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You are the patient, not the customer


Healthcare 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:

  1. Healthcare providers
  2. Insurance companies

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 doctor.  

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.

High 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 appointment.

Where is the customer service in healthcare?

Let’s 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.

However, 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.

Now 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.

The 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.

It 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.  

Reflags 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.

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