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[kizayaen.livejournal.com]

Not technically tech support, but related. I'm a DB coder working with a company that handles insurance enrollments for client companies as a go-between for their HR departments and the insurance carriers.

Email received 4/10/07, 5:24PM:

"(Name deleted) enrolled newly adopted child on 4/9 at 4:12. Mres. (name) called today wanting to know why BCBS* still does not show newly adopted child on medical. Please let me know when BCBS receives and acknwoledges receipt of status change so I can call her back at (phone number deleted) to inform her of addition."

Say WHAT? You think that if you call up to a third-party enrollment call center 45 minutes before close of business, you're going to have active coverage the NEXT MORNING? Are you smoking crack? Have you ever even HEARD of the insurance industry before?

We had to explain to the call center enroller that we take enrollments all week and then send files to update their databases once a week. Fortunately for Mres. (name) and family, BCBS gets theirs today. They'll probably have coverage by Friday. If they'd have called at 4:12 TODAY and demanded coverage, it would have been more than a week before they would have received coverage.

*BCBS = Blue Cross Blue Shield

Comments

[zercool.livejournal.com]

Ought to remove the name. Or make it something obviously false. "John Doe". HIPAA and so on.

[kizayaen.livejournal.com]

I am a big fan of "name not removed so as not to protect the guilty," but I suppose you do have a valid point.

So edited.

[arkady.livejournal.com]

You missed another incident of where you used their name... down the bottom.

[kizayaen.livejournal.com]

Yeah, I got halfway through editing and decided I didn't care about a last name alone. Kinda hard to do any damage with nothing but a surname.

[geekgrrl-ca.livejournal.com]

I have seen coverage reinstated within 30 minutes of finding out it's canceled, but that's a special circumstance.

[gilded_lady]

And we've had therapists in our group recredentialed within like 3 days, but yeah, that's due to extraordinary conditions. You're lucky to get anything done in a few weeks through any insurance company!

[canray.livejournal.com]

Tell them to watch "The Incredibles". ;-P

[trixtah.livejournal.com]

hah hah. It's just like those idiots who expect we back up their c:\ drives, or, failing that, that we backup network filestore every 5 minutes - "I changed a document 15 minutes ago - can you get the original back?" In your dreams, mate.

[fuzzyr.livejournal.com]

If you know the answer, why only once a week?

[kizayaen.livejournal.com]

Two reasons.

One, industry standard.

Two, turnaround times. Usually we receive an enrollment file from the client on one day, process it into our system, generate the carrier file on the next day day, the SQL package taking anywhere from three minutes to an hour and a half to execute. It undergoes QA inspection, we transmit either later that day or the next day depending on how long QA took to clear it. Carrier picks it up the following day, uploads it to their system, processes it, validates all the database updates, sends us an error report with any records unable to be loaded. We determine cause of error, fix and resubmit file if necessary. If errors are due to us having received bad data from the client, we need to notify them and get them to fix their data and/or tell us what their data should be fixed to. Send error report with resolutions back to carrier with copy to client.

It's just not feasible at all to do this more than once a week.

[fuzzyr.livejournal.com]

Okay, thanks. I had no idea how things worked in the industry, so I'm glad to have a little insight.

[kizayaen.livejournal.com]

The high level overview is this:

Client (The A Corporation) has employees who get medical benefits.

Client hires us (B, Incorporated) to administer their benefits. We operate enrollment centers where employees of A can call up and get explanations of their benefits. Client sends us weekly database import feeds indicating who is eligible to receive what benefits.

Client has their insurance carriers (C Healthcare Ltd, D Vision Co, E Dental Corp)

We take the eligibility files from A, process them into our system, maintain records of the enrollment and election changes from our enrollment centers, then weekly send a database export feed to each of C, D, and E.

C, D, and E each have their own enrollment databases, and it's those which determine whether or not you can use your insurance when you're in the doctor's office.

[kizayaen.livejournal.com]

Should have pointed out volume, too. The process described above is for one single-file data feed. I personally process sixty-seven feeds per week encompassing a total of eighty-four files.

(I know the exact counts because our QA director had me create a report on it yesterday for the senior vice president of IT so we could point out how hard-working and industrious we all are.)