Ok. It’s 11:45 P.M. on Thursday, February 29th, 2024. I got Clarence “Gate-mouth” Brown “Sometimes I Slip” playing low, a half of cup of Joe, and metaphors are dancing across the page - some good, some horrible, but no keepers.
My issue is that I am haunted by an angry letter the Fund received and how, despite the Funds efforts and the facts, this individual firmly believes that we suck. So, I think I am going to “riff” on this individuals rant.
Now, being of candidly nature, I will be the first person to admit that we are not perfect. We do have our moments of “suckiness.”
However, the times and the situations that this individual is ranting about were not caused by any failure of this Fund. Simply put, this individual just doesn’t like the results that they generated by not acting in accordance with the rules of the Plan.
Which leads me to Newtons third law. (Sweet segue, right?)
Don’t worry; I’m not going to ask you to do any heavy mental lifting going forward. Rather, I am only asking you to consider the following: when was the last time you read the Health and Benefit Summary Plan Description Book? It’s probably been a minute, right? Now consider, is your understanding of those H&B benefits based upon what you learned upon reading that book, or is it based on what you heard about the Plan or think how something should work? Take a moment and think about that. It could very well be a little bit of all those things.
Putting aside the aforementioned successful group of journeypersons, everyone else, if they are being truly honest with themselves, would most likely admit that their understanding of the Plan is not at the level that they would like it to be and know it should be.
Case and point, the proper way to use the HRA Credit Benefit Debit Card. Ahhh, yes. There it is. The collective groan of the loyal readers whenever they see me going down that path.
Keeping in mind that adage that there is a fine line between a rut and a groove, I am going to use another Fund Benefit as an example. Specifically, this Plans Care Management benefit. How many of you know about this service and what it does?
This Benefit assists those individuals on the Plan with conditions requiring extensive or on-going medical services and/or prescription medications. One of this services primary focuses is to ensure the timely and coordinated access to medically appropriate levels of health, support services, and continuity of care through the initial and ongoing assessment of the participants, and other family members’, needs and personal support systems. Sounds like a pretty sweet benefit, right? That’s because it is.
Now, as December 31st, 2023, 2.9% of the participants of the Plan are responsible for 53% of all monies paid out in 2023. In other words, the totality of the claims of 98 people is in excess of the totality of all the claims submitted on behalf of the other 3,300+ participants of the Plan.
One would think that the aforementioned service would be greatly valued by each of those 98 individuals. Sadly no. Only twenty percent (20%) have ever engaged in that benefit and service. Crazy, right?
I know what you are thinking. Does the remaining 80% even know about this benefit. They do. How do we know? Simple. The Fund Office keeps track of all those calls. So, we have confirmation that the Plan’s Care Management team has not only reached out to each one of those individuals but receive confirmation as to how many times they have reached out. Believe it or not, some of those participants have been contacted as many as twenty-nine (29) times and counting.
The reality of the matter is that this population has chosen to never interact with the Plans Care Management service and benefit. Now when we state, “never” we mean never. 100% of that 80% population has not answered any of the several calls that have been made to them. Nor have they ever returned any of those phone calls.
Why don’t they take advantage of this free benefit? Who knows? However, I suspect it has something to do with them never taking the time to learn about their benefits.
Which brings me back to Newton’s 3rd law. You remember that right? Forces. Interactions and action-at-distance-interactions like magnetic and electrical forces. (See what I did there?) Does any of this ring a bell or vaguely so? That’s ok if it doesn’t. All you need to know is that forces come in pairs-equal and opposite - action-reaction.
Now, by actively choosing to not engage with the Care management benefit, these individuals have in essence pushed themselves away from one of their responsibilities under the Plan. That decision has set into motion an equal and opposite force. The effect of which I highly recommend that they look up within their Summary Plan Description book and learn about, quickly.
Suffice it to say, that the realization of the consequences of their decision not to engage will be a lot more unsettling than learning that the Fund Office keeps track of those calls.