Taking a Shot at my Health Plan

I got a flu shot yesterday. I was at a CVS, saw a sign, whipped out my insurance and credit cards, and got in line.

Turns out that my insurer wasn’t reimbursing it – I rolled my eyes, paid the 20 bucks, and went about my day.

Ouch…done. Kudos @CVSHealth for easy access to a flu shot. Shame on you @BCBSTX for not covering retail flu shots. #publichealth

— Naveen Rao (@naveen101) October 27, 2014

The tweet I sent out afterwards opened up a full can of worms. Like a white blood cell, the twitter response was quick and targeted. The social media manager was helpful and patient – but it became clear she was operating with her hands severely bound with red tape. I passed along my policy ID via direct message (twitter, not EHR), and she said she would look into it. Thus began a comedy of errors:

• I received an e-mail with a secure attachment about an hour later.
• I tried opening it up on my phone but it wasn’t mobile-optimized so I couldn’t. I asked if she could just e-mail it to me because I was on the road, but she said they are not allowed to do that.
• I set up an account this morning, logged in and saw that I was covered – except that a vaccine requires a prior referral by my PCP, and must be done at an approved facility.
• Since I’d already paid for the immunization, I needed to download a form, contact my PCP, fill it out, mail it in, and keep my fingers crossed that it gets approved before waiting for the reimbursement check to show up in the mail.
• Finally, I typed a response telling them how inconvenient this was for me and how I can’t be bothered. When I tried to submit it I got an “unknown command” screen with a bunch of web jargon I couldn’t understand. I have no idea if they saw my response or not.

Paying a Premium for Professional Incompetence

Let’s start with the basics: communication. I submitted my policy ID number via direct message on twitter so they could look into my particular coverage. Convenient for both of us. Yet when I wanted my coverage info in kind, they 1) forced me to set up a new portal account that 2) wasn’t mobile friendly and 3) didn’t allow me to send a message back to them. HIPAA has done a great job of protecting me from my own health information.

Second is the process, a Frankenstein’s monster right in time for Halloween. I sent my info and set up a new account digitally, which sent me to a complicated PDF form that I need to print out and send via snail mail, to get a check mailed to me that I can then deposit. On one hand, at least some of this is digital now. On the other hand, it’s clear that nobody has sat down and thought this process through from start to finish. It is completely convoluted and inefficient – no digital claims submission process, which means someone is manually entering handwritten data back into a computer. BCBS has proven more than capable of taking my premium payments digitally through a linked bank account…but why no electronic refund process?

Most egregious is the policy and benefit itself – at the highest level, why are health plans giving people a hassle about getting a flu shot? It’s been recommended by the CDC for the last 4 years. My PCP is a good guy, but I’m not going to set up and pay $20 for an appointment to see him (copay cost = cost of the shot at retail), nor will I go out of my way to some designated facility when I can get it done within the confines of my day to day life (a.k.a. the patient workflow). Instead of embracing widespread access to care and leveraging these new venues for consumer-friendly healthcare delivery, it seems health plans’ heads are stuck in the sand.

Bold Claims (For You to Print Out and Mail In)

The point of this diatribe is that health plans just don’t get it. When you go to trade shows and see insurance executives talk about member engagement and digital communities, they are jerking you into in a fictional reality that nobody actually lives in. Apps are talked about with fervor while simple communication by phone and e-mail remains unavailable. “Engagement” today is an archaic world of customer service line robots and long wait times, of paper forms that are printed, mailed or faxed around, of redundant patient portals and non mobile-accessible communication.

While we move towards systems of population health management, health plans (and increasingly providers) are opting for common cents rather than common sense. This is not a secret – almost any interaction with a health plan reveals a deeply entrenched focus on their own financial health rather than that of the general public. This manifests itself as squabbling over which annual lab tests are covered, or pricing out preventative health services under the banner of consumer-driven care. More broadly, the IT systems on which we are spending billions, are purportedly working towards a public health infrastructure (at least, according to the ONC). What happens if the organizations administering large swaths of this system have their shoelaces tied together?

While there are small glimmers of progress – the social media customer service was a nice touch – they still amount to lipstick on a pig. The incumbent health insurers have really become too big to fail. There is a decided disconnect from people that putting up a Facebook page or twitter account can’t repair. Insurance companies talk about a global awareness about our tendencies, our preferences, and our day-to-day lives – yet they’ve changed nothing operationally or culturally. The benefit design would benefit from better design.

With all the mania surrounding the Ebola virus, many have questioned how prepared the US healthcare system really is for such a public health threat. When an insurance behemoth exhibits such levels of gross incompetence when it comes to a measly flu immunization, it’s unfortunate – for everybody – that health plans don’t seem to have much of a plan at all.