You are the patient, not the customer

Healthcare is personal. When we start to see 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. It’s just a good value, as long as someone else pays the bill.

Have you ever tried to call a specialist, ask for an appointment, and tell him that you are paying cash? Very few specialists will 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 customer.

If we follow the money in health, there are two entities, so to speak, that control everything:

1. Health service providers

2. 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 just to wait two hours in the waiting room. They don’t even offer a snack, although they will bill your insurance an hourly rate for an average of 7 minutes in conversation with the doctor.

If you think about it, the doctor charged you $ 150 for that visit, which is just under $ 22 per minute they spend 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 a full day’s pay and still have to pay for this doctor visit.

High deductible health plans are more common these days for money savvy folks, as well as a way to control costs to make premiums more affordable. With these plans, policyholders first have to meet a higher deductible for everything they need for medical and pharmaceutical services to gain access to insurance company coverage. More and more providers may immediately validate this information and request payment from you before your doctor visit, or they will cancel your appointment.

Where is the customer service in health?

Let’s say you have some pending items to attend to in your medical 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 are going to shell out so much money out of pocket?

Get some estimates and check the quality of the work.

However, in today’s healthcare world, we cannot have immediate access to prices or the quality of employment information. 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 idea of ​​your question because the staff don’t have the information. Why is this?

Because you are not the client, only the patient.

Now we 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 out-of-pocket price is less for you than with insurance coverage. Why is this?

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 calculate how much they have to charge to do this. Over time, they may suffer a small impact in 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 in the customer’s country. Also, if the cost of goods increases, the customer pays for it. In this case, it goes deeper than that.

It cost the insurance company money to review each claim. Many insurance companies have a dollar amount limit. I have heard that 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 push the medical claim automatically.

The red flags could be a medical claim code from a particular provider that is incorrect or is assumed to be under 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 pays them more money. They will do so 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 non-profit company, they still fill in the premium reserves for early claims. They know that providers engage in this overbilling practice. They add a little more to the premium to cover these costs. For them, that’s better than auditing these claims submitted by 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 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 eliminate the fee for a primary care visit and go to a direct primary care facility 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. Part of this is at no additional cost to the employer and, in some cases, to the employee.

Let’s make the patient the real customer again