elissa ely

Insurance, and a lesson in patience

We were polite, the insurance company rep and I. I had waited a long time on hold before reaching any voice. Having reached her, it was as if we were sipping tea together now, cupping our wrists, pinkies outstretched. Both of us understood it was not her fault that she had to enforce unreasonable rules.

I had called to request several medications for my patient. Each one needed prior insurance authorization; the company formulary, recently revised, no longer included them. With each drug, the representative asked for the patient’s date of birth. I offered a lump of sugar and pointed out that a birth date is unlikely to change. She agreed, and passed a plate of crumpets. This rule was not her doing. We both understood.

There were other challenges to our patience. She could not spell the name of one medication the formulary disallowed, and did not know what it was for. Yet she was required to ask: Had alternatives been tried first? No, I explained, because her insurance company did not cover them, either.


After we had registered the patient’s birth date numerously, she turned to my information: registrations, address, phone number, name. She had a little trouble with the spelling of my name, which happens. I spelled the first name, then the last. She asked for the first again. I gave it, more slowly. She asked for the last again. I put my teacup down. It wasn’t her fault, but, even so.

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“What was that first name again?” she said.

“Doctor,’’ I yelled. “The first name is doctor.’’

My office was next to a psychiatrist who had recently graduated from residency. One of my walls, the one facing our shared alcove, did not rise all the way to the ceiling. There was a gap of a foot or two where sound flowed freely, in frank HIPPA violation.

We had shaken hands when he arrived, but otherwise, had had limited contact. I would have liked to provide an example of aged graciousness to him, and to the insurance rep, too: passing the cream, offering a scone. Too late. I thought of the bread bakery where I get multigrain loaves.


The place is always full of light, with a woman in a hairnet behind the counter. She serves the irritable lunch crowd and the weekend croissant line with the same unflappability. Once when I had waited a long time, she gave me a free cranberry pecan roll. It was very placating. She’s someone who knows how to pour tea.

“Why are you always so calm?’’ I had said to her the morning she handed me the roll.

She took my loaf of multigrain and bagged it.

“It’s easier that way,’’ she said.

Elissa Ely is a psychiatrist.