There is a particular kind of optimism required to call an insurance company. You begin with the quaint belief that somewhere within the organization exists a person who knows why the organization did what it did. You have a question. They presumably have an answer. The telephone, one of civilization’s more established technologies, will connect the two of you.

This was my first mistake.

I was trying to figure out why an insurance claim had been denied. The denial said that a particular code was invalid, which would have been useful information had I actually used that code. I hadn’t. I had the original claim sitting directly in front of me, and the code on it was entirely different from the one referenced in the denial.

This seemed like the sort of discrepancy a brief telephone call might resolve.

The insurance company disagreed.

Its automated phone system kept hanging up on me. I would call, navigate several prompts, make what I thought were responsible selections, and then suddenly find myself alone again. There is something almost personal about being hung up on by a machine. With a person, you can at least imagine there was a misunderstanding. A machine has reviewed your options and concluded that the best next step is your removal.

I tried again. The system hung up again.

This was a large insurance company, the sort of organization that processes enormous amounts of money and makes decisions every day about medications, procedures, tests, hospital stays and whether various portions of the human body have met the appropriate criteria for reimbursement. It seemed reasonable to expect it could also maintain a telephone call.

Eventually, I gave up on the telephone and opened the online chat.

A representative appeared.

I explained the situation carefully. My claim had been denied because, according to the denial, I had used an invalid code. I had not used that code. I had used a different code. I was looking at the claim. Could someone please explain what had happened?

“One moment please.”

I waited.

There was an investigation.

More waiting.

Finally, the representative returned with the results.

The claim had been denied because the code used was invalid.

This was an important moment in our relationship because it established that we were working with very different definitions of the word “investigation.”

“I can read,” I typed.

I will concede that customer-service diplomacy may not be my greatest strength after prolonged exposure to administrative nonsense. Still, the problem seemed straightforward. I did not need someone to read the denial to me. The denial and I had already spent considerable time together. We were practically dating. I wanted to know why it referred to a code that did not appear on the claim.

“One moment please.”

Then came another phrase, one that anyone who has spent enough time dealing with large bureaucratic systems will recognize immediately.

“I’m sorry for your frustration.”

There may be no sentence in the English language more exquisitely engineered to acknowledge a problem while assuming absolutely no responsibility for solving it. It has the soothing cadence of empathy and the practical utility of a decorative pillow.

We continued.

“One moment please.”

“I’m sorry for your frustration.”

“One moment please.”

I began to suspect that these were not sentences so much as the two available settings.

Meanwhile, I kept returning to what I believed was the central fact of our discussion: the insurance company had denied my claim because of a code I hadn’t submitted.

I explained this again.

There was another investigation.

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At some point, time lost its usual structure. I don’t know exactly when a customer-service chat becomes a lifestyle, but I believe I crossed the threshold somewhere around the hour mark. I was no longer a person trying to resolve a claim. I was a resident of the chat box.

Then, after approximately 90 minutes, the system logged me out.

There are moments when technology achieves a kind of comic perfection that would feel heavy-handed if a screenwriter had invented it. Ninety minutes into an unresolved conversation about an inexplicable denial, the system responsible for helping me resolve the inexplicable denial decided that what the situation needed most was for me to leave.

So I logged back in.

I prepared myself to meet a new representative and begin the oral history of the claim from its earliest known origins. Instead, something extraordinary happened.

I was reconnected with the same person.

Ordinarily, this would be excellent news. Continuity! Institutional memory! A human being familiar with the case!

Unfortunately, it was the same human being familiar with the case.

Still, we pressed on.

The representative eventually informed me that the correct code to use was, let’s call it XYZ.

I looked at my claim.

XYZ.

I looked at the message.

Use XYZ.

I looked at my claim again, because by this point I had begun to distrust my relationship with numbers, letters and possibly reality.

XYZ.

“I used XYZ,” I explained.

The representative told me that XYZ was the code that needed to be used.

“Yes,” I said. “That is the code I used.”

The claim, I was reminded, had been denied because of the code.

Which code?

The incorrect code.

Which I hadn’t used.

What code should I have used?

XYZ.

Which was the code I had used.

We had arrived at Who’s on First?, except nobody was getting paid to laugh.

Abbott and Costello built an entire routine around two people being unable to establish who was playing first base. It works because the audience understands something the characters cannot seem to communicate to one another. My version had three characters: me, the representative and an insurance company computer system that appeared to have developed its own interpretation of the claim. The computer was winning.

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It would be easy to dismiss the whole episode as one more irritating encounter with customer service, the sort of thing that happens when modern life collides with an automated phone tree. Except healthcare is filled with versions of this conversation, and the stakes are frequently considerably higher than my afternoon.

Somewhere, a patient is waiting for a test to be authorized. Somewhere, a physician’s office is trying to get a medication covered. Somewhere, a staff member is appealing a denial for a procedure that has already been performed. Someone is sitting on hold. Someone is entering the same information into another portal. Someone is being transferred. Someone has just heard that their call is very important.

And somewhere, inevitably, someone is being thanked for their patience after having demonstrated absolutely none.

We talk endlessly about the cost of American healthcare, usually in numbers large enough to become abstract. Premiums. Deductibles. Hospital bills. Drug prices. Reimbursements. What receives considerably less attention is the enormous quantity of human time required simply to make the machinery move.

My 90 minutes will never appear on anyone’s balance sheet. Neither will the hour a practice employee spends appealing a denial, or the afternoon a patient loses trying to determine why a bill arrived, or the physician’s lunch spent on a peer-to-peer call explaining to another physician why a patient needs the thing the first physician already documented that the patient needs.

“There is a particular kind of optimism required to call an insurance company. You begin with the quaint belief that somewhere within the organization exists a person who knows why the organization did what it did.”

This is labor. It simply has the unusual financial advantage of being performed largely at someone else’s expense.

Perhaps that is part of what makes the system so durable. The inefficiency is distributed. Ten minutes here. Forty-five minutes there. Ninety minutes in a chat box. Nobody sends the insurer an invoice for the collective years of human life spent navigating its processes.

Eventually, I realized that I had spent an hour and a half trying to answer an almost comically simple question: Why did you deny my claim for using a code I did not use?

I still didn’t have an answer.

I did, however, know which code I should use.

XYZ.

Fortunately, that was the code I had used in the first place.

There really ought to be a billing code for this.

I would submit it, but I’m fairly certain they’d tell me I used the wrong one.