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Taking a Shot at my Health Plan

by ndrao | October 28, 2014

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.

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.

7 responses to “Taking a Shot at my Health Plan”

  1. Sue Ann says:

    I laughed at your experience — not out of spite or malice.

    WELCOME TO THE WORLD OF ACTUALLY DEALING WITH AN INSURANCE COMPANY!!!

    This is the new reality for practices. Every company has it’s little quirks, and computers have made it WORSE, not better. They use technology to knock us around.

    And we are actually 10 years and counting with an EMR — we look for tech to incorporate.

  2. Naveen says:

    Thanks for laughing with me Sue Ann. This is not surprising to most – the point is not to get swept up in slick marketing presentations about future visions when even the basic X’s and O’s of tech (and customer service 101) are entirely missing.

  3. Not a surprise. As a recovering health care executive, I can attest to the internal failures that contribute to this. Not criticizing nor defending, just sharing observations.

    1) Very few top executives care about end to end experiences. It is not measured and it is not incented.
    Every function has its own budget and separate metrics. Rather, individual parts of the experience are measured; call times, pt satisfaction scores, meeting employer based measures quality scores and more. Case in point; seen any billboards lately touting how good ABC plan is? “We rank #1 — we really figured out how all the pieces work together”.

    2) it takes real work to figure out good end to end processes from the Patient or Member point of view. If not funded as a project and mandated top down, the people who care about changing things are stuck trying to meet budgets and operating issues. Working across the aisles is fun and rewarding but not if you are alone.

    3) Many of these problems are already well known inside. Many patients are vocal, but In a culture where “we care about you, but honestly it’s really about us”, true patient involvement is limited if at all.

    4) It’s not very sexy. Will the board be impressed that the organization cleaned up the flu shot retail experience? Likely not, although they should.

    There is hope… Ignore the customer at your own risk. The true disruption in health care will come from the people not being well served. I hope.

    • John Moore says:

      Hello Anna-Lisa,
      Been quite some time since we last saw each other but happy to see that you are still reading our occasional ramblings on the state of the healthcare market.

      With that in mind, thanks for providing an insider’s view as to what actually occurs on the inside – quite insightful esp. since it is coming from one who worked at one of the more progressive HCOs in the country. Obviously, we still have a very long ways to go.

      Give my regards to Phil, Danny, and the rest of the Conversa team.
      John

  4. Yes, it’s what we call “brutal reality”. Everyone in big companies has good intent, but not necessarily capacity.
    “Big companies, Major Distractions”

    Can I send you a separate email with a couple questions? thanks

  5. […] The problem, as colleague Naveen Rao detailed during last fall’s flu season, is that healthcare’s engagement problem goes much deeper than tech. […]

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