Here is a great story from a friend: My pal Jane, who started a new plan year this summer. Her previous plan was an HSA-qualified HDHP, and she did the math and decided to choose the same plan this year, although the providers and network are different due to a change in carriers.
Jane’s husband first went to see his ophthalmologist for a routine eye exam. The doctor spent a cursory amount of time with him, mentioned that one of his eyelids was drooping and discussed the benefits of Lasik surgery (without Jane’s husband asking). When Jane received the EOB, turns out the ophthalmologist’s office coded his visit as a diagnostic rather than a preventive visit, resulting both in a higher reimbursement to the office and a higher bill for Jane, because a preventive visit would have been covered under her plan.
A few days later, Jane’s husband went to CostCo pharmacy to fill his prescription. Jane was horrified to learn that the prescription had cost $180 (cash, out of pocket). It turns out that CostCo is no longer a pharmacy provider in Jane’s plan, though no mention of this was made to Jane’s husband when he filled his prescription.
Jane is savvy and determined. Plus, she hates to waste money. She called her carrier about both experiences and the response was that she would have to deal with both the doctor’s office and the pharmacy on her own. Jane called the doctor’s office, asked to have the visit recoded as a preventive visit – because it was – and the office refused. Not until Jane spoke with the office manager and threatened to go public with what she considered dishonest practice did the office manager concede and agree to resubmit the code to the carrier.
Jane then called CostCo, explained what happened and asked the customer service representative why her husband wasn’t told that CostCo was no longer in the plan. The response? A full apology. “This is our fault. Please bring back the medication and we will reimburse you 100 percent. And please accept our apologies for this.”
Customer service, right? It is an attitude and an approach to treating patients like the customers they are, with the service they deserve. The carrier could have done a better job of communicating to Jane as a new enrollee what she would need to know about the providers and network in her new plan. We call that onboarding.
And the take-away experience for Jane? She will absolutely remain a CostCo shopper – the unequivocal way they handled her complaint built loyalty. But what about the provider? Increasingly Americans are holding health-care providers to the same service standards as retailers. Jane is watching her dollars and maximizing her benefits and is using the same savvy in health care as she does everywhere else in her life. With Target and WalMart increasing their footprints in health care, traditional health-care providers need to remember that more of their patients and customers are like Jane.