Care is personal. When we go to the doctor, it’s about us, or what’s inside us. These are things we’re 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 are only a good relationship as long as someone else foots the bill.
Ever tried to call a specialist and ask them for an appointment and tell them you pay cash? Very few specialists take on a cash paying client. Some will if you can find them. Why is this? Because you are the patient, not the customer.
If we follow the money in healthcare, there are two entities, if you will, that control everything:
- Healthcare providers
- Insurance companies
Customer service is out of concern. Schedule an appointment that is convenient for your doctor and not for you. Then you show up only to wait in the waiting room for two hours. They don’t even offer a refreshment while in a conversation with the doctor they charge an hourly rate to your insurance for an average of 7 minutes.
If you think about it, the doctor charged $150 for that visit, which is a little less than $22 per minute they spend with you. The doctor rate does not imply that you have taken a private or wellness day that could have been used for something else. In some cases, people lose an entire day’s wages and still have to pay for this doctor’s visit.
High-deductible health plans are more common these days for the money-conscious, as well as a way to control costs to make premiums more affordable. With these plans, policyholders must first pay a larger deductible for everything they need for medical care and pharmacy in order to access insurance company coverage. More and more providers can immediately validate this information and require payment from you for your visit to the doctor, otherwise they will cancel your appointment.
Where is customer service in healthcare?
Let’s say you have some pending cases in your healthcare system. You already know that the costs of the procedure are deducted from your deductible. What does a savvy shopper do when they know they’re going to get so much money out of pocket?
Get some estimates and see the quality of the work.
However, in today’s healthcare system, we cannot immediately access information about prices or the quality of work. The industry does not publish the information. There is no menu board like in a restaurant or a service professional. When you call they have no clue about your question because the staff don’t have the information. Why is this?
Because you are not the customer, but the patient.
Now we go to the pharmacy. If you go to one of the largest 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 cash to you than with the insurance coverage. Why is this?
Again, you are not the real customer.
The insurance company is concerned with calculating risks and building financial reserves for future claims while trying to make a profit. They estimate how much they should ask for this. Over time, they can take a small hit in some years, knowing that they will pass the loss on 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. Moreover, if the cost of goods rises, the customer pays for it. In this case, it goes deeper than that.
It cost the insurance company money to assess each claim. Many insurance companies have a threshold amount in dollars. I’ve heard these thresholds are as much as $50,000, but only $5,000. If the claim is below that amount and there are no other red flags, they will automatically roll over the medical claim.
Red flags could be a medical claim code from a particular provider that is incorrect or should be covered by another code. It could be a completely wrong code. This can happen unintentionally. In other cases, they will add stuff on purpose and change the coding to get more money from the insurance company. They’ll do this knowing it’s insurance fraud if they get caught. However, the consequences are that the insurance company will ask them to do the billing again. A small tap on the wrist compared to the pay they get from the insurance company.
How does the insurer deal with this? They charge us more money in the premium. Even if the insurance company is a not-for-profit company, they still replenish reserves from the premiums for expected claims. They know that carriers do this practice of over-billing. They add a little more premium to cover these costs. For them, that’s better than checking these claims made by the providers.
Customer service in healthcare is gone. You are no longer the customer, but the patient. How do we get it back? We demand it. We put control back in the hands of the real customer. Teach employees and their families how claims work and where to turn to control costs. You can even scrap the fee-per-visit primary care and go to a Direct Primary Care facility and not worry about additional costs per visit.
You can have your employer use real claims data to make adjustments with the employees to take back control. Part of this has no additional costs for the employer and in some cases for the employee.
Let’s go back to making the patient the real customer
You are the patient, not the customer
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