We’re offering a friendly challenge to the CEO’s of all health plans: leave your corner office and walk a mile in the shoes of people covered by your plan. What do you see? What touches your heart? What are you doing right? And what needs fixing? Notice a common theme in your walkabout: a lack of plain old common sense.
Here’s a case-in-point from an experience with Oxford, as we attempted to help our client through the health care maze. She engaged our services, signed a HIPAA form, as well as a form authorizing Health Champion as her representative. Because many health plans have their own authorization forms (wouldn’t standardization be in everyone’s best interests?), we immediately contacted Oxford. Here’s what ensued in our dealings with customer service:
O: Reading from the computer screen (no thinking necessary!): the completed form must be mailed to Oxford at their Bridgeport, CT address.
HC: Our client needs immediate help. Can we scan the signed form and email it?
O: No.
HC: Can we fax it?
O: No.
HC: If we overnight it, how long before the information becomes available to customer service reps?
O: About a month.
HC: Is there someway to move this along?
O: Nope.
HC: Our client needs help now. Isn’t there something we can do?
O: Well, you could get her on the phone with you, call in together so that she gives permission for the rep to answer your questions.
And you didn’t tell us that upfront?
We did just that. Our list of questions was long and the customer service rep was ill prepared to answer them, frequently placing us on hold to check with someone or something (a manual?). We reached the end of a long business day and our client was fading (remember, she’s dealing with health issues).
HC: Let’s finish this tomorrow. Can you note in the system that we received permission to speak to Oxford; can we continue the call in the morning without having to get our client back on the phone?
O: No.
HC: Why not?
O: We can’t do that. We are only allowed to get verbal approval for one call.
HC: But the call isn’t finished.
O: Sorry we can’t do that. The federal law, HIPAA, prevents us from doing that.
Since when? (When in doubt, quote the federal law, even if you’re wrong!) Now, there’s common sense in play!
CEO’s: are you paying attention? While health and clinical services are critical to accreditation from the National Committee on Quality Assurance, we suggest that, a common sense standard is just as critical.
Your thoughts? Post your experiences, comments and insights.