallet's owner had this insurance in the first place--to say nothing of giving out his phone number. I apologized profusely for my inability to help him, suggested he enlist the help of the local police, and added that the wallet's owner would surely appreciate his efforts.

May your holidays be full of good will toward all--and be unencumbered by complicated federal privacy legislation.

Tales from the cube

toothpastefordinner.com

Most nights I come home from work with a couple of choice stories for Mrs. Gerbil. These stories fall generally into one of three categories: Calls that Break My Heart, WTF?, and Oh My God I Thought I'd Never Get That Person Off the Phone.

Although I skipped kindergarten (I was a precocious little gerb) I do know about sharing, and I think I'm generally pretty good at it. So, I hereby share a handful of vignettes, previously heard by Mrs. Gerbil.

I can't believe we let you into the network
me: Does the member meet criteria for a parity diagnosis?
caller: Yes, she has bipolar disorder and major depression.
(explanation for those unfamiliar with DSM-IV: by definition, you can't have both)

And you are calling now because...
caller: Oh, I didn't think you were open now.

Try again later
caller: Is this DirecTV?
me: I'm sorry, you have the wrong number. This is a mental health insurance company.
caller: Oh. Do you have the number for DirecTV?
me: No. You might try the phone book, though.
(the next day)
same caller: Is this DirecTV?
me: Sorry, no. This is a mental health insurance company. Try the phone book.

How can I help you?

They tried to make me go to rehab

I get a lot of calls from people who want to go to detox, or who want their family members to go to detox. Often they are legitimate candidates for immediate, do-not-pass-go-do-not-collect-$200 detox. For example, they've decided to go cold turkey from alcohol and now are tremulous and sweating. Or they've been quadrupling their Xanax and their psychiatrist won't write another prescription. Withdrawal from alcohol or benzodiazepines can be fatal; and detox is a medical procedure which (hopefully) keeps the withdrawal process safe. I can't begin to count the number of alcohol- or benzo-dependent people I've had to convince to go to the hospital immediately... not tomorrow, not the next day, not next week when they already have time off from work. I've found "Withdrawal can kill you" to be a fairly effective tactic.

Opiate detox is another story. Opiate withdrawal is highly unpleasant, to say the least; but it is not necessarily dangerous. Managed care does not always cover opiate detox, especially of the inpatient sort. I have no idea why. But if I get a call from someone who wants to detox from Vicodin, I tell them to go to the hospital immediately. Some will ask whether withdrawal will kill them. I reply, "At the very least, if you try to do it yourself, it will be extraordinarily uncomfortable."

But then I have some people who want to detox from cocaine. There is no medical detox procedure for cocaine. Cocaine is rapidly eliminated from the body; so even if there were a way to do cocaine detox, it would have to be done very quickly. When people ask me for cocaine detox referrals, I tell them to go to the ER right away if they have any unpleasant physical symptoms or pre-existing cardiac problems. But unless they are suicidal, homicidal, or using alcohol or benzos with their cocaine, they can most likely wait until the next day for an assessment for some other level of care.

My favorite callers, though, are the parents who want their teenagers to go to marijuana detox. (Oddly, no one ever seems to call for detox for their own pot habit.) Again, there is no medical detox for marijuana. Marijuana hangs out in the body for a while, but there's really nothing to do about it--and no real need to do anything, either. I am often tempted to tell these folks that marijuana detox is a home procedure involving a couple bags of potato chips administered over the course of a few hours. But I don't, as this would be poor customer service.

There's no place like someone else's home

For Christmas last year, Mrs. Gerbil and I ordered her father a great new doormat.

There was a problem with the way the order was processed, however. It was supposed to be shipped directly to him in Seattle, but billed to us in Berkeley. What actually happened was that the order was shipped to him at our Berkeley billing address--where he obviously does not live. Having already paid a stiff UPS rate for the initial wrong delivery, we sucked it up and paid a stiff US Postal Service rate to get it to its rightful location. We were not pleased.

But our troubles did not end there.

Apparently, our innocent, incorrectly processed doormat order landed Father-in-Law Gerbil on a "new homeowner" list--for Berkeley, where (as previously stated) he does not live. At first we got a few Bed Bath & Beyond coupons, addressed to "Our New Neighbor." We were confused. We'd been in Berkeley for a year and a half and had been getting at least two BB&B coupons per month, addressed directly to me. But BB&B coupons never expire, so the more the merrier, right?

Then we--or rather, Father-in-Law Gerbil--started getting ads from exterminators. And roofing companies. And house painters. And Lasik eye surgeons. And gyms. And the AARP. And real estate agents looking to sell his home for him, which is even funnier given that we pay rent for the address at which he does not live.

I dutifully cross out the address on each piece of mail, scrawl NSR (no such recipient) in big bold letters across the front, and stick it back in the mailbox. This works fairly well, although not for all the mail we get for people who don't live here. Some church has been trying to get a former tenant (who hasn't lived here in at least six years) to attend their Christmas and Easter services, and they do not seem to know from NSR.

But what really got me is yesterday's mailing from the PG&E Care program. Like all good utility programs, PG&E has a discount program for customers with low incomes, disabilities, or assorted other things which might interfere with paying ridiculous energy bills. Father-in-Law Gerbil was thereby informed that he may be eligible for a discount from a utility company which serves an area in which he does not live.

Our PG&E account is in my name. I pay the bills every month, and occasionally I get medieval on their asses. Occasionally I get something from the Care program, but since we don't qualify, I just toss the mailings in the recycling. Anyway, the important part of this is that there is already an active PG&E account at this address, in excellent standing, and it is not in Father-in-Law Gerbil's name.

Even better: Just before said mailing went out, PG&E cashed my check for our most recent bill. Which bill, I hasten to add, does not bear any part of Father-in-Law Gerbil's name.

Father-in-Law Gerbil loved the doormat, by the way.

Understanding the system

Mrs. Gerbil is always after me to remember that not everyone knows how The (Managed Care) System works.

I usually regale her with at least two work stories each night. Sometimes I just need to de-brief a particularly stressful call; but more often than not the first line of my tale is, "Oh, my God, I had the most ridiculous call tonight." (It should go without saying that I never vent any identifying information--but there, I've said it anyway.) And then Mrs. Gerbil gently chides me for forgetting that the average person does not grok The System.

Hell, sometimes I don't even grok The System. But I will admit that I have a low tolerance for certain types of lack-of-grok, viz.:

Calling the emergency line for a non-emergency. It's 10:30 on Friday night and you have just realized that one of your claims was denied. You call the phone number on your insurance card, press 8 (a prompt clearly demarcated for emergency use only), and demand to know why your claim was denied. I will only inform you that this is a routine matter which is handled during business hours only. Perhaps hearing this will anger you; but unless your claim status poses a risk to yourself or others, it's not an emergency.

Calling the emergency line for a non-emergency matter which has nothing to do with mental health. You go to the pharmacy on a Satuday afternoon, and lo and behold, your co-pay for Lipitor has changed. You call your medical carrier, but they are closed. You hang up, call again, and select the prompt for mental health services. (Huh?) And then you press 8 and demand to know why your Lipitor suddenly costs $50. I will only inform you that you have reached your mental health insurance and we do not have anything to do with your prescription benefits. Perhaps you acknowledge that you just pressed prompts randomly to get a live person; but alas, I have no more information about your Lipitor than you do.

The guess and check method. You are calling about a hospital admission. You have not actually determined who the insurance carrier is, as you haven't bothered to look at the person's insurance card. So, you take a wild guess, and (because you are wrong) you think I should give you the correct information. Perhaps I do know whom you should be calling, and I might even transfer you if you're nice; but there is a reason that triage has already xeroxed the card.

I can't believe you just asked me that. If you work for a hospital, you should know how The System works. Please do not ask me to describe the difference between an HMO and a PPO. Perhaps you are new; but honey, this really makes my teeth hurt.

Enjoy the hold music

Thank you for calling The Afterlife.

If you know your party's extension, please dial it now.

For heaven, press 1.

For hell, dial extension 666.

For purgatory, please stay on the line and someone will be with you as soon as possible.

Privacy, please

Yesterday our block hosted an enormous garage sale. You wouldn't believe how excited this made me. Garage sales were an important part of my youth. Unfortunately, I have difficulty getting rid of stuff; and when I was younger I would often decide, midway through the sale, that I actually wanted to keep various items.

So my parents instituted a rule: Nothing that leaves the house can go back in the house. It worked.

Well, Mrs. Gerbil and I made a small wad yesterday. But the tragedy of it all was that I had to go to work after a few hours. I would much rather have been sitting out in the driveway than telling callers that I honestly do not have their claims information. Alas.

But before I went to work, I found myself with a little dilemma. Mrs. Gerbil and I live three blocks from a clean and sober house, approximately half of whose residents were my clients at my previous job. I've run into them at bus stops, in downtown Berkeley, in restaurants, and even in the corner liquor store (where they buy cigarettes and snacks, and we buy milk and Ben & Jerry's). It doesn't really bother me, and it certainly did not bother me while they were my clients.

Yet yesterday, I was pre-emptively bothered. I saw one of them walking down the street, then walking back up the street with some garage sale loot. Our building is set back from, and perpendicular to, the street; and there's a privacy fence around the driveway. Thus: I could see him, but he couldn't see me.

I started wondering: What if he comes to check out our wares? Not that he would buy any of our girly stuff, but what if he strikes up a conversation with Mrs. Gerbil and me? How would I introduce him? Should I introduce him? And is it a bad thing if he finds out where I live, even though I haven't worked with him in months?

(Mrs. Gerbil and I have already discussed what might happen if one of my former clients approaches both of us. The agreement: She is not to ask me from whence I know this person, as "I can't tell you" is fundamentally the same as "That's my client.")

My worst fears, however, were not realized. A short while later, he zoomed back up the street, garage sale loot in hand, without so much of a glance up our drive.

I still wonder what might have happened, had he checked out our stuff. It's hard to observe the "I'll acknowledge you only if you acknowledge me" rule when the person is literally at your doorstep. And what if he'd bought something? Would I have felt weird taking his quarter for one of Mrs. Gerbil's sci-fi/fantasy novels?

Signs point to "yes."

Later in the afternoon, Mrs. Gerbil went off to Walgreens to retrieve a prescription of mine. The staff at our Walgreens generally does a terrific job of authenticating their customers, even those whom they recognize (such as yours truly). However, Mrs. Gerbil reports that the pharmacy tech tried really, really hard to give her someone else's prescription.

Apparently the tech asked dutifully for my name and address--and then proceeded to hand Mrs. Gerbil the bag directly behind mine. Mrs. Gerbil protested, "That's not the right one!" The tech said something to the effect of "Did you move? It looks like we have the wrong address on file."

Mrs. Gerbil pointed out that not only have we not moved, but the name on the bag was not mine. They went back and forth about this for a bit before the proverbial light bulb came on, and the correct bag made it to Mrs. Gerbil's little paws.

I'm not even going to begin on that one. Hip-hip-HIPAA, dudes.

"No" means NO.

One of the unfortunate things about my job is that I cannot do a single thing about claims. I cannot tell anyone the status of a claim. I cannot reprocess a claim. I cannot even say whether a claim has been received. This is because I am not in the claims department.

My department never closes. The claims department does. When the claims department is open, I can transfer callers to a real live person over there. When the claims department is closed, not a single real live person is there to receive the transfer. And the only thing I can do is say to wait until the next business day--which can be a tall order if it's 7pm on a Friday night.

I don't know why it is so difficult for people to understand that I can't view their claims information. I get at least three calls per day that go like this:

caller: I am calling about a claim that my doctor submitted three months ago.
me: I'm sorry, I can't see any of your claims information. The claims department is open Monday through Friday, from...
caller: But my doctor sent in this claim three months ago and it hasn't been paid yet.
me: I apologize for the delay, but as I said I do not have access to any information about your claims.
caller: What do I have to say to get you to pay my therapist?
me: Please call back when our claims department is open and they will be happy to assist you.
caller: But why can't you help me with my claims?
me: Because I am not in the department that handles claims. That department is closed right now.
caller: Oh. Okay then, bye.

As you can imagine, I get very tired of saying the same thing over and over and over again. I probably say "I can't see any information about your claims" in my sleep. Sometimes I feel like I'm David Spade in that one commercial, except I'm not saying "NOOOOooooo!" for the passive-aggressive hell of it.

Mrs. Gerbil suggested that I come up with fun, creative ways to impart this information. Last night we came up with a whole slew while we were supposed to be sleeping.

Some of them were inspired by cheesy martial arts movies:

~ Your claims information is silent, like the ninja.
~ Your claims information is as the first crocus of spring, but it is still December.
~ Your claims information is as a deer, deep within in the forest.
~ Your claims information is as concrete shoes at the bottom of the Hudson River.

Some of them were inspired by television:

~ In the world of managed care, claims information is considered especially valuable. In this company, claims are handled by an elite squad known as the claims department. These are their hours...

Some of them were inspired by folk songs:
I cannot give you your claims status
I cannot do squat about claims
That's done by another department
So why are you talking to me, to me?
Call back, call back
Call back on Monday at six AM
Call back, call back
Call back on Monday at six.

And some of them were inspired by nursery rhymes:

Baa baa black sheep, have you any wool?
Yes sir, yes sir, but I don't have any of your claims information.

The man in the moon came down too soon
And asked the way to Norwich;
He went by the south and burnt his mouth
From eating your claims information.

Old MacDonald had a farm
E-I-E-I-O
And on his farm he did not have your claims information.

Alas, I don't think this would qualify as good customer service.

A word to the wise

After many, many months of under-employment, I finally found gainful work a few months ago. In the words of Mrs. Gerbil, having a real job is "totally crazy like whoa."

Since late February I have been working the swing shift (including weekends) in the call center of a humongous behavioral health insurance company. Mostly I'm quoting benefits, issuing authorizations, and pre-certifying inpatient stays. But occasionally I get crisis calls, which are always interesting.

In addition to rather sizable paychecks, this job has provided some perspective in my quest to Fix The World By Complaining. I'm now a lot nicer to call center representatives whom I contact in my personal life--because I know now that they can't change a whole lot of anything, no matter how angry I get about it.

I've also learned that every call is documented, or at least should be documented. Details of your calls to your health insurance are considered part of your medical record--which means you can request to see those data at any time. I would hate to see the notes our former health and dental plans have on me.

And I have learned about the mute button.

The mute button is the best way to put callers on hold without actually putting them on hold. It's weird and uncomfortable to be on the phone with a stranger while neither of you is saying anything, right? and it's so much better to be on hold, right?

Okay, maybe not. But in any case: If you don't hear the hold music, you are probably not on hold. You are likely on mute. Which means that the call center representative can hear everything you are saying.

So hold thy tongue, knave.

Public Transit Story #16: So what?

Oh boy! A public transit story and a customer service story all in one handy package!

I called to register a complaint today. Usually I do this online, but even though I always check the little box to request an email reply, I've never received so much as a "Thank you for submitting a comment." So I called, thinking it would be less complicated and more conducive to immediate gratification. Of course, I was wrong.

Me: I'd like to register a complaint about a driver.
Representative: Okay, what happened?
Me: This has happened before with the same driver and I've complained before. The driver arrives several minutes late, leaves the bus running and the door open, and goes to buy a snack. Then I have to run for a connection that should have several minutes of overlap.
Representative: But you said the bus is already late.
Me: Yes. I'm not calling because the bus is late. I'm calling because the driver leaves the bus running while buying a snack--when the bus is full of passengers!
Representative: [silence]
Me: The driver leaves a running bus for two or three minutes, while it's full of passengers.
Representative: So it's an unauthorized stop, then.
Me: It's my actual bus stop. We all get on the bus and then the driver gets off. I'm concerned because someone could just drive the bus off.
Representative: Oh. That is a problem, isn't it.

I've been sick for the past few days, but as Mrs. Gerbil says, it's a sure sign that I'm better when I start rectifying things again.

I swear, Officer, it's not mine!

Mrs. Gerbil and I went to Kohl's yesterday, in hot pursuit of random items of clothing and accessories. I find Kohl's to be rather hit-or-miss. It's almost always a miss when I'm in search of pants, as they don't carry small enough sizes. (Go ahead, hate me now.) But yesterday, when I was not in need of pants, it was a hit. For just under $35 we acquired three shirts, two pairs of socks, and three pairs of earrings. Pretty darn good, if you ask me.

The cashier handed me a very familiar-looking pen with which to sign the charge slip.

"Hey," I said, "I thought that looked an awful lot like a Seroquel pen!"

The cashier replied, a little too quickly, "Oh, that's not mine. Someone must have left it here. I don't know where it came from."

I guess the stigma of mental illness extends even to abandoned pharmaceutical swag.

Not-so-phunny pharm

I have terrible allergies.

Often people ask me which is my allergy season. I have no allergy season because in my world it's always allergy season. And so I must take anti-allergy (and anti-asthma) medications every single day. I've been doing this since I was three years old. It's old hat. In fact, I can rattle off the name of almost every prescription and OTC allergy drug I've taken over the past 24 years. Most of these have since gone off the market, been reformulated, or just spontaneously stopped working for me.

Which leaves me, at the moment, with three prescriptions to contend with. My insurance company loves exactly one of these. Another they agreed to love when my doctor assured them that I do, as a matter of fact, have asthma. A third they agreed to tolerate when my doctor assured them that none of the other drugs out there are effective for me. (When I rattled off my prescription history for her, she stopped me after a minute or two and said, "I think maybe we'll just mention a few of those.")

On Friday I went to the pharmacy for some refills. I was quite surprised, and not in a pleasant way, to find that the aforementioned third medication cost $50 instead of my usual $15. My insurance sets co-pays of $15 for generics it likes, $25 for brand-name drugs it likes, and $50 for anything it doesn't like. I freaked out, but knowing I'd be in a world of hurt without this stuff, I paid for it anyway. Once outside the store, I called the insurance company to inquire as to WTF?

The representative offered me three absolutely ridiculous explanations:

1. Your prior authorization expired yesterday.
Okay, so first of all I had no idea that prior authorizations expire. Second of all, I'd gotten preauthorizations for both my refills on the same day last year, but only one of them had a co-pay change this year. For the one which did not change, my doctor merely stated that I had a life-long history of asthma, and amazing! it still costs $25 instead of $50. I was left to conclude that diagnosis-related prior authorizations don't expire, but drug-related ones do. Which is odd, considering how long it would take to demonstrate each year that the rest of the formulary still doesn't work. That wouldn't get points for patient-friendliness, either. So why should my doctor have to remind the insurance company of my history every 12 months?

2. Oh, and that drug changed tiers as of the first of the year, so it's always going to be $50, even though it's generic.
Last year, it was tier 3, which meant $50 per fill unless my doctor and I jumped through hoops to lower the cost to $15. From tier 3, there's nowhere to go but up. Curious about whether they'd quietly implemented the industry's first 4-tier system, I asked the representative which tier it was now. "Three," she said. I pointed out that it was tier 3 in 2006, and it's tier 3 in 2007, so what's the difference? Had they changed the co-pay rules for tier 3? "No," she said. So if I get my prior authorization renewed, I should get my medication for $15 again, right?

3. No, because the prior authorization isn't related to how much you pay. Your doctor has to demonstrate medical necessity for us to cover the drug. You can't get it filled at all without a valid prior authorization.
Obviously I had successfully filled my prescription that day, so what's this about needing a prior authorization to do it? "Um," said the representative. If the drug (sticker price: about $75) will cost me $50 with a prior authorization, and I've just proven that it also costs $50 without a prior authorization, then what, pray tell, is the point of the prior authorization? Isn't the prior authorization supposed to give me my own personal formulary? "The pharmacy that was charging you $15 was making a mistake," she said, changing the subject, "but it was saving you money." It's not saving me money now, I replied, and the pharmacy just charges me what you tell them to. "Um," said the representative.

Unfortunately, before we could get this all settled, I had to go to work. And the insurance company is closed over the weekend--so I've got to wait until tomorrow to get to the bottom of

THE MYSTERY OF
THE PHARMACY BENEFITS
THAT NO ONE,
NOT EVEN MEMBER SERVICES,
UNDERSTANDS.

Tune in next time for another exciting episode of Gerbil vs. the demons of Market-Driven Healthcare!

In which my good turn daily turns bad.

Around here, there are lots and lots of homeless (or nearly homeless) people. Many of my clients are homeless, have recently been homeless, or are teetering on the edge of homelessness. Many of the people with whom I chat at the bus stop fall into one of those categories as well. Very few of the people I encounter on the street are of the screaming-at-fire-hydrant sort. Those who are (like the gentleman I encountered today, who demanded to know, "Who is going to resurrect Batman? Who is going to resurrect the Penguin? We need the Addams family! You have these dungeons with dead people in them! Those dungeons you have are full of people! Who will resurrect Batman and Robin? Frankenstein knows what you did last night!") just happen often to be louder and more malodorous than the rest.

I am hesitant to give out money. My work has taught me that many people do use this money for alcohol or drugs, although perfectly well-housed people also buy alcohol and drugs. But this is only part of the reason why I don't respond to requests for my spare change... with my spare change. If I give someone a quarter or two, it's not going to do them much good because everything here is just so ridiculously expensive. What I prefer to do, when I'm able (I'm not exactly loaded myself), is to bypass the "could you spare some change" and go straight to the "so I can get something to eat."

I've only had one person really and truly turn me down. He was adamant that I give him a dollar "for something to eat." I didn't have a dollar on me, but I did have a bag lunch with two yogurts, some pretzels, and an apple. I offered him the yogurt, but he said he couldn't eat dairy and did I have a dollar? I offered him the pretzels, but he said he couldn't eat salt and did I have a dollar? I offered him the apple, but he said he didn't want any fruit either and did I have a dollar?

Last night my best friend and I went to see Dar Williams in concert. I got to the venue a little before my friend did, so I scoped out the neighborhood for a little snacky-snack. As luck would have it, the neighborhood consisted almost entirely of bars, a few Indian and Mexican, and fancy townhouses. I don't drink, I don't get along well with Indian or Mexican food, and I certainly don't raid the fridges of total strangers, so I didn't have a whole lot of options.

And then this woman came up to me. She wanted fifty cents for some yogurt. She said she was several months pregnant and very hungry. I said I'd be happy to take her to the deli across the street and buy her a sandwich or something. But she wanted to go to the Mexican place with the juice bar "because it's more nutritious." I couldn't really argue with that, so in we went.

There was a pretty long line, which gave us several minutes to chat. I asked about her pregnancy, her living situation, what kind of social services she was getting, whether she knew about various types of government assistance... Her story seemed quite genuine, all the details hanging together. She asked me for fifty cents to call the doctor in the morning. "The place you're staying doesn't have a phone?" I asked. She said it didn't. I gave her fifty cents (actually, fifty-five) on the condition that she ask her doctor to hook her up with a social worker.

Suddenly, we were at the head of the line. The cashier (who was probably also the manager) took one look at us and started doing something with the register tape. I stared her down, and finally, after several more people came into the restaurant and queued up behind us, she asked for our order. My companion got out half her order before the cashier/manager cut her off and asked me what I wanted.

"Nothing for me, thanks," I said, "I'm paying for her. And I don't think she's done with her order."

The cashier/manager person went back to doing whatever it was with the register tape. With some prompting from me, my companion continued with her order. The cashier/manager continued to ignore her. "I don't think she heard you," I said, loud enough for the cashier/manager to hear. "Say again what you want."

The cashier/manager whispered to me, "We've had problems with her. What can I get for you?"

"Nothing for me. I'm just buying her some dinner," I repeated.

"I want this for here," my companion said.

"You can't have it for here," said the cashier/manager. "You have to have it to go."

"This is discrimination!" said my companion.

"You can wait outside and I will bring it to you," said the cashier/manager. She asked for my name. I told her but then said to put the order under my companion's name, as I had to leave and really, I was buying dinner for this woman. The cashier/manager reluctantly accepted my payment.

To my companion, I said, "I'm really sorry. She says she will bring you your food outside. I can't really do anything else." My companion looked very sad, but then she spotted a newly empty table inside--and happily sat down with her drink and her cookie, awaiting her taco. She gave me a hug, thanked me for helping her out, and declared that I was a godsend.

I looked back over my shoulder as I left to meet up with my friend. As far as I could tell, no one forced this woman outside to wait for her meal. I heard no ranting, raving, yelling, or screaming. I saw no young, well-dressed customer storm out on account of the slightly disheveled, very pregnant woman in their midst.

The whole thing left me with, well, a really bad taste in my mouth. It was clear that this woman had a history with this particular establishment. Perhaps she often begs for food there. Maybe she sits inside and nurses a single can of soda all day when it's cold and rainy, and the owners and the locals think she's an eyesore. Whatever the back story, the cashier/manager was doing her very best to put off a customer. Unless things have changed drastically since my days of food service work in high school, the customer is still the person with the wallet.

As a well-dressed young adult with a wallet, I was no different from the rest of the well-dressed young adults with wallets in the restaurant... except that I wasn't opening my wallet for myself that night. Sure, the staff has the right to refuse service to anyone; but whether I'm buying for myself or for someone in a faded hand-me-down sweater, my seven dollars ought to be as good as anyone else's.

What was that again about the kindess of strangers?



PS:
M., take good care of you and your baby.

Rantings of a Luddite philistine

I recently asked Mrs. Gerbil (who has a much better grasp of such things than I) whether performance artists need a cognizant audience. For example, if a performance artist sat at a bus stop in downtown Berkeley and just stared suspiciously at passers-by, I doubt anyone would realize it was performance art.

Put another way: Can you do performance art for the plain old art's sake?

Mrs. Gerbil said that performance art relies on the relationship between the artist and the audience. The audience at least has to know that something out of the ordinary is occurring--and that it's occurring on purpose. Downtown Berkeley is full of people who stare suspiciously at passers-by. Therefore, unless the bus stop performance artist squirted soda water at people wearing red sweaters and just stared at everyone else, it's not a very effective performance.

I don't understand performance art. I think it's very strange, although I also think it's an excellent punch line.

Knock-knock.
Who's there?
Performance artist.
Performance artist who?
Performance artist.
Performance artist who?
Performance artist.
Screw you! Go away!
Performance artist performance artist performance artist PERFORMANCE ARTIST...

The real question, however, is this:

If tree falls on a performance artist in the woods and no one's around to watch, is it still performance art?

In other news, I got a new cell phone last week. The last time I got a new phone, I had to convince the Verizon guy that I did not want a camera phone. Our conversation went something like this:

VG: So how come you don't want a camera phone?
Me: Because I don't need my phone to take pictures. That's why I have a camera.
VG: But you could use your phone to take pictures.
Me: All I want to do with my phone is make and receive calls. I don't need to take pictures with it, I don't need to surf the web, I don't need to send text messages with it.
VG: But if you had a camera phone, then when I called you, you could see a picture of me on your phone and know that I was calling you!
Me: Um, I program in people's names. Because I can read.

This time around, the Verizon guy didn't give me a hard time about not wanting a camera phone. Our conversation, however, was pretty amusing:

VG: So what do you want your phone to do?
Me: Make and receive calls.
VG: That's it?
Me: Yes. That is it. I don't even care about text messaging.
VG: You don't use text messaging????
Me: No. I figure, if someone needs to tell me something, they can call me. If I'm not there, they can leave me a message.
VG: But text messaging is cool!
Me: I turned off text messaging a few years ago because it cost me money to receive messages like "I'm bored." If people are bored, they can call me and tell me about it.
VG: Uh, yeah. I guess you have a point there.

When Mrs. Gerbil found out that I didn't have text messaging, back when we were still living apart, she said, "Oh, that must be why I sent you all those text messages and you never replied!" Which leaves me to wonder:

If a performance artist doesn't know that I don't have text messaging, is it performance art if he tries to text me that a tree is about to fall on him?