February
2007
Beauracracy
We’ve been having a little bit of trouble with our insurance company. Now let me first start out by saying we have excellent care and more than I could ever imagine is covered without me having to think about it. The trouble we’re having is with our supplemental insurance. My complaint is not with what they cover (although I would really rather they forego the acupuncture and pay for massage therapy), but that, well, they (or their computers) are just stupid. This past October Bran was in the ER with pneumonia. We left the hospital at 4am and tried to get his prescription filled, the pharmacy couldn’t get it to go through and at 4am there was no one to call. The next day, in a state of exhaustion, I went to our local pharmacy. They couldn’t get it covered, either, so I just paid for it. I think it was a whole $16. Amoxicillin has been around for so long, you’d think it would be even cheaper than that. Anyway, I talked to the “people” at the University to get it fixed and they apparently did.
However, we ran into problems again last week. The boys had their first ear infections and were not happy wandering through the grocery store for an hour, simply for the pharmacy to tell me that Bran’s could not be covered again. Arghhh! (maybe I do say that alot) 
The pharmacist was nice enough to have the pharmacy eat the cost since, well, in his own words, ‘amoxicillin is so cheap.’ I called our insurance company to find out what was wrong. Because they are twins we now have to include their middle initial when filling a prescription (We used to have to give them separate birthdates… Drew was born a month earlier according to their computers… So, I guess it’s an improvement). The pharmacist put a period after the “N” and that, my friends, was the big mistake. Apparently it screwed up the whole system such that even after a phone call, they couldn’t verify Bran as the correct child and fill his prescription.
A period…
Now why couldn’t the person on the other end figure this out? Maybe it’s not just the computers… I’ll give them one more break since we’re not your “normal” family, though I may dread the next time I have to get a prescription filled for Brandon.
You’d be surprised (or maybe not) at how common this is. One of the big struggles we have as a company is data quality issues – in many cases the people who do the data entry don’t really know or care how what they put in impacts the rest of the system. Unfortunately, often this causes much larger problems for the whole system.
When I was at Pittsburgh Public Schools, we spent days each year matching up the public assistance files to our records. We wanted to make sure all the students who were eligible for free/reduced lunch status received it. But on both sets of data (ours AND the public assistance rolls), there were huge discrepancies – wrong birthdates, grossly misspelled names, nicknames, etc.
Even now with my company, we have a guy who spends a great deal of time telling districts about data quality issues. It is a huge headache.