It’s Their Move

There’s a game that’s been on the market for a long time.  It’s been around as long as Candyland, Risk, Mousetrap, and Monopoly.  It’s a game with new versions every year, and the level of difficulty increases with each one. It has lots of rules and they constantly change while you play.

It’s called Insurance Won’t Pay.

The game board looks like an Escher print.  You play against the Insurance as a patient, doctor, or hospital.  If you are a doctor, the game piece looks like a little androgynous person with a stethoscope.   If you are the patient your game piece looks like a little androgynous person on a gurney.  The Hospital is a building. Duh. The insurance is a big obelisk on the far side of the board.

There are specific places along the way on which you will land and stuff you will have to do in order to get the insurance to pay.   Otherwise, you have to go back to the beginning.  The insurance starts out with the most money and the biggest bank, the hospitals have the second most, the doctors have the third most, and YOU only get enough to pay the monthly premiums … and maybe a FLEX account for extra expenses.

You roll the dice and start. You pay the premium. You move ahead but land on a GET SICK space.  Now you need to figure out where your next move will be.  The insurance does not have to make a move.  The doctor lands in a Clinic space. You roll again and move to the Clinic space where the doctor is because it’s YOUR doctor. It’s a good, strategic move. The doctor pulls a card that says Treat The Patient.

WHOOPS!  You lose a turn.  The doctor is on your plan, but the clinic ISN’T. The insurance doesn’t pay and you have to move backwards. The doctor moves ahead to the Golf Course space.  You need a Money card to pay the clinic out of pocket. Luckily, the roll of the dice has landed you on the Pawn Shop space.

It’s your turn again. You get to pick a card.  It says you are very, very sick now. You can’t move ahead because you haven’t paid your monthly premium yet.  The doctor rolls and moves from the Golf Course to his Office space. The insurance does not have to make a move. Now you get to move ahead because you pulled a Paid My Premium card. You move ahead to your doctor’s Office space. The doctor picks a Write a Referral for Lab Work card. So far so good!  No penalties!   You get to move to the In Your Network Hospital space where the in-network phlebotomist takes your blood. You roll again and get to go Home and accumulate some money.   On your next turn you land on a Too Bad space because the lab technician who analyzed your blood is not part of your network!   Wah Waaaah. You pull a card that says DENIED, and on the back it says YOU PAY. The insurance does not have to pay. They keep your premiums and invest in Uber.  You roll again and land on a  safe space. You pick a card. It says Sell Plasma. You earn money and get to stay in the game.

On your next turn you move again. You pick an Appeal card. You get to play two Appeal cards and the insurance denies the first one and doesn’t have to move. You pick a Have To  Pay For Medical Records card. You move forward a space and land on the Uber square where you pick up a part time job schlepping people for extra money. You have no idea what to do next so you end up lost in the Badlands. Now might be a good time to play that second Appeal card! You play it now because you have the medical records. Wha Whaaaaa! The insurance denies the appeal for PAST TIMELY FILING. You have to move back three spaces. You land on the Collection Agency space.  You lose a turn.

You move again after you pick a Paid the Premium card. You land on the Heart Attack space. You roll the dice and get an Ambulance. The Ambulance (a really cute little piece with flashing lights) takes you to the closest Emergency Room space. YOU lose a turn because it is not an Emergency Room on your plan. After you are stabilized, you are moved to an Approved Hospital space. Now the hospital gets to play.  You are admitted to the floor. The hospital gets to roll dice because they earned an admission. But they lose a turn because they pulled a card that says Patient’s Insurance. They can’t verify what kind of insurance it is because it has many different names. The hospital doesn’t know the contract. You don’t have your card. You lose a turn. The hospital gets another turn and picks a card that says Provide Good Care. You get to leave the hospital space and move forward all the way, almost, to the Insurance Obelisk. You roll dice and are sent Home to pay another premium.

UH OH!   The hospital loses a turn because they did not call the insurance fast enough when you were in the Hospital space.  They did not pull an Authorization card when you landed there. The insurance does not have to move. Two moves later the hospital pulls an Approved Inpatient Authorization card. YAAAAY. It looks like the hospital may get another turn after all! They move all the way to the Insurance Obelisk and roll the dice. They have to go backwards 20 spaces because the insurance decided to go with the Failure to Notify Them Right Away card instead of picking the Good Care the Hospital Provided card. The Authorization card the hospital picked is deemed invalid. The rules changed in the middle of the game. The hospital loses another turn and the insurance gets to keep your premium and not pay the hospital and they didn’t even have to make a move.  On the next turn the hospital goes back to the beginning. The hospital picks an Appeal card. They send the Appeal to the Obelisk via the Messenger piece, (a stork.)

The insurance gets the Appeal but returns it via the Messenger because they have moved to a DIFFERENT obelisk.  It’s your turn and you roll and move forward to the CVS space where you cannot get your meds because you pull an Investigational Or Experimental card. The insurance does not pay for those. You move backwards until you reach the Plasma Center space where you sell more plasma. The doctor is out of the game.

The hospital pulls another Appeal card and sends it to the new Obelisk via the Messenger. The insurance rolls the dice and lands on the Deny the Appeal Because Now It’s Too Late space.  The insurance gets to keep the patient’s money and the hospital’s money. The hospital pulls a Write it Off card. The hospital loses a turn.

Meanwhile, you pull a Sick card again. (Too many hours driving for Uber while working full time somewhere else.) You jump ahead to the correct Hospital space with the correct doctor who is allowed to play again. The hospital pulls an Approved Authorization card as soon as you land there.  On your next turn you pull the worst card, The Die In The Hospital card. There’s a cute coffin piece that is placed on top of the hospital. You are out of the game. The hospital rolls the dice and makes it to the Send the Insurance a Bill space.  The bill goes with the Messenger to the correct Obelisk. It’s the Insurance’s move.

They get the claim and deny it for not medically necessary. They keep the money. They win.

~written by Deborah Klein, Safety Harbor resident blogger