Health care is personal. When we start seeing the doctor, it is about us or what is inside us. These are things that we are not going to tell 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 that this relationship is one-sided. You’re just a good relationship, as long as someone else picks up the tab.
Have you ever tried to call a specialist and ask for an appointment and tell them that you are paying cash? Very few specialists accept a client who pays in cash. Some will if you can find them. Why is this? Because you are the patient, but not the client.
If we follow the money in health care, there are two entities, so to speak, that control everything:
- Health service providers
- insurance companies
Customer service is outside of healthcare. Schedule an appointment that is convenient for your doctor and not for you. Then you show up only to wait two hours in the waiting room. They don’t even offer a snack, even though they will bill your insurance an hourly rate for an average 7 minute conversation with the doctor.
If you think about it, the doctor charged $150 for that visit, which is just under $22 per minute spent with you. The doctor’s 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 miss out on a full day’s pay and still have to pay for this doctor visit.
High-deductible health plans are more common these days for the money-savvy as well as a way to control costs so premiums are more affordable. With these plans, policyholders first have to meet a larger deductible for everything they need for medical and pharmacy services to gain access to the insurance company’s coverage. More and more providers can validate this information immediately and require payment from you before your doctor visit, or they will cancel your appointment.
Where is the customer service in healthcare?
Let’s say you have some unfinished business in your health care. You already know that the cost of the procedure will be credited to your deductible. What does any smart shopper do when they know they’re going to shell out that much money?
Get some quotes and check the quality of the work.
However, in today’s healthcare world, we can’t get immediate access to information about pricing or quality of work. The industry does not publish the information. There is no menu board like in a restaurant or professional service. When you call, they have no idea about your question because the staff don’t have the information. Why is this?
Because you are not the client, only the patient.
Now let’s go to the pharmacy. If you go to one of the larger national chains and ask them for the cash price, and they know you have health insurance, they won’t give you the cash price. In many cases, the cash price is less out of pocket for you than with insurance coverage. Why is this?
Once again, you are not the actual customer.
The insurance company is in the business of calculating risk and building 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 may take a little hit for a few years, knowing that they will pass the loss on to the policyholder the following year.
Sounds like everything else, right? Sales taxes increase in a county or state, and then the customer pays for it. Also, if the cost of the goods increases, then the customer pays for it. In this case, it goes deeper than that.
It costs the insurance company money to review each claim. Many insurance companies have a dollar amount threshold. I’ve heard these thresholds are as much as $50,000 but as little as $5,000. If the claim is below that amount, and there are no other red flags, they automatically submit the medical claim.
Red flags could be a medical claim code from a particular provider that is incorrect or is supposed to have a different code. It could be completely wrong code. This could be done unintentionally. In other cases, they will add things on purpose and change the coding so that the insurance company will pay them more money. They will do this knowing it is insurance fraud if they get caught. However, the repercussions are that the insurance company will ask them to redo the billing. A little bump on the wrist compared to the reward they get 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 fill premium reserves for advance claims. They know that providers do this practice of overbilling. They add a little more to the premium to cover these costs. For them, that is better than auditing these claims submitted by providers.
Customer service in health care is gone. You are no longer the client, just the patient. How do we get it back? We demand it. We put control back in the hands of the real customer. Educate employees and their families on how claims work and where they can go to control costs. You can even waive the primary care visit fee and go to a direct primary care center and not worry about additional costs per visit.
You can have your employer use actual claims data to make adjustments with employees to regain control. Some of this is at no additional cost to the employer and, in some cases, to the employee.
Let’s turn the patient back into the real customer