back to school for writers

Welcome to the Back to School for Writers blog series. Every Wednesday until the end of September, a guest poster will share their knowledge and expertise on a specific topic. Today’s guest is Liana Mir, who takes us behind the scenes of the insurance industry.

The Big, Bad Insurance Company

The insurance industry has been demonized a lot over the years for good reasons and bad, all painted with the same nasty brush due to several common misconceptions about how it works and due to the fact that insurance is not what I would consider the best way to pay for regular health care. Insurance should generally be kept for emergencies

That said, I went to work for the largest national health insurer maybe five years back and stayed there for three years. In that time, I learned that many of my own misconceptions about insurance, particularly dental insurance, were wrong.

Myth #1: Claims are Processed by People

This is startlingly false and is the foundation for most of the horror stories that circulate regarding insurance.

Reality: Your insurance claims are processed by a system and are then troubleshooted by people. That means that most claims never get a pair of human eyes. The computer reads what is dumped in by your health care provider, interprets the claim with varying degrees of accuracy, then uses a set of rules generated from your plan, your group (i.e. employer, association, etc.), and your state’s laws. Unless the system finds an error it cannot resolve or you or your provider call in about the claim or explanation of benefits, that baby will never see the light of day.

Myth #2: Insurance Companies Don’t Care

We have all heard of the big bad that does not want to pay for “cosmetic” or experimental procedures that are actually necessary. We know that insurance companies drag their feet over coughing up the money you have paid into their coffers for such a time as this. What we rarely hear about is what the people behind that computer system are actually up to.

Reality: The truth is that insurance companies do care about your satisfaction and wellbeing. Quite a lot, as a matter of fact! They have competition.

Insurance companies make money off of their customers being well and healthy and will gladly pay for any reasonable preventative care they can convince you to use. They scrutinize their bottom line and reputation extremely carefully and evaluate any mishandled claim that comes to their attention. They try to train their customer service representatives to be genuinely helpful and knowledgeable, even though those same reps will not be able to grant you an exception to the rules.

Insurance processors, in particular, scrutinize every problem claim with two things in mind: preventing fraud (you would be surprised how many billions of dollars are lost on health care fraud each year) and helping patients get their money. We read those handwritten notes (though the computer doesn’t, so don’t hedge your bets) and research their validity. If you told me that for health reasons you couldn’t get any x-rays taken to prove you need an expensive procedure, then I would most certainly send back a request for more information on why we just paid for x-rays three months back. And that brings me to…

Myth #3: Your Provider Knows What He’s Doing

Often times, you would rather not submit an insurance claim if the provider can fill it out for you. After all, they know how to fill it out correctly, right?

Reality: The biggest issue I ran into with paying claims was that providers entered information in the wrong fields, skipped fields altogether, failed to provide their address or keep their account with the insurance company up-to-date, or worse, repetitively returned a request for more information with a copy of the same information-less claim. What could I do for their patient? By the rules, nothing. If we had low call-volume in customer service, every once in a while I could get someone to call and drag out the information we needed. To say nothing of the claims sent in to the wrong insurer altogether.

When I got my own dental work done, I filed my own claim.

Myth #4: Insurance Companies Don’t Pay Up as Promised

This comes back pretty solidly to the issues inherent with using a computer system and a lot of human error. Computer systems will screw up payments due to human error on the claims, and human error is rampant.

Reality: Insurance will pay according to those nasty little things called rules. And trust me, as an insurance processor, it was a pain to try to go around the rules to get something paid anyway. Computers aren’t very flexible.

There are three main aspects to getting a claim paid:

1. Know what your benefits are before getting treatment. Get a pre-certification or pre-approval on your claim or call up the company and ask them whether said treatment is actually covered. If it isn’t, ask whether there is another plan that will cover it. There usually is.
2. Fill out the form correctly. If your provider fills it out, ask to look it over before he or she sends it and make sure it’s as accurate and complete as possible.
3. Use the phone. Want to make sure a human sees that claim and processes it correctly? Call up customer service and follow up on your claim. You can get a status report and most minor errors corrected. If you have too much trouble, escalate the claim. You can get almost anything paid once it hits a senior manager.

Insurance companies do pay up, but only what has been promised.

Myth #5: All Insurance Companies Do It the Same

For a long time, I believed that dealing with one big, bad insurance company that refuses to pay without giving you a hassle is the same as dealing with any other one. The more I coordinated with other companies’ benefits and received health care myself, the more I realized this idea is patently false.

Reality: Every insurance company has its own way of trying to protect the bottom line. Automation is primary, but automation leads to glitches. Systems can be set up to pend the most expensive varieties of glitches or automatically pay or deny according to what will cost the least. My insurance company ate several thousands of dollars annually to pay for any duplicate requests for a particular kind of x-ray because it would have been significantly more expensive to pay for a human to look at every incident of such a common claim.

Some insurance companies deny all expensive or major procedures without really looking at them, then pay literally anything if the claimant calls in. Some insurance companies hold all such procedures and have them manually reviewed for necessity or prerequisites, denying for more information as needed. One is a reactive strategy, and the other is preemptive, but most strategies can all be gotten around by one thing: a phone call.

Unless your claim looks suspicious, most processors and customer service agents want to pay your claim, but they won’t do it if the plan you picked says they can’t unless you’ve got a great reason they can take to their boss for an exception. Most claims will never be seen by a human, so if your claim got denied, read the explanation of why and make sure the computer or your provider didn’t screw up on the form. And as a writer, please take these things to heart when you write about the little desk job insurance employees who will never see their customers in person but who do want to help. If you really want that evil insurance overlord, just make it the computer.

 

Liana Mir reads, writes, and wrangles the muses from her mundane home in the Colorado Rockies and, occasionally, from the other side of the Barrier. Visit her online at http://www.lianamir.com.

Welcome to the Back to School for Writers blog series. Every Wednesday until the end of September, a guest poster will share their knowledge and expertise on a specific topic. Today’s guest is therapist and writer Tami Clayton who dispels 5 myths about the mental therapy profession.

I’ve worked in the field of mental health for the past sixteen years, most of that as a child/family therapist, and in all that time, I have yet to read about or see in a movie or T.V. show a therapist that isn’t portrayed as unethical, devious, deceptive, coercive or in some way inaccurate. It’s no wonder many people see therapists and therapy as suspect. And if you only went off of what you read or saw in those forms of entertainment, then you’d be right.

In preparation for this post, I asked several colleagues about the characterizations of therapists in books, movies, and T.V shows. Before any of them answered my question, every single one of them said if they knew there was a therapist in a movie or T.V. show, they would avoid watching it (or at least the part with the therapist) because of how inaccurately (and terribly) we are portrayed. After I explained why I was asking, all of them were eager to share what the inaccuracies they’ve seen. Here’s what they mentioned:

(Note: I’m using the term ‘therapist’ to also mean ‘counselor’ and consider the two interchangeable for the purposes of this post.)

Myth #1: All therapists subscribe only to Freud’s theories and techniques – you know, the bespectacled, bearded older man psychoanalyzing the client while he or she reclines on the sofa talking about their dreams filled with obvious phallic symbols.

Reality: Psychoanalysis is just one theory among many out there for a therapist to use and claim as their theoretical orientation and in my humble opinion, a good therapist draws from a few different theories in order to best meet their clients’ needs. As for the sofa bit, I’ve always worked in social service (read: underfunded, underpaid and overworked) so many of us have offices that are so tiny there’s no room for one. Also, unless you have sought out a psychoanalyst and want to lie down on a sofa, clients are usually sitting up on the sofa or in a chair.

And for the record, in regards to dream analysis – sometimes a carrot is just a carrot.

Just sayin’.

Myth #2: Therapists must always be overly solicitous about a person’s feelings and only ask questions like “And how does that make you feel?”

Reality: Yes, therapists do ask about feelings, but in all the years I’ve been a therapist, I can’t think of one time I inquired about it in this manner with a child or an adult. A person’s feelings are just one aspect on which we guide clients to focus their awareness. Current patterns of thinking, coping mechanisms, past trauma, past and present relationships, self-esteem, self-awareness, and many, many more topics can be delved into in therapy depending on what a client is seeking it for at that time.

Myth #3: Therapists become close friends with, date, have sex with or have some kind of an outside-of-the-office relationship with their clients.

Reality: Aside from this going against everything you’re taught in your counseling or psychology program, this kind of thing is considered unethical for therapists to do and it can get you a nice malpractice lawsuit and/or the revocation of your license if the infractions are severe enough. The breaking of boundaries is probably the biggest inaccurate portrayal of therapists in movies, T.V. and books. Unless the therapist in your story is the antagonist and needs to engage in such nefarious activities, please reconsider having him or her be a blatant boundary breaker. It’s giving all of us a bad rap.

Myth #4: A client is “cured” when the big epiphany comes wrapped up the big “Aha!” moment.

Reality: Therapy and the therapeutic process is rarely, if ever, a neat, tidy, linear process in which a client reaches a total resolution and is cured of what was ailing them. Therapy is not like getting over the flu or a cold. It can be filled with many ups and downs, a lot like life itself. While epiphanies can certainly be a part of it, they hardly denote a “cure” or complete absence of the mental health symptoms that previously plagued the client. Resist the urge to have your character reach an easily obtained epiphany that somehow cures them. Therapy is a process with many steps forwards and backwards. (Sadly, this is something the insurance companies completely fail at comprehending, but that’s a rant post for another day.)

Myth #5: Therapists are always “on”, assessing people and passing judgment about others’ mental health every moment of the day. This myth is played out in movies, T.V. shows and books, but is just as prevalent at a cocktail party where the inevitable question of “what do you do?” arises when meeting new people. As soon as the word ‘therapist’ is out of my mouth, people often become wary and think I’m assessing the state of their mental health and passing judgment on them.

Reality: I diagnosed you ten minutes ago.

Just kidding.

Well, sort of.

Those of us drawn to this helping profession are obviously interested in human behavior and human nature which is why we’ve chosen to do what we do. Even so, we are not always “on the clock” writing mental health assessments in our heads of everyone we meet. Sure, I may wonder about a person’s underlying motivations for saying or doing certain things and yes, I may have a vague notion of what that person’s thought patterns or coping mechanisms might include. But unless you are going to pay me for my time and effort, I’m not usually going to spend much more time thinking about it beyond that. And as far as passing judgment, unless you are behaving in an utterly deplorable manner, I’m typically not in the habit of casually passing judgment on the state of other people’s mental health. We all have baggage and we’re all on a journey, even us therapists. Personally, I’d rather lend a hand than stand aside passing judgment.

There are also a lot of misconceptions and misunderstandings of the different terminology used in the field of mental health. Here are some terms and their definitions to help in better understanding the field:

A psychologist is someone who has obtained his or her PhD in the field of psychology. They can be refered to as therapists or counselors if they so choose, though most go by the term psychologist.

Therapists and counselors are not psychologists. Therapists and counselors have typically have obtained their Master’s in counseling psychology, psychology, or marriage and family therapy.

Social workers (someone who has completed their Master’s or PhD in social work) can also be considered a counselor or therapist. Quite often, the term social worker is used in movies, T.V. shows, and books as synonymous with someone who works in child welfare. This is not the case. One is a job/career (child welfare caseworker) while the other is what someone who has graduated from a social work program (social worker).

The term “shrink” refers to a psychiatrist, a medically trained doctor who can prescribe psychotropic medications. Psychologists, therapists, and counselors are not psychiatrists and the terms are not interchangeable, though the two types of professions often work in together when treating a client.

I won’t go into detail about different diagnoses here because this post would become far too lengthy. If anyone has questions about a diagnosis for their character or would like further information about symptomology of a particular diagnosis for a character, feel free to contact me and I would be happy to help.

Hopefully this was useful to those who are writing about someone who works in the mental health field or to anyone wanting to learn more about therapists/therapy in general. For an example of an accurately portrayed and well-written therapist, check out This Much I Know is True by Wally Lamb. Aside from being a fantastic book, it has one of the few well-written therapists in it that I’ve ever read.

Tami Clayton is a YA and Middle Grade writer with a passion for travel, all things dark chocolate and coffee, and reading everything she can get her hands on. She is a child and family therapist by day, writer by night, and a dreamer of far off lands she hopes to one day explore in person. Visit her online at Taking Tea in the Kasbah.

Welcome to the Back to School for Writers blog series. Every Wednesday until the end of September, a guest poster will share their knowledge and expertise on a specific topic. Today’s guest is David Gale. The eagle-eyed among you might’ve noticed that we share a last name, so I’ll confess up front that he’s my smart and funny husband, who put this post together for me on short notice.

Well, Rabia asked me to help out with her “Back to School for Writers” series. I’m supposed to talk about something I know, so since I’m a programmer, here goes: five things Hollywood (and many writers) often get wrong about computers.

1) A geek with a computer can hack anything.

You know the scene: the Good Guys are under attack by the Big Bad, everything seems doomed, and then the Nerd pulls out his laptop, hacks into the Big Bad’s computers and takes it down with a single keystroke. We’ve all seen it happen, most egregiously in Independence Day. And I’m here to tell you: it ain’t gonna happen that way unless the Big Bad is a bumbling, clueless technological neophyte–AKA a Minion, in which case they have no right being the Big Bad in the first place. There are a host of different reasons why this scenario is impossible, but the main one is simple: any computer system that holds the Ultimate Top Secret Plans of Doom will not be connected to the internet. You’re going to have to go to a specific location and pass through several layers of security and encryption just to get a listing of the files you still don’t have access to. There was a flurry of excitement recently when someone suggested that they might hack the Curiosity Mars rover, based on the fact that NASA is able to update the rover’s computers from Earth. But then people realized that, in order to pull this off, they’d need to replicate NASA’s Deep Space Network system in order to broadcast a strong enough signal, in addition to breaking the encryption and figuring out the right commands to send. Not something you do in your spare time.

2. When computers break, there’s smoke and showers of sparks. I swear, the electrical engineers who built the Enterprise’s computers must have been paid with baseball cards*, because those things are held together with spit and bubblegum. The ship gets hit–with the shields still up!–and suddenly every computer panel is sparking like a major French city on Bastille Day. Um, no, that’s not going to happen. When a computer goes belly-up, it’s actually pretty boring: things go black and quiet. It’d take a catastrophic heating-related failure to cause smoke (and even then, at least half the time, you’ll smell something but not see anything), and sparks–or even components melting–are only going to happen when something is pushed way beyond its manufactured specifications. People building battleships design a safety margin in, so things generally peak out at about 80% of the safe zone. Oh, and they also build in redundant fail-overs for the really important stuff, so that even if something goes boom, things keep working.

* Yes, I know there’s no money in the Star Trek universe’s Federation. So clearly they needed to come up with something else.

3. Computers talk like robots.

War Games is one of my all-time favorite movies. If you haven’t seen it yet, go dig up a copy. It’s one of the best “rogue computer nearly wipes out the world” movies ever, hands-down. But, I confess, it has some issues. And I’m not even going to mention the “sequel” that came out a few years ago…(shudder)…er, where was I? Oh, yes, talking computers. See, when Joshua–the computer from War Games–talked, he used a monotonous, robotic-sounding voice. And that’s been par for most major computer systems out there (the ones which have gotten a talking role, at least) for the last thirty years. But even in the early 1980’s, computers could synthesize voice decently. And we’re in 2012 now; everyone’s got GPS units that sound like, well, whatever we want them to. And if a GPS can do that, then my Doomsday Computer to End All can talk to me in a nice, soothing voice as it searches for the missile codes it needs in order to blow everything to little tiny bits. It may not get every inflection right, but it’ll be close.

4. Computers can’t deal with logical fallacies. There’s a Star Trek episode where Kirk destroys an android bent on enslaving humanity by saying that someone who has just confessed to being a liar always lies. The android can’t resolve this paradox–is the liar lying about being a liar?–and breaks down (complete with smoke, but, amazingly enough, no sparks). Unfortunately for Kirk, there’s very little chance that an artificial intelligence strong enough to handle natural language processing (necessary for understanding spoken commands) will not be able to disregard commands that it doesn’t understand. It doesn’t need to establish the truth or fiction of the statement; it just needs to decide to ignore it. And if it’s not capable of ignoring commands, then you can stop it just by, well, commanding it to stop.

5. Computers will eventually become so smart that they decide humanity is not needed.

At least in The Matrix, humanity continued to serve a purpose once the computers had taken over. They didn’t need our brains, but they did need our magical ability to produce electricity from our imaginations. But the main problem I have with that premise isn’t with the boundless energy of humanity (I’ve often wondered if I could eliminate my electric bill by putting my seven-year-old in a giant hamster wheel hooked to a generator); no, my problem is that computers are only as smart as we can make them. Oh, and there’s an entire class of problems that computers can’t solve at all (to be fair, neither can humans, but we can often intuit solutions without needing to do all the hard work). So we can make computers “smart” enough to calculate the value of pi to 5,000,000,000 digits (eventually), which no human will bother doing–but only because we’re smart enough to know how to calculate pi. It’s the same with everything we tell computers to do, even landing on Mars. Sure the computer’s doing the heavy work, but we had to tell it how to do the work in the first place. If we can’t figure out how to do something, we’re not going to be able to build a computer that can figure it out. And that’s the dirty little secret of artificial intelligence–until we can fully understand ourselves, how we think, how emotions work, what intuition and art fundamentally are, we’re not going to be able to create anything that can truly be said to think for itself. And if we ever reach such a hyper-conscious state…well, the intelligences we create will still be childish compared to us.

Oh, and here’s a bonus: if you’re still worried about the Robot Apocalypse, here’s what it will look like.

BIO: David Gale is a programmer by day, but don’t hold that against him. He loves his wife, Rabia, very dearly–even to the point of guest-posting on a moment’s notice. He’s also the creator of WriteTrack, a tool for writers who want to write a large number of words in a small amount of time, but don’t want to do the math to figure out their daily goal. And if you’re really curious/in need of something to put you to sleep, you can visit his blog.

Welcome to the Back to School for Writers blog series. Every Wednesday until the end of September, a guest poster will share their knowledge and expertise on a specific topic. Today’s guest is Liv Rancourt. Welcome, Liv!

I WISH Birth Looked Like TV

Thanks, Rabia, for having me on your blog. Since your theme is Back to School for Writers, I wanted to talk a little about a topic I deal with on a daily basis and the disconnect between reality and the way it’s portrayed in the media.

Birth.

My daughter is a big fan of the TV show Bones, and has watched many if not all the episodes. In the 2011 season finale, Bones gavebirth to a baby girl. She and her partner Booth were in a barn in the middle of nowhere when the baby arrived. On his own, Booth prepared to attend the birth, and after a series of discrete camera angles, there was a lovely baby cradled in the arms of her weary mother, the brave father reclining at her side.

Um, yeah. In case you were curious, that’s not exactly how it goes.

In reality, giving birth is a hard and glorious thing. I know this from both personal and professional experience.  I have the enormous privilege of witnessing deliveries almost every time I go to work, and while I don’t want to violate anyone’s privacy, I’d like to share some observations about what birth is not…and what it is…

Birth is not a political act, regardless of what you’re told in your birthing classes. There are as many ways to have a good birth as there are women having babies. People will share opinions about everything from the place the baby is born to the use of pain control medications to clothe diapers vs. disposables. And really, the important thing is to have a healthy baby, right? My observation is that people who approach things with that attitude – who aren’t hung up on living out their fantasy birth – are better able to cope with whatever the outcome.

Birth is messy. St Augustine said, “Inter faeces et uriname nascimur.” Between shit and piss we are born, and while smell obviously doesn’t translate to the movie screen, it’s definitely part of the real birth experience. So is blood, and sweat, and sometimes pus, and other less-appealing matter.

It can be loud, too. In addition to the laboring woman, you’ll hear the father and attendants coaching and cheering her on. I can usually tell when  Mom is getting close to delivering because the pitch drops and her cries become grunts. I’ve heard older nurses talk about the days before epidurals became common when “women used to scream babies out.” It’s a raw experience, and I have yet to see a dramatization that comes close to capturing what really goes down.

Birth is not safe. Wikipedia cites the most recent infant mortality rate in the US at about 7/1000 live births. Canada does better with 5.3 infant deaths per 1000 live births, while at the other end of the scale, Afghanistan has an infant mortality rate of 144 babies per 1000 live births. Equally concerning are the statistics for mothers. The maternal mortality ratio looks at the number of maternal deaths per 100,000 live births. For 2003, those numbers range from 2000 deaths per 100,000 live births in Sierra Leone to 0/100,000 in Ireland.

Something about statistics: it’s real hard to drill down a cluster of numbers to ONE individual birth experience. As a neonatal provider, I only get invited to someone’s first birthday party if they meet certain criteria. There have to be risk factors, indicators that something could be going wrong. And I’ll tell you what, even after fifteen years of doing this job, when I hear the baby’s heartrate start to slow down as Mom is pushing and see the tension in the obstetrician’s eyes, my insides clutch and I start praying. A couple quick Hail Mary’s help me focus and keep me from hearing the pleading in Dad’s voice or from seeing the tears in Grandma’s eyes.

That’s the part that the media NEVER gets right. Regardless of the type of birth you choose, there’s only so much you can control, and it’s that struggle, with the possibility of disaster hanging out in the corner of the room, that makes birth so scary. It’s also incredibly humbling, as again and again I witness this miraculous occurrence.

And birth is a miracle, folks. Whether your baby is an eight pound cherub delivered in your bedroom at home or a one pound peanut delivered in a major medical center, it is one of the few truly universal experiences.  You get any group of mothers together, and sooner or later they start swapping birth stories.  It’s a bonding thing, a rite of passage.  And every birth I’ve ever attended has brought up deep emotions for the people involved. I can’t say they’ve all been positive feelings, but it’s never a neutral thing.

On an intellectual level I understand why they don’t show the reality of birth on network television. They don’t need to. Seeing Bones and Booth on the ground in a barn with their new baby gives us an outline, and lets those of us who have been through it fill in the raw, messy, scary bits.  Every time I watch an episode like that, however, I end up shaking my head.  The portrayal would be so much richer if they’d just get a few more of the details right.

So how do you create a realistic portrayal of a birth? With such an overwhelming experience, it’s easy to fall into melodrama or rely on clichés. The best approach should start from the truth. If you’ve never given birth before, ask those who have what happened and how it went. Most women are willing to talk about their birth experience and will share possibly more than you ever wanted to know. Did they have problems with preterm labor, high blood pressure, or diabetes? How did they know they were in labor? It doesn’t always start with a broken bag of waters. How did they cope with the pain? You can learn a lot from real-life experiences.

For a concrete template, Wikipedia has a nice write-up on Childbirth, which gives an overview of the process and explains many pertinent terms.  Each birth is unique, and a woman who has given birth to more than one child has more than one story.  My daughter was born a month early. I had several days of early labor before my water broke and things began to progress. My son was a week late – isn’t that just like a guy? – and I had to get mad at God before labor would start. The one common element was how little I could control in either situation.  Well, that and the pain. And the incredible peace and joy I felt, holding a new little person in my arms.

Birth is a complicated process and the media rarely gets it right. To create a realistic portrayal of birth, start from the truth, using a few smelly, painful, frightening, joyful details. Remember that most of the time the outcome is beautiful, except when it’s truly devastating. It’s that fear, the wild-card element, that makes it so humbling. If you can capture that in your writing, then you really are creating art.

Liv Rancourt writes paranormal and romance, often at the same time. She lives with her husband, two teenagers, two cats and one wayward puppy. She likes to create stories that have happy endings, and finds it is a good way to balance her other job in the neonatal intensive care unit. Liv can be found on-line at her website (www.livrancourt.com), her blog (www.liv-rancourt.blogspot.com), on Facebook (www.facebook.com/liv.rancourt), or on Twitter (www.twitter.com/LivRancourt).