Navigating medical customer service

Before I share a few observations and experiences, let me first note that too many Customer Service Representatives (CSRs) are likely understaffed and undertrained to do the jobs they are asked to do. The healthcare system in the US is complex with a lot of moving parts, including consolidated entities on the provider side and insurer side. In other words, there are plenty of opportunities for the system to fail the customer, provider and insurer.

Through all of this, the patient has to be the navigator of his or her customer service experience. Otherwise, the patients may not realize they are not being treated fairly. As evidence that I am not personalizing this more than I am, let me mention two things.

First, I have a friend who runs a successful business advocating for insured patients. Her firm is hired by companies to help their employees and retirees navigate the healthcare insurance system. In essence, they advocate to get the insurers to pay for what they say they will in plan documents. No more, no less.

Second, as a retired benefits manager and consultant, I am familiar with the complexities, but there are people who know them far better than I. So, what concerns me is people who get maltreated  by the system and don’t know they can push back or don’t feel comfortable in so doing. The various acronyms, footnotes, poor communications, entities and touch points are confusing.

Rather than lament issues, let me offer a few tips to help in the navigation.

– If you need a pre-authorization for a surgery or procedure, start at least a week before or as soon as you can. Ask what they need and make sure they know who to call. An increasing number of providers are putting the burden more on patients to get the process started.

– On any call or reach-out, save emails or notifications, write down notes, names, dates and phone numbers – there are many, especially with centralized functions for smaller doctor offices. Recently, I was given multiple numbers to call (and addresses) from each party.

– Read your EOBs – Explanation of Benefits – including the footnotes as to why something was unpaid or pending. There may be an action needed on your part. If have a non-ACA, non-Medicare or non-employer plan, there may be a need for medical information to confirm this is not a pre-existing conditon.

– If you feel uncomfortable with asking questions of your doctor or insurer, write the questions down or include someone to advocate for you. Don’t be afraid to ask what someone said as it can be confusing or the person may not be the best communicator. And, if it is a major surgery or procedure, it is more than OK to seek a second-opinion.

– Follow-up. This is critical. Hand-offs are made to do things and the receiving entity may not confirm it has the ball. As a result, while you are waiting, nothing is happening. If medical records need to be there in 30 or 60 days, follow-up 10 – 15 days before those deadlines.

– Finally, be as diplomatic and polite as you can, but sometimes it is hard. So, be prepared to say something like, “I am sorry to be a pain, but this is frustrating.” Also, if urgency is needed, please share that need. Some readlng this may note there are websites to facilitate this process, but too often, the website does not do what you think it is doing. It may just be recording a query and not codifying an action. You may be surprised how frequentIy I have to read to the CSR what another part of the company sent me.

Again, there are many fine people in these positions who want to get things right for the patient. It is often said, good people make up for a bad structure.  Yet, it should not be as hard as it is. Until it is made easier, you must be the navigator of your customer service.

Please feel free to share your ideas and reactions.

Diplomatic Persistence


I have written several times about the dearth in customer service. For the most part, we must be the navigators of our own customer service. Without our diplomatic persistence, we may fail to be served. But, we do need help.

I have been involved the past few days with an entity trying to resolve an arbitrary decision on the part of an internal department which places a burden on me to recoup money owed to my family. I will spare the details, but to prevent them from doing it again on another set of transactions, we had to enlist the help of a customer service person and her manager as advocates.

The role I am being asked to play here is not new and will happen again with another entity. It may even happen with this one, but I sure hope not. Variations of both words in the title are key – diplomacy and persistence. Being a jerk will solve little and will make it harder to get advocacy. The customer service person I was speaking with was just the messenger. Yet, diplomacy also means tactfully sharing your frustration. You want them to agree with you that you have been wronged and she did.

The persistence is vital as well. I often say in follow-up after a reasonable time, “I apologize for being a pest.” Also, the first answer may be “no” as it was in this case because of internal processes, so asking for further advocacy can help, especially when you are in the right. I understood why they did what they did in general for risk management, but our circumstances were unusual and did not fit their norm. So, the internal department’s action unwound something very easy made it more time-consuming and bureaucratic.

On the positive side, after much pleading and with the manager’s advocacy, we got a yes answer with a caveat. That is all I could ask for. I will still have to remedy with another vendor their first decision, but I hopefully prevented them from repeating the process. I am so very thankful to the two people who advocated for us. They are gems.

Customer service has to be customer centric. This situation was resolving a problem this organization caused by internal processes. The group that caused it was not being customer centric, but more risk averse. My wife pointed out that what about people who do not have an understanding of financial matters and accepted decisions that were not appropriate. Or, in this case, may not know to follow-up with the other vendor. They may end up being shortchanged because of an arbitrary decision by an internal group.

Diplomatic persistence is key, but so is knowing where you may have been wronged. But, without the former two words, your hope of getting resolution is lessened. My fingers are crossed that this remedy will remain holding.

A vanishing art – the follow-up

In our age of instant communication, one of the vanishing arts is the art of the follow-up. Before our instant communication, people were not as diligent to this art, but even now, when it should be so simple to do, it is seemingly a missing part of communication. What do I mean by the follow-up? This is a quick response to let the requester or sender know that you have the ball, understand the message, received the message or recognize the effort of the sender. Further, when you have executed the request or favor, it is the communication to the requester that you took care of it.

I should be able to stop there and people should realize that is something we all must do. But, many of us do not, so it leaves the requester or sender wondering. Even when I worked in a client service setting, there were not as many colleagues who were good about letting you know they took care of something, which should be a modus operandi.

In marketing settings, this happens all the time. You reach out to people you want to do business with or have a meeting with and get zero response. I have often said “no” is an acceptable answer, so it is OK to tell me no. One of the better follow-up people I worked with would say “just tell me no or kiss my foot or something.” Yet, we would rather leave people hanging with expectation. However, that is in marketing, where you expect these kinds of responses.

One of the worst examples of the failure to follow-up occurs when I am forwarding a resume for a friend to someone else in a large organization. What becomes embarrassing is when that person fails to let the person know something and you have to chase it down. I usually tickle file follow-ups with people, but it need not be so hard. You end up embarrassed with your friend because someone else did not follow-up. Again, a “no, we are not interested or have no openings” would be fine.

What surprises me most is when I am a customer and get these kinds of responses. Nada. Nothing. I sit here wondering “did he or she receive my message?” or “maybe the person does not work there anymore.” When something is meaningful to me to know it is being done, I make a note to follow-up. “Did you get my request and do we need to provide any further information?” I have noted before that the customer service is on a steep decline. And, all it takes is a just a little more communication than is done and it would improve by a noticeable margin. Such as:

– I received your request and will take care of it by the end of the week. I will let you know when I have done so.

– I have it on my list of things to do. When is this needed by?

– I wanted to let you know I took care of your request. Here is  a copy of my response.

– Thank you for your request. Unfortunately, we cannot comply with such request, but do thank you for reaching out.

– We cannot easily comply with all of the items in your request, but can more readily respond to these items. Will that be sufficient?

Please follow-up with others. It will make all of our lives better. And, it will reduce a few headaches.

 

The Lost Art of Customer Service

One of the best customer service people I have met is my former administrative assistant, Brenda. She was so good, I often had her reach out to clients or colleagues on my behalf. One of my female colleagues told the story of how Brenda had reached out to her while she was on a plane trip down from New York to see if she needed any changes to a report the next morning. This was at 10 pm. Changes were needed and Brenda came in early the next morning and made the changes for this colleague in advance of the Board meeting for which the report was intended. The traveling colleague was effusive with praise, but this was par for the course for Brenda.

I mention Brenda as excellent customer service is becoming harder to come by. It is a lost art. Just today, I had to close out a mutual fund account with a bank because they could not stay out of their own way. What should have been an easy transaction for a custodial account that would have kept business for the bank left me with two choices – close the account or set up another account for my son. Well, I am sorry it was just easier close the account and the bank lost future business as a result. This is not the first time I have had to navigate through their processes to accommodate something. Last year, I wrote how I had to go down to the branch to pay them a fee to have the bank wire transfer money to their own mortgage company. Mind you, I could have done this transaction online in about 45 seconds, but was told I should not pay off the balance in that manner, as it would mess them up.

Customers have to be the navigators of their customer service. This is especially true when calling customer service representatives (CSRs), who tend to handle more routine problems. When you have a problem that takes the CSRs off script, then you need to help them through the process. Have your information handy, know your questions and what you want to accomplish, but most of all be patient and extremely diplomatic. Even in the examples above, I was patient and kind, but persistent. It is OK to tell them this is puzzling or troubling, but if you become a jerk about it, your chance for a successful interaction declines. And, it is more than OK to ask for a supervisor, but if you were a jerk to the first person, you are flagged to the supervisor as a belligerent caller. So, be pleasant, but be persistent. You do catch more flies with honey.

One of the dilemmas in dealing with CSRs is their processes get in the way on unusual issues. For example, in dealing with a need to change a prescription drug from a generic substitution drug (which made my son break out in a rash) to a “dispense as written” brand name drug prescription took some effort. The drug company agreed to the substitution after his doctor sent in a new prescription form, but then I got a denial letter days after my call and had to call again. The CSR said the denial letter was automatically sent and I would be getting another letter soon with the approval of the change. “Why could you not stop the first letter from going out?” I asked. “Sir, we cannot do that,” she said. “But, that is confusing,” I responded. “I know,” she replied.

The worst calls to make are the dreaded technology support calls. I know they are at a minimum a two-hour call, so the patience of Job is required. The calls could be called Saturday killers as it is not unheard of for them to last longer than the two hours. Nothing is easy when something on your computer messes up or a virus gets through. I appreciate what they do as they try to figure out what in the heck happened, but it does exhaust your patience and diplomacy skills.

Most people vote with their feet and don’t do business with companies after very poor customer service experiences. Often, our hands are tied and we must use these providers, such as the prescription drug company that my employer uses. Changing banks is also difficult and they know it. I have so many things tied in with this bank, a change would take a major effort. Plus, the other problem is where would I go? Most banks tend to get in their own way, so a change would not assure better service. So, I accept the historical known bank relationship to one where I would have to learn how to navigate a new system.

The only answer is we need more Brenda’s in the world. If we had more, customer service would improve and maybe we could spend less time on the phone or online. Other than that, I wish for each of you a major dose of patience and diplomacy.