is personal. When we start seeing the doctor, it is about us, or what
is inside of us. These are things we do not go telling the public. Over
time we build this relationship with the doctor. There is a comfort zone
when it comes to our doctors. The unfortunate thing is, this
relationship is one-sided. You are only a good relationship, as long as
someone else is paying the bill.
Ever try calling a specialist and
ask them for an appointment and tell them you are paying cash? Very few
specialists will take a cash paying customer. Some will if you can find
them. Why is this? Because you are the patient, but not the customer.
If we follow the money in healthcare, there are two entities, if you will, that control everything:
Customer service is out of healthcare. Scheduling an
appointment that is convenient for your doctor and not you. Then you
show up only to wait for two hours in the waiting room. They do not even
offer a refreshment, even though they will bill your insurance an
hourly rate for an average of 7 minutes in a conversation with the
If you think about it, the doctor charged $150 for that
visit, which is just under $22 per min they spend with you. The doctor
fee does not include the fact that you took a personal or wellness day
that could have been used for something else. In some cases, people lose
a whole days pay and still have to pay for this doctor visit.
deductible health plans are more common these days for money savvy
people as well as a way to control cost to make premiums more
affordable. With these plans, policyholders have to meet a larger
deductible first for everything they need for medical and pharmacy to
gain access to coverage from the insurance company. More and more
providers can validate this information right away and require a payment
from you before your visit with the doctor, or they will cancel your
Where is the customer service in healthcare?
say you have some pending items to take care of in your healthcare. You
already know that the cost of the procedure will be credited towards
your deductible. What does any smart shopper do when they know they will
be coming out-of-pocket that much money?
Get some estimates and review the quality of the work.
in today’s healthcare world, we cannot get immediate access to pricing
or the quality of work information. The industry does not publish the
information. There is no menu board like at a restaurant or a service
professional. When you call, they are clueless about your question
because the staff does not have the information. Why is this?
Because you are not the customer, just the patient.
we head to the pharmacy. If you go to one of the biggest national
chains and ask them for the cash price, and they know you have health
insurance, they will not give you the cash price. In many cases, the
cash price is less out-of-pocket for you than with the insurance
coverage. Why is this?
Again, you are not the real customer.
insurance company is in the business of calculating risk and build in
financial reserves for future claims while trying to make a profit. They
estimate how much they have to charge to do this. Over time, they can
take a small hit on some years, knowing they will pass on the loss to
the policyholder the following year.
It sounds like everything
else, right? Sales taxes go up in a county or state, and then the
customer pays for it. Additionally, if the cost of goods goes up, then
the customer pays for it. In this case, it gets more in-depth than that.
cost the insurance company money to review every single claim. Many
insurance companies have a dollar amount threshold. I have heard these
thresholds are as much as $50,000 but as little as $5,000. If the claim
is under that amount, and no other red flags, they push the medical
claim through automatically.
Red flags could be a medical claim
code from a particular provider that are incorrect or supposed to be
under a different code. It could be a wrong code entirely. This could be
done unintentionally. In other cases, they will purposely add things
and change the coding to get paid more money from the insurance company.
They will do this knowing that its insurance fraud if they get caught.
However, the repercussions are the insurance company will ask them to
redo the billing. A small smack on the wrist compared to the reward they
receive from the insurance company.
How does the insurance
company combat this? They charge us more money in the premium. Even if
the insurance company is a not-for-profit company, they still pad the
reserves from the premiums for anticipated claims. They know providers
do this over-billing practice. They add a little more to premium to
cover this costs. To them, that is better than auditing these claims
submitted by the providers.
Customer service in healthcare is
gone. You are no longer the customer, just the patient. How do we get it
back? We demand it. We put the control back in the real customer’s
hands. Educate employees and their families how claims work and where
they can go to control costs. You can even eliminate the fee per visit
primary care and go to a Direct Primary Care facility and not worry
about additional costs per visit.
You can get your employer to use
real claims data to make adjustments with the employees to take back
control. Some of this has no additional cost to the employer, and in
some cases the employee.
Let’s move back to making the patient the real customer
Article Source: ezinearticles