Computer Says No

Have you ever had one of those conversations with Shelly from “customer service” that ends with you wanting to chew your own foot off?

Our conversation began friendly enough:  she was just calling to verify my insurance for an upcoming appointment on Monday.  That should have tipped me off that trouble was brewing right away, as all of my doctors and procedures are “Eisenhower.”  Eisenhower is a medical center with a massive campus in nearby Rancho Mirage; it is, for example, where the Betty Ford Center is located.  Eisenhower Medical Center is like a little town; specialties from cardiology to oncology have their own buildings on the campus, and they have multiple satellite offices throughout the Coachella Valley for everything from imaging to lab work.

One of the benefits I have always seen to Eisenhower is the ease with which I, as a patient, can access doctors and services without having to reestablish my insurance coverage or recount my medical history – which is complex and extensive – every time I do something new.  Eisenhower’s IT system, which connects all their facilities, means that everything about me (medically) for the last 12 years is available to the person in front of me.  It also means that my financial and insurance information – which hasn’t changed in those twelve years – is also available.

A good example of how it’s supposed to work was last Wednesday.  I have had a painful UTI (urinary tract infection) since Monday.  My PCP (primary care physician) prescribed some medication, but it was not making me feel any better.  So when I called him on Wednesday, he told me to go to the Eisenhower Urgent Care center on Sunrise Way near my residence.  As I waited to be called in the waiting room, I was amazed at how difficult it was for the non-Eisenhower patients to check in:  they were having to show ids, present insurance cards for photocopying, recite medical and symptom histories, sign consent for treatment forms, etc… etc.  I walked (well, rolled) in, gave them my name and birthday, and they said, “okay Mr. Wilkinson, have a seat, we’ll be with you in a moment.”  Once in the exam room, the doctor noted and told me that I had a UTI (as opposed to me telling her) that was not responding to treatment, because my PCP had already charted that in their system.  After a brief conversation and examination, she prescribed a different medication which was electronically transmitted to the pharmacy.  All I had to do was go home and wait for the new drug to be delivered.  On the whole, I am very happy with the way Eisenhower “works.”

As I said, my conversation with Shelly began friendly enough.  My upcoming appointment on Monday is with the pulmonary clinic on the main Eisenhower campus.  She wanted to verify my insurance, which hasn’t changed since 2008 (it’s Medicare primary with Medi-CAL secondary); Medi-CAL is California’s Medicaid program.  She said, “well I see that you have Medicare but that you were disenrolled from Medi-CAL, so you no longer have a secondary.”  As politely as I could, I said, “oh, you must be mistaken, I am still active with Medi-CAL.”

“I am the Lord thy God, which have brought thee out of the land of Egypt… Thou shalt not… Thou shalt not… and I say unto thee now, Matt Wilkinson, TaxPoodle, son of Robert, has been disenrolled from Medi-CAL.”

I know this cannot be accurate, but on the off chance that something silly had happened, I grabbed my laptop and logged into the benefitsCAL.com website.  As I expected, I am enrolled and active with Medi-CAL, so, still maintaining a pleasant tone, I shared that information with Shelly.  I will now try to recreate our conversation from this point:

“Well Mr. Wilkinson, you’ll have to ask them why they disenrolled you.”

“But they didn’t disenroll me.”

“Our system shows that you no longer have Medi-CAL.”

“So you’ve said, but I am on benifitsCAL.com right now, and it says I do.”

“You can call your local Medi-CAL office and the worker assigned to your case can tell you why they disenrolled you.”

“But they didn’t disenroll me.”

“Our system shows that you no longer have Medi-CAL.”

(this went on – round and round – for several minutes, Shelly interrupting and talking over me in the most amazingly condescending way)

This SNAFU is not Shelly’s fault.  Some computer users, especially those of the large systems I spent most of my professional career programming, develop a sort-of mental paralysis; they no longer think or see the need to – whatever is on the screen in front of them is reality, is truth, is incontrovertible, and is not subject to review.  Somebody using their brain would say ‘hmm, we have two computer systems saying the opposite thing, one must be wrong; now let’s figure out which one and why.’  And I won’t even mention how the fact that I checked into Urgent Care of the same healthcare system with the same insurance just two days ago without the issue of Medi-CAL coming up would indicate a problem isolated and specific to our conversation this morning.  The conversation turned heated, particularly after she matter-of-factly said, “don’t worry that you’ve been disenrolled from Medi-CAL, we’ll just send you a bill for whatever your primary insurance doesn’t cover.”  I’m afraid I had to ask to speak to her supervisor after that.  He, of course, was not at his desk, but his voicemail encouraged me to leave a detailed message, to which he promised to respond within 72 hours – which is after the appointment at the heart of all this! I am currently thinking some rather unkind thoughts about Shelly and her supervisor.

It reminded me of David Walliams from Little Britain.  A young man comes into the bank for a loan.  Walliams is Carol the loan officer, this young man’s “Shelly.” Carol types away at her computer’s keyboard, looks across the desk at the young man, and says “Computer says no.”