Monday, December 14, 2015

How to Screw Cancer Patients Over Like a BOSS: Tips Gleaned from the Folks at MVP Healthcare


How many times have you said this: “Man, I wish there was a quick and easy way to screw over a cancer patient and not pay for services that should be covered!” Well, if you’re an insurance company, you’ve likely uttered this at least 5 million times a day, and you probably have a very precise method for addressing this. But MVP Healthcare may have a better solution!
            MVP is for the first time (unintentionally) revealing its secrets for dicking over cancer patients and aggravating them to the point of insanity, and we think you’ll find it’s very efficient. 
Let’s take a look at how the process works, with one patient we’ll just call Heather, and let’s say she had aggressive breast cancer and is looking for reimbursement for out-of-pocket expenses related to nipple tattooing, a widely recognized final stage of breast reconstruction:

No, not a fan of MVP at this point.
Step 1: Make your company policy known upfront while feigning faux compassion. Example: “Oh Sweetie, I don’t know the specifics of your case, and you haven’t even submitted any paperwork yet, but go ahead and file that claim. They’re not going to pay it.” Cancer patients enjoy being called things like “honey” and “sweetie.” These verbal pats-on-the-head are a sure crowd-pleaser!

Step 2: Don’t bother to say things like, “You needed pre-approval,” because your company’s policy is to deny these claims no matter what the fuck Heather does. This is also the point you ignore all supporting documentation Heather has sent, including a letter of explanation and support from her plastic surgeon and photos of her titties. Holy fuck! Why did this crazy bitch send pictures of her carved-up boobs? Ain’t nobody want to see that shit! Lunch is RUINED!

Step 3: Point out that nipple tattooing by prominent tattoo artists who are known nationally for doing these sorts of things are not covered because they’re not recognized providers. Ignore the fact that hair salon owners are also not recognized providers but insurance companies, including MVP, often cover the cost of the chemo wigs they provide. Roll your eyes if Heather mentions her plastic surgeon doesn’t do tattoos, so she had no other options for completing her reconstruction.

MVP apparently thinks this looks completely normal.
Nope, no tattoos needed here.
Step 4: Speaking of chemo wigs, ignore Heather when she tries to use the example of the time you attempted to deny her coverage for a chemo wig, though her benefits book said you covered 50 percent of the cost, and you tried to deny payment for fat grafting as part of her reconstruction because you viewed it as “cosmetic.” Fuck, don’t these cancer patients ever let ANY shit go?

Step 5: Never give a straight answer. Let’s say Heather calls to check on her claim because she never received anything in the mail acknowledging it but she sees online that it was just denied, with accompanying vague codes mentioning a random code is missing or that she should have only had one nipple done per day. Inform her that, why, you just CAN’T figure out what’s going on and you’re sending her claim back for reprocessing, which should clear things up. Have a good laugh about it when you get off the phone.

Step 6: Play loose with deadlines. Have the first representative tell her that reprocessing her claim should take a couple of weeks, then when that deadline passes, have the next representative tell her that, no, you have 30 days before you have to make a decision. When THAT deadline passes, have a supervisor (let’s call her Sue) tell Heather when she calls back that, “Hey, you were told initially that we weren’t going to pay.” When the patient puts up a fight and mentions what she’s calling a “runaround” (PFFFT! WHATEVER!) tell her you’re on the case and you’ll get back to her with more information on how to proceed. Give her your direct phone line, but –AND THIS IS IMPERATIVE—make sure it’s the wrong number.
I finally feel complete with the tattoos.
But "feeling complete" is not something MVP covers.

Step 7: When Heather calls the next day and points out that the number you gave her directed her to a pre-recorded message, telling her that to go further, she will have to answer some questions and she’ll be entered to win a free cruise, let out a little laugh and make your voice sound apologetic about giving her the wrong number.  Also, make a mental note to bring up with your company’s top brass that you have a great idea for a cancer cruise, which will round up all of the cancer patients and set them adrift on the ocean.

Step 8: Make up more excuses. Something like, “Well, it appears in order to get this claim settled, we have to formally deny it. It was never properly denied.” Heather will mention that there were denial codes attached to her claim and she will ask, “Doesn’t that constitute a formal denial?” This is where you say something super confusing, like, “I would tend to agree with you.” Heather will ask what the fuck that means, but you don’t have to answer. Make it known you’re just the messenger! You should also at this point pretend you still care about Heather’s well-being, and that you want to help her get this claim settled, even though that would mean working against your own company. Maybe she won’t figure it out. 

Step 9: Record a denial of appeal in record time. This will let Heather know how wrong she is—and yeah, go ahead and try to file a level 2 appeal, you dumb shit, Heather. You’ll want to assign a senior medical reviewer for her appeal who is in a totally unrelated field of medicine, say, family practice, and have that person be so fucking dated that he/she could have theoretically been the attending physician at the Battle of Gettysburg. Such a top-notch doctor overrides a practicing plastic surgeon with extensive experience in breast reconstruction and microvascular surgery EVERY TIME.
Step 10: If the patient mentions that all stages of reconstruction are covered by the Women’s Health and Cancer Rights Act, stick your fingers in your ears and go, “La la la la – I CAN’T HEAR YOU!”


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