Pat Pawlack — North Hollwood, California

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There is a lot wrong with the medical system in California these days – skyrocketing premiums, a lesser level of care, lack of accountability. Pat Pawlak has fallen prey to one of its most bizarre characteristics, a phenomenon she calls "the creep factor." Pat is dissatisfied with her agent, and has been for some time.

The problem: under the current system, she can’t replace him.

This means that he remains free to abuse her verbally, which he has done, making cracks about her weight. More to the financial point, he continues to make money off her enrollment in the Blue Cross system, even though he has done nothing to help her: au contraire.

Pat, who lives in North Hollywood, sells and distributes international films. Her encounter with the Twilight Zone of the health care delivery system began in 1991, when she applied for coverage at Blue Cross. The organization turned her down because, they said, she had a history of bladder problems. She persuaded Blue Cross that she had had surgery to fix the condition, and that it had been caused in the first place by medications, which she later stopped using. Blue Cross then insured her.

Things went along nicely for eight years. Then, in 1999, Pat raised her deductible. No sooner had she done so than she got a phone call from a strange man. "What the hell are you doing?" he asked. "You can’t raise your deductible!"

He identified himself as her insurance agent since 1991 and told her she needed his permission. When Pat, aghast, balked, he grew both insulting and threatening. He said he remembered her because she was ‘really fat’ (she isn’t) and told her she was stuck with him. "I know everything about you." he said, ominously. "It’s here in my computer," Not only that, he added, "I know important people" at Blue Cross.

It was clear what was happening. The agent’s income was tied to Pat’s account. If she raised her deductible, that meant less money for him. "Whatever they’re paying him is based on my insurance," Pat says.

"I called Blue Cross," Pat says. "They said, ‘you can’t change agents.’" They did tell her they would deny him access to her files. "That made me wonder how does he have access in the first place. It’s very creepy." They did allow her to raise her deductible.

Pat became very busy with her film business, and let the incident go.

A year later she received a generic flyer from the agent, advertising his services. "It was the creep factor," Pat says. The agent didn’t even remember the hassle he had put her through. Pat began a climb up the corporate ladder, trying to get someone at Blue Cross to excise this human carbuncle from her account.

The results were predictable. A company executive said his hands were tied because the agent did not want to remove himself. Pat began to experience the ‘pinball effect" that happens to people who complain about health care: she was bounced around like a little silver ball in a an arcade game, from Blue Cross to the Department of Managed Care to the Department of Insurance. Nothing worked.

"This man is receiving a commission and I don’t want him to be," Pat says. "I was appalled at his manner, but this whole thing that I can’t remove him creates this man’s arrogance."

As she pushed forward she learned that the letter denying him access to her files had disappeared. Industry representatives told her they could nothing because she had not documented his calls. "That’s like being robbed on the street and the police saying it never happened because I didn’t videotape it." A woman at the Department of Insurance became abusive, yelling and calling Pat ‘thick-headed" for persisting.

The man is still her agent, and she is still trying to change that. "I’d like to see them show me something I signed that says he has to be my agent in perpetuity."

Pat concedes that most people would have given up by now. "Most people would back down. They don’t complain; they don’t make waves." But she says that’s part of the point: You have to be tenacious in standing up for your rights, especially when the ‘level of meanness" reaches so high.

Consumer Watchdog
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