She tangled with health insurance every day for 25 years. And loved it. Here’s what she can teach us.

Dan: For 25 years selling health insurance in Austin, Texas, Jim Gideon had a secret weapon. Well, not so secret. He made sure every client— and every prospective client— knew about her.

Jim Gideon: [00:00:12] We would tell our clients, listen, you don’t need to be on the phone for four hours with blue cross blue shield.

Let, let us do that. I have a person

Dan: [00:00:21] That person was Barbara Faubion.

Barbara F: [00:00:23] I did it as a full time job for 25 years.

Dan: [00:00:27] No problem too big, no problem too small. Did you lose your prescription-drug card? And you’re at the pharmacy, with a sick kid, and they won’t deal with you? Call Barbara, she’ll fix it. You’ve got cancer, and chemo, and a six-inch-thick pile of bills you don’t understand? Barbara will go through em.

Barbara F: [00:00:49] I mean, it didn’t matter who you were in the company, you have a claim and you have a problem call Barbara and Barbara took care of it.

And that’s who I was. And I loved it.

Dan: [00:00:58] In our last episode, we talked with Steve Benasso— he’s an HR director who wrassles with health insurance every month for the people in his company. Barbara was his teacher on this stuff— he said he learned everything from her.

So, Steve does this every month. Barbara did it every DAY? For 25 years? And loved it? That’s someone I was SUPER-curious to talk with.

And after talking with Barbara— and with Jim, her employer— I got curious about something else too. Jim says employing Barbara was terrific for his business.

So … why aren’t there more people out there doing what she did? Hm! We’ll get into it.

This is An Arm and a Leg— a show about the cost of health care. I’m Dan Weissmann.

I’m a reporter, and I like a challenge. So my job on this show is to take one of the most enraging, terrifying, depressing issues in American life— and I mean, right NOW, the competition on that score is EXTREMELY tough, but still — and bring you something that’s entertaining, empowering, and useful.

Right now, I am leaning in to that “useful” part. This podcast these days is a school for financial self-defense. Because the cavalry isn’t coming. And I can’t think of anyone I’d rather get a lesson from than Barbara Faubion.

She became an expert pretty much by accident. Her kids were old enough that she was ready to take on some part time work. She ended up working for Jim…

Barbara F: [00:02:37] because his office was five minutes from my house. . And I didn’t even know what health insurance was, dan. I didn’t know anything about it.

Dan: [00:02:45] I mean, she knew it existed. But her husband had been taking care of that stuff.

And she kind of fell into the troubleshooting role when the woman who *had* been handling claims went on maternity leave.

She left Barbara a list of 800 numbers to give to clients who had questions.

Barbara F: [00:03:06] I went, you know what, I’m not giving out 800 numbers. That’s not a service. I got on the phone with the insurance company and got the answers.

I was learning all that as I was going along, because I’d ask a question and then I get off the phone and I’d go, well, wait a minute. I need to know this too. And I was on that phone until I had all the answers before I called that person back or emailed them.

So nobody from the day I started doing it had ever talked to an insurance company, which that’s like gold.

Dan: [00:03:39] And Barbara really took care of people. with returning phone calls. Right away.

Barbara F: [00:03:45] , people were just shocked that I would call them within 10 minutes of calling me. but the thing is I wanted to talk to you before I started working on it, because I have all these questions to ask you that you hadn’t even thought about.

Dan: [00:04:02] And then as soon as she put down the phone with you, she’d call the insurance company, get those answers,

Barbara F: [00:04:10] , type it up and email it to you the same day. I mean, it was unheard of, he will go kidding me.

Dan: [00:04:17] But she says it was easy to do: She knew exactly what she had to ask.

And — especially as time went on— she knew who to ask. And they knew her.

Barbara F: [00:04:30] it got to be where I just call and go. This is Barbara Faubion and they go, how are you? I mean, we were like friends,

Dan: [00:04:36] And: She knew when the answers she got weren’t adding up.

Barbara F: [00:04:40] See, I knew enough to go. No, I don’t think so. According to this policy data, and I call them out on it

That’s the thing that’s scary about people talking to the insurance company. They don’t know if they’re getting the right answers or not. I knew when I was not getting the right answer.

Dan: [00:04:59] Right. How, how often would you say you were not getting the right answer?

Barbara F: [00:05:04] A lot.

Dan: [00:05:05] So, let THAT sink in for a minute. A lot of the time— even knowing what to ask, even knowing a lot of the time WHO to ask— she wasn’t getting the right answer.

So, on the one hand, holy crap: most of us would not know any of those things.

And this too: Barbara says when she couldn’t get to the right answer quickly— getting there took a LOT of work, and a LOT of time. For Barbara. Who knew a lot.

So that completely stinks.

But on the other hand: HUH! If we can learn, if we can dedicate the time to it, a LOT of the time we might find places where we’re NOT actually supposed to pay what we’re told the first time out. There’s money we may not have to leave on the table.

So, let’s get the lesson: What were the actual problems Barbara solved?

It’s important to say that one thing Barbara did a LOT of didn’t involve detective work, and didn’t reduce anybody’s bill. A lot of the time, she just made clearer for people what all the paperwork actually meant, what they actually owed. She says people appreciated that too.

I mean, the news wasn’t always great— THAT’S a problem no one person’s gonna solve— but at least it was clear.

But again, a LOT of the time, there was a problem.

She talked with me about two big buckets of issues. One was when the insurance company seemed to be the source of the problem: They were denying something that really they should have approved.

Then, it’s time to file an appeal. And most of the time she won.

Barbara F: [00:06:57] I filed two or three appeals sometimes, but then I would win it at the end of the day, you know, six months later

Dan: [00:07:04] Or even a year. And the reason she won: she picked her battles.

Barbara F: [00:07:09] I didn’t file one, unless I thought I really had a good chance of winning. I mean, I didn’t file it because somebody didn’t like their answer, they got from a company.

Dan: [00:07:18] And getting to the point where she had enough information to know if this was a battle worth picking? Took time.

Barbara F: [00:07:26] literally, I could be on the phone for four hours talking about one claim I’m talking, okay. Let me talk to your supervisor. Okay. Let me talk to, you know, I mean, I’m, I’m just going up the ladder You had to spend all that time on the phone to get all your information, to be able to file that appeal.

And here’s an advanced tip from Barbara: She knew a lot. But she also knew to just ask a direct question.

Barbara: I didn’t have any problem asking, what do I need to do to appeal this? And then they would tell me. Well, it says in the policy that this is excluded or whatever or not. So how do I get around that? How do I word it? And they would give me information. the thing is you just have to ask. A lot of people wouldn’t even know to ask.

Dan: [00:08:16] That is something that— if we’ve got the patience for the whole process— seems worth trying out.

You wanna file an appeal with the insurance company, ask them a BUNCH of questions. Direct questions. Because sometimes, according to their own rules, they SHOULD be paying for something they’ve said no to. That’s the first big bucket.

And asking the insurance company questions is also how Barbara figured out when a particular case fell into the other big bucket: A coding problem.

The provider had used one billing code for something they’d done— and this insurance didn’t like that code.

But if the provider used a different code to describe the same thing, everything could be fine. And Barbara had ways of finding out.

Barbara F: [00:09:06] I mean, this was definitely after time, you get to know them and everything. I got well, okay, Sally, tell me what, what code is covered. I mean, what, what’s the code?

Dan: Yeah.

Barbara F: So they’re not supposed to give it to you,

Dan: [00:09:21] And sometimes they wouldn’t, not even for Barbara. But Barbara knew how to play the game that way too. She’d look up a bunch of codes for whatever was on the bill, and test them out.

Barbara F: [00:09:36] and I go, so is this code covered that they go? Yeah. And I went, okay.

Dan: [00:09:42] She says it’s like 20 questions: They’ll answer yes-or-no questions, and not just for her. You just have to know which questions to ask. Which takes a LOT of figuring out. And there’s not an easy map— Barbara did tell me that. But: This would be interesting to learn more about in another episode— how do we look this stuff up?

How do we become code-breakers? I mean, even just the WORD “code” is interesting, right? When something is in code… it’s secret. Or at least: It’s not in plain language.

But Barbara’s here to tell us: Code-breaking, however much work it takes, isn’t enough. There’s more slow, patient work to do.

She says once she got the right codes, her work was not over. Had to get the provider to re-submit their bill, with the codes the insurance company would cover.

Barbara F: [00:10:36] And I mean, after pulling teeth out of the lion’s mouth or two months, they would finally send in the correct codes and they would get paid. Meanwhile, our client was not doing anything. All they were doing is just letting me take care of it. But it finally got paid correctly because we got the correct codes put in.

Dan: [00:10:55] Man, THAT sounds good.

Barbara F: [00:10:57] A lot of people thought I was doing magic, then I really wasn’t. All I was doing was just being their advocate and having enough knowledge to get on the phone and get it resolved.

Go through the six months. It may be take to get it resolved and, and just do it. It wasn’t any magic.

Dan: [00:11:17] Six. Months. But, OK, fair warning.

And Barbara did have one bit of magic.

Barbara F: [00:11:22] I was always friendly. I mean, you know, people get really pissy with insurance

Dan: [00:11:27] Not Barbara

Barbara F: [00:11:28] respected their job. And even if I didn’t agree with what they’re telling me, I wasn’t nasty about it. You know? So people didn’t mind working with me.

Dan: [00:11:38] Which absolutely makes sense. I mean yes, it makes sense that people responded to her being nice.

And it makes sense that Barbara was ABLE to be nice. Because this was a JOB for her. So one, that’s a little less nerve-wracking than having your OWN money on the line— maybe an unsettling amount of money.

Two, that meant she kept getting better at it, more confident.

And three, she was on the clock, earning a paycheck. If she was on the phone for four hours? She wasn’t stealing time from her job, or from her family, or whatever other obligations.

All that stuff— the pressure of some wild amount of possible debt, the feeling of being one-down because the other person knows more than me, the pressure of stealing time— me personally, that can leave me edgy, resentful, less friendly.

I think that’s why Barbara’s friends couldn’t believe she got out of bed to DO this job for 25 years.

Barbara F: [00:12:43] I go, I love my job and they go, you love your job. You spend your whole day talking to an insurance company. Are you kidding me?

Dan: [00:12:52] But getting PAID to talk to an insurance company, that takes the edge off.

And paying Barbara to do that was an easy call for her bosses. Because she kept their customers extremely happy.

Barbara F: [00:13:06] You have a happy customer. You keep up. You keep them. I mean, not to brag or anything, but there were clients that we have because of the customer service.

Yep! Like Steve the HR director from our last episode— he picked them for that exact reason. So when Jim and his partner merged with a bigger agency, of course they brought Barbara with them, and kept her doing customer-service full-time. Here’s Jim:

Jim Gideon: [00:13:33] they would all always question us, going: “We don’t have anybody else in any of our other 20 locations, that’s paying for that person to do that.” Of course we go. “Why not?”

Dan: [00:13:45] Jim says joining the bigger agency made it even clearer how valuable Barbara was.

Jim Gideon: [00:13:51] When we watched the other brokers in their staff, their staff would get it bogged down.

Dan: [00:13:56] Jim and his crew would see those brokers hustling on their deadlines— they wanna close this deal, they’ve gotta be ready for an enrollment meeting tomorrow.

Jim Gideon: [00:14:07] and then they get a call

Dan: [00:14:09] A call from a client who’s like, “I’ve got a problem with a claim.”

Jim Gideon: [00:14:15] and know, now you’ve got to decide, are you going to, I’ll take this call and work for eight hours on it.

Dan: [00:14:20] Or are you going to get your other stuff done? Jim never had to decide. He’d just call Barbara.

And he encouraged those other brokers to call on her too, whenever they got stuck.

Jim Gideon: [00:14:34] And in the amount of 45 minutes later, she’d call and goes, “Done!” And they go, “What did you do? We haven’t got Humana to answer the phone yet.”

Dan: [00:14:44] Yeah, well they were calling Humana’s 800 number. Barbara was calling the right person on their direct line. She added incredible value.

Jim Gideon: [00:14:53] So we always saw that. Yeah. And defended it to the end.

And I’ll be honest with you. When she retired,

I retired because I wasn’t I didn’t Yeah. You know, she carried my water for a long time.

And part of my shtick was that

Dan: [00:15:11] And when Barbara left, the agency didn’t hire somebody else to do what she did.

Jim Gideon: [00:15:14] it just wasn’t part of the agency model and that’s fair. I’m not telling them how to run their business.

Dan: [00:15:19] But it seems WEIRD, right? That a position that seems so valuable— where everybody can SEE how valuable it is— that nobody’s like, “Hey, we should do that.”

And it’s not just this agency. Barbara remembers how excited her bosses were when she first got going.

Barbara F: [00:15:38] And he kept telling me there’s nobody in the country that probably does what you do now. I don’t know if that’s true or not, but he had clients that were going, man, we’ve never had this service before.

Dan: [00:15:48] Yeah, so WHY should this be?

Why should it be so unusual for health insurance brokers to prioritize customer service?

My pal Marshall Allen has an idea. He’s a reporter for ProPublica who’s done a LOT of stuff on health insurance.

He’s gonna fill us in, right after this.

This episode of An Arm and a Leg is a co-production with Kaiser Health News. That’s a non-profit news service covering health care in a America. Kaiser Health news is not affiliated with the big health care outfit Kaiser Permanente. We’ll have a little more information about Kaiser Health News at the end of this episode.

Marshall Allen has been reporting on health insurance for years at ProPublica. We talked last year about how insurance companies use medical devices to spy on us. CREEPY. But a super-fun episode, actually— and it includes some great examples of how we can actively fight back.

Marshall did a big story that explains why most health-insurance brokers don’t make Barbara Faubion-style customer-service a real priority. It’s because they’ve got a major conflict of interest.

Marshall Allen: [00:16:59] those brokers are having all of their commissions funded through the insurance plan.

Dan: [00:17:04] That is: If you’re an employer shopping for health insurance, and you “hire” a broker… you don’t pay that broker. Instead, when you actually buy insurance, they get a percentage. From the insurance company. So…

Marshall Allen: [00:17:18] the question is, who is your broker working for? Are they working for the employer and the employees, meaning they’re going to fight hard against the insurance company or are they working for the insurance company, which happens to be the entity that is signing their paychecks.

Dan: [00:17:38] I mean, funny-not-funny, right? Standard commissions are like three to five percent. And it’s not just straight commission: Insurance companies offer bonuses to brokers for bringing in a lot of business.

Brokers sent Marshall information on these bonuses: Sign up a big group, you could get 100 thousand dollars.

Marshall Allen: [00:17:57] You can get six figure bonuses for signing up a big enough employer with an insurance company.

Dan: [00:18:03] And remember, that’s the BONUS. You’re also getting a commission.

AND there’s another set of bonuses. If you do enough business for a given insurance company— across all the employers you sign up— you can earn rewards, perks.

Marshall Allen: [00:18:18] like a fancy trip, like a cruise, a trip to the super bowl. I mean, these are nice perks, right? So it might be a fancy vacation.

Dan: [00:18:26] that gives me an incentive to say I could go to the super bowl. if I get enough people to sign up with blue cross. So I’m going to push blue cross because Cigna is offering the Disney cruise. And we did that last year with my family.

That was nice. This year, I want to go to the super bowl. I’m pushing blue cross. And so who’s, who’s got the carrot is kind of the question here, right?

That’s exactly right

And that’s not all. Because the insurance company ALSO has a stick. One that brokers would be dumb to ignore.

Marshall Allen: [00:18:56] If they run afoul of that insurance plan, they could be what’s called decommissioned, which means they’re cut off and they lose their commissions.

Dan: [00:19:05] Yeah, THAT is a pretty good reason to avoid being too aggressive.

I mean, Barbara wasn’t aggressive. Barbara was always nice. But still. The whole arrangement gives you an idea of why a broker is almost always going to prioritize doing sales for the insurance company over doing customer service for you.

Mainly it’s because you aren’t the customer. The insurance company is the customer.

So we shouldn’t expect a gazillion insurance brokers to hear this podcast and go, “WE ARE RESTRUCTURING RIGHT NOW to HIRE MORE BARBARA FAUBIONS.” Like I’ve said before, the cavalry isn’t coming. That’s why this show is focused on learning self-defense.

And just to put all the cards on the table, at one point Barbara says to me, “I dunno about your podcast, Dan.” About self-defense. She says she’s not sure how people can just do this for themselves. Or who we can get to do it for us.

Barbara F: [00:20:07] there’s a great need for what I did, but people don’t have the time and resources to pay somebody to do what I did.

Dan: [00:20:15] I tell her, this whole conversation leaves me kind of split. Like, on the one hand, we obviously need an army of Barbaras, and gosh won’t somebody please go create one.

And on the other hand: wait a minute.

I’ve mentioned before how an economist named Bob Pollin looked at how many people would be thrown out of work if we had a system like Medicare for All:

These are people who work for providers, fighting with insurance over bills, and people who work for insurance, fighting on the other side. People who don’t actually provide any health care.

It was 1.8 million people.1.8 million jobs I looked up how that compares to the number of jobs that we think were saved by bailing out the U.S. auto industry in 2009. It’s more jobs. A LOT more jobs.

And I think— with all respect to the folks in those jobs— damn, that’s a BIG layer of waste in our system.

And I think: Hey, so if somebody said, “I have a plan for an Army of Barbaras”— wouldn’t that just be adding ANOTHER layer? Wouldn’t we just be adding to the number of people participating in our medical system, needing to be paid, who don’t actually provide medical care?

So, I tell Barbara: I dunno about my podcast either. Like, I know it’s not a panacea. I just know we’re IN this world where most of us are exposed to these huge financial risks.

Barbara F: [00:21:52] Yeah, no, totally,

I totally agree with you.

Dan: [00:21:55] Yeah. Yeah. you’re like, I don’t know about your podcasts, both of us are just like, it’s stinks. We don’t have switch. We can flip and be like, this is taken care of. but I think there is a pitch that like, this is an investment that we should be prepared to make you know, it’s like learning to be your own handy person or

Barbara F: [00:22:12] And learn how to hookup your own technology.

Dan: [00:22:15] Barbara says she knows what that’s like.

Barbara F: [00:22:18] I’m very challenged with internet stuff. I’m very challenged on mortgages and stuff like that. I don’t want to deal with it. I want somebody to take care of it for me.

Dan: [00:22:29] And Barbara agrees most of us can’t get somebody to take care of this health-care stuff for us. So if we’re on our own, Where do we start? She says: Just get on the phone.

Barbara F: [00:22:43] . call the company and ask them why that’s not covered. And if you don’t like the answer you ask, why, explain it to me. .

Dan: [00:22:53] Yeah, don’t take answers at face value.

Barbara F: [00:22:55] And that’s the biggest thing. And that’s what I do.

but I started out not knowing questions to ask

Dan: [00:23:01] Yeah. after a while you were an expert, but you didn’t start out as an expert.

Barbara F: [00:23:04] No, I didn’t even know what PPO and HMO was. I was such a rookie,

Dan: [00:23:12] And I mean, if YOU don’t know what an HMO or a PPO is, do not sweat it. Just remember: One, Barbara did not know either when she started, and TWO, at that point GOOGLE did NOT EXIST.

And neither did this show.

So SOME things are gonna be a little easier for you.

And in the name of making things easier, I just want to highlight the big thing I’m taking away here.

Beyond the recap of what we’ve BEEN hearing a fair amount on this show— fighting back can take a LOT of time, and patience, and tenacity, and it doesn’t always work, because our system sucks—

There’s this nugget: How often IS there a problem that— if you’ve got the patience and tenacity— CAN get fixed? A LOT.

So just keep going.

Actually, while you’re at it, Barbara emailed me this one reminder after we talked: Any time you get on the phone with these folks, be ready to put these three things at the top of your notes about the call: One, the phone number you called. Two the person’s name — whatever they’ll give you— and three: A *reference number* for the call. Barbara says there’s always a reference number.

So, ready, set: Keep going.

Last time on this show, I closed by asking you to tell me what was keeping you going right now, what was getting you through. I’m not going to lie— NOT A LOT OF FOLKS RESPONDED.

Which I get. For the last bunch of months, What-gets-you-through has been a major, major ask on social media. A lot of us are getting-throughed OUT.

I DID get a really nice response from Michael in Boston. He said— to paraphrase— this year sucks. Trying to stay positive “has been a challenge.” But he says “A small upside is that I’ve been way more creatively productive than any other time I can remember.”

He’s written a bunch of songs, and he sent me YouTube links to videos that show him and his bandmates — they’re called The Rockmores— each recording their own part at home— at a super-safe social distance. There are also quick shots of them learning how to use video-editing software. IT IS SO CHARMING!

This tune is probably my favorite. It’s called “Going Down Now” I’ll have a link to it in this week’s newsletter: You might want to subscribe. That’s at arm and a leg show dot com, slash newsletter.

In the last newsletterLast time, I shared what’s been getting ME through— that would be our family’s cat and— please get ready a possibly embarrassing acknowledgement— the music of Paul McCartney.

My Boomer siblings played me “Hey Jude” in the actual cradle. His voice is the sound of comfort. He’s been putting out solo records for 50 years. I’ve been making playlists. And playing them over and over.

And here’s something I’m looking forward to: This fall, I’ll be tackling a question I’ve been curious about since I first started this podcast. Health care is about a sixth of the U.S. economy. Three point six trillion dollars. WHERE does that money GO? Whose pockets does it end up in?

A full accounting is… well, it’s beyond the reach of this independent podcast. But we can ask some big, interesting questions: Like, how much of it goes to profits? How much goes to salaries above, say, $500,000?

I’ve started to find some people who know how to find the answers. So stick around for that this fall.

Meanwhile, thank you so much for supporting this show. I am taking on this 3-point-six trillion dollar set of questions from the three-season sun-porch behind my son’s bedroom. And I can do it because YOU are making it possible when you support this show on Patreon. If you want to help out that way, go to arm and a leg show dot com, slash support. Thank you.

We’ll be back in two weeks.

Till then, take care of yourself.

This episode was produced by me, Dan Weissmann and edited by Marian Wang.

Daisy Rosario is our consulting managing producer, and Adam Raymonda is our audio wizard. Our music is by Dave Winer and Blue Dot Sessions.

This season of An Arm and a Leg is a co-production with Kaiser Health News— a non-profit news service about health care in America that’s an editorially-independent program of the Kaiser Family Foundation.

Kaiser Health News is NOT affiliated with Kaiser Permanente, the big health care provider— they share an ancestor. This guy Henry J. Kaiser— he had his hands in A LOT of different stuff. Concrete. Aluminum. Ship building. When he died, more than fifty years ago, he left half his money to the foundation that later created Kaiser Health News.

You can learn more about him and Kaiser Health News at armandalegshow.com/kaiser

Diane Webber is Senior Editor for Broadcast and Taunya English is Senior Editor for Broadcast Innovation at Kaiser Health News— they are editorial liaisons to this show.

Finally, thank you to some of our new backers on Patreon and some who increased their pledge. Pledge two bucks a month or more, and you get a shout-out right here.

Thanks this week to:

Gerri Boyle, Jordan Schneider

Lindy Brandt, Dan Swihart,

Joan, Catherine Avila,

Theodore Kraig, and Carla Keirns

Thank you so much