The text came from our 20 year old. His girlfriend had gone to her doctor to get the implantable birth control, Nexplanon, which (as every parent of a teenager might be happy to know) is nearly foolproof for 3 years. Needless to say, we were thrilled.
It cost $1,500 and insurance wasn’t paying.
The Explanation of Benefits that Was Anything But
Impossible, I said (after all, there’s not much I know about but health insurance and the Affordable Care Act [ACA] are two). The ACA requires that most health insurers/employers provide all FDA-approved contraception with no out-of-pocket cost.
It took several back and forths between the girlfriend, her father, and me, including copies of the statement from the insurance company, before I figured it out. She was only seeing the insurance company statement, called an explanation of benefits (EOB), showing what was billed and what was paid. She didn’t owe a thing.
And therein likes one of the many problems with health insurance today. It’s unnecessarily complicated and confusing. After all, how many mere mortals understand what an EOB is? The difference between charges and allowable amount? Between premiums, deductibles, and copayments? Do you know who your preferred providers are and why they are preferred? (Hint: it has nothing to do with their brilliant white smile). Is that bariatric surgery medically necessary or just vanity?
Who the hell knows?
To Regain Our Trust, The Insurance Industry Needs to Change
Luckily, the insurance industry is beginning to get wise to the fact that most of us have no clue what they’re talking about when they send us information or we try to navigate their web sites. Maybe one reason is that that, according to the 2016 Edelman Trust Barometer, the healthcare industry is second-to-last on the trust barometer (only the auto industry is worse) and little better than financial services, the guys who triggered the Great Recession.
Humana learned this the hard way when it asked people to describe their feelings around the words “health” and “care.” They got a lot of warm fuzzies. Then they asked people to describe their feelings around the word “healthcare.”
The result was about the same if you sent a butcher in to do a demonstration at the annual North American Vegetarian Convention. This time they heard words like “frightening,” “complicated,” “should be simpler.”
The findings were a wake-up call for the company, which is shifting its entire culture. As Wendy Dowd, enterprise director of consumer experience at Humana said, the company is challenging the conventional thinking. “It’s no longer what the boss or even CEO says, it’s what the customer says.”
The true customer is no longer just the employer or government. Today, individuals have far more say in the insurance we choose.
Why the sudden awakening? Because the true customer is no longer just the employer or government. Today, individuals have far more say in the insurance we choose. The individual market, higher deductibles, and employers moving to the own private “exchanges” means whiplash for health insurance companies (and others in the healthcare field) who now need to really pay attention to us. Plus, many are actually graded by government and accrediting agencies based on customer feedback.
So they’re trying to change. Humana, for instance, is doing away with terms like “customer complaints” (who wants to be seen as a complainer when we’re just trying to find out what the heck is going on?) in favor of “resolution.” Other companies have hired designers who understand the customer mindset to redesign everything from forms to web sites to digital apps.
And they’re talking about things that would certainly make our lives easier (and that we already have from other industries but hey, let’s cut health care some slack, it is, after all, 15 years behind the times.). For instance, one executive suggested, why not use geomapping so that when you enter an ER you get a message telling you what your copayment will be, whether the ER is in- or out-of-network, and, oh by the way, there’s a far less expensive urgent care center 2 miles away.
They’re working on apps that let us file claims by taking a picture with our phone, just like we deposit checks; and that can solve most problems faster than a member service rep.
Now It’s Time for Patients to Speak Up
So here’s the point of this column (you knew it had to have a point, right?). Your insurance company wants your feedback. It really does. Many even have high-ranking executives with words like “customer experience” in their titles.
Call them. Text them. Shoot them an email.
Tell them what you want. Because these days, they have to listen to us.