Posts Tagged doctor

Medical Customer Service — getting worse

phonemonkeyCustomer service for most large businesses has gotten worse over the past few years according to American Service Index .  Of course, cable companies and cell phone companies are the worst but medical related customer service is also at an all time low.  This blog is not about phone calls to doctors and nurses but to insurance companies, retirement plans, ambulance companies, pharmacies etc.

You probably have your own horror stories (please add them in the comments).  Here are a few from friends and family:

  • The long term care insurance plan that repeatedly credited an account then send out a bill for the same amount.
  • The ambulance company customer service that changed billing codes to anything they thought would get a claim paid but could not send any documentation for a Medicare appeal.
  • The insurance company customer service that could not stop double billing for insurance coverage — “that’s a computer problem”.
  • The laboratory customer service representatives that only know the amount of a bill but not the service that was performed — “we only do what is ordered” —  they billed a urine culture but no urine sample was obtained.

One person had to call customer service over 20 times to get a medical billing problem resolved.

There are 2 major problems:

  1. customer service is outsourced — if the answers are not in the “computer” then you will get no help
  2. there is no follow-through.  Meaning, customer service says they will send a message to some department that will respond in “7-10 days”.  But, they never do and you have to call again.

So here are some suggestions for dealing with medical related customer service:

  1. Be prepared — have your customer number, billing number, a bill itself and other things you may need.  Many medical bills will have billing codes (CPT codes and ICD10 codes — look them up online if you can).  If your are calling for someone else (like a spouse or parent) — make sure that person can come to the phone.  A cool way to make this easier is to use Skype to include multiple people in a call if they live elsewhere.
  2. Be friendly, not overly stern.  Remember:  you are dealing with a person, possibly one that has little control over the company, don’t make their day worse.  You will get better results with honey than vinegar.
  3. Take notes as you talk.  Absolutely record the name of the representative, the date and what they tell you to do.  If possible get a phone number, fax number, email address and post office address if you need to communicate further.
    Depending on the urgency or the dollar amount in question (like over $20) then send a letter to customer service  summarizing your discussion and what still needs to be done.
  4. Is it worth your time:  If the problem in question is minor consider dropping the issue — your time is worth something. If you have to call back because you did not get a call or letter that was promised or the instructions you followed were wrong then demand to talk to a supervisor from square one — not another front line customer service rep.
  5. Go to the next level:  if the supervisor can not solve the problem or wants you to wait for a call-back or something to come in the mail tell them you need the phone number of the executive office or CEO in case the issue is not resolved since that is where you will call next.  Again send a summary of your discussion to the supervisor.
  6. The executive team:  If the problem is not resolved by the supervisor then call the executive office or CEO — you can almost always find the executive office phone number with a Google search for the business if needed.  Again, send a summary letter of the conversation.  Or if you can not get through send a certified letter with your concerns.

Pay the amount that is billed — but mark your checks “under dispute” if indeed there is a financial issue.  In general, resorting to legal action is a waste of time and money for disputes less than about $1000 since most legal fees will exceed that amount.

Complaints to the Better Business Bureau, the State Licensing Board, the State Attorney General or the Insurance Commissioner often get their attention.

If you are going to go nuclear, first send the CEO a brief letter with your complaints, the harm that has been done and what you want them to do — say you are serious and do not plan to drop the issue (no threats!).  Wait a while then send a second letter of what actions your are taking and do them – complaints to local or state officials or start legal action.

Medicare fraud is a serious matter, it should be reported as soon as it is identified.



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I’m Sorry — difficult for doctors

sorrybearSaying “sorry” is the human thing to do.  Doctors and nurses should say it when they feel it.

Saying “sorry” seems to have two meanings:  1) something bad happened and I understand your emotions  2) something bad happened and I had some connection with the event for which I feel partly responsible.  Bad things do happen in health care but “sorry” is a very uncommon utterance for health care providers.

Dr. Abigail Zuger writing in the New York Times 7/14/14 “Saying Sorry, but for What?” compared how she felt about a plumber who broke a valve in her house with medical personnel who broke other things —  neither said “sorry.”  Sorry truly does not fix anything;  but, the absence of “sorry” is infuriating.

The problem is ego.  Ego infuses some health care providers with the notion bad things are an act of God but good things are an act of ME.   Absence of “sorry” is a sure sign of defense (a defense of self).  Perhaps the health care provider was spanked as a child or yelled at by teachers.  Who knows … ego has gone wild.

Quality health care depends on people believing errors are due to system failures.  When providers fail to embrace that philosophy they fail to correct problems.  No failure, no correction.

A fall in the hospital can be deadly.  Recently, a family member fell in a room while no nurse was present and they died.  The nurse did not say “sorry.”  There was no acknowledgement of responsibility.   No acknowledgement the system was at fault, no realization there was a better way, and no reason to prevent future deaths.  The simple statement “sorry, I wish I had been there to stop the fall, we will investigate this to help others” would be the right thing to say, and believe.

Lawyers are not the cause of excessive health care ego.  However, lawyers with the threat of suit are a convenient excuse.  When bad things happen honesty and caring are much more likely to assuage the displeasure of a family than stonewalling.


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