The Blob Wins

On pre-authorizations, three-bucket theories, and the humbling art of letting a process do its thing.

The setup

I needed a medication. Nothing dramatic, just a prescription that required a pre-authorization before the pharmacy could fill it. A pre-auth, for the uninitiated, is the insurance company’s way of making sure your doctor actually wants you to have the thing your doctor said you need. It is bureaucracy doing a lap around itself.

I did not understand how the pre-auth process worked. And here’s the thing: I thought that was a solvable problem.

The phone calls begin

First, I called my doctor’s office. They told me to call the insurance company to check on the status. So I did. The man at the insurance company buried his answer in four minutes of ambient words, the bureaucratic equivalent of a loading screen, but eventually I got it: no pre-auth had been submitted yet. He told me to call the doctor’s office back and let them know.

So I called the doctor’s office. Again. They said they’d get to work on it.

Then the pharmacy may or may not have become involved. I wasn’t sure. Which meant I had questions. Which meant I called the doctor’s office. Again.

The three-bucket theory

By this point, I had developed what I felt was a fairly elegant mental model. I explained it to the woman who answered the call:

There are three buckets. Bucket one: the doctor and the patient. Diagnosis happens here; the prescription originates here. Bucket two: the insurance company. They receive the pre-auth request, review it, and approve or deny it. Bucket three: the pharmacy. Fulfillment. You move through them in sequence: diagnosis, approval, fulfillment, and once you understand the sequence, you can figure out where things are stuck.

I was proud of this. It was clean. It had a logical flow. I asked her if I’d understood it correctly.

She said: “Well, it depends.”

And then she explained, graciously and patiently, all the ways in which buckets aren’t really buckets. The pharmacy sometimes contacts the insurance company directly. The doctor’s office sometimes learns things from the pharmacy before I do. The insurance company sometimes needs more information from the doctor before they can even log the request. Things happen in parallel. Things loop back. The sequence I’d imagined was more of a suggestion.

The blob

After a few minutes of this, I stopped her.

“Okay,” I said. “I think what you’re telling me is that it’s not three buckets and three processes. It’s just a blob. It happens the way it happens, and there’s no real map for it.”

She laughed. Yes, she said. That was actually a pretty good way to think about it.

The blob. Formless, moving at its own pace, indifferent to my mental models. Not broken, just opaque. Somewhere in the blob, people were doing their jobs. Somewhere in the blob, my pre-auth was being processed. I just couldn’t see it, and this is the part that took me five phone calls to accept.

I didn’t need to.

What this is actually about

The pre-authorization eventually came through. Of course it did. It was going to, with or without my three-bucket framework.

What I’d done, across those calls was convince myself that understanding a process was the same as controlling it. That if I could just map it clearly enough, I could move it faster. This is a very me thing to do. It’s probably a very you thing too: the belief that enough clarity and enough effort can short-circuit systems that simply aren’t built to be short-circuited.

Good enough isn’t giving up. It’s recognizing when your energy is better spent trusting a process than auditing it.

The doctor’s office was doing its job. The insurance company was doing its job. Probably the pharmacy was doing its job, in whatever order it does things. The blob was moving. I just couldn’t resist poking it.

The good enough principle, this time around, looked like this: make the necessary calls, confirm that the thing is in motion, and then the hard part, stop calling. Let it blob. Trust that someone somewhere is working the process, and that you will get your answer when the answer is ready.

I’m still working on this one.

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If this made you think of someone, feel free to pass it along.

And if you’ve had your own “good enough” moment where you stopped trying to optimize something and just let it work, I’d be interested to hear it.

I may also do a few short conversations with readers down the road. If that’s something you’d enjoy, just let me know.