Wednesday, October 07, 2015

Fun times on the phone with health care payments systems

Over the past two days there have been at least four hours of phone time spent trying to work out problems with health care payments systems, two of them.  Probably everyone gets to have this experience from time to time.  Frustrating, exasperating, mind-boggling, these are words that come to mind.

The first was with Genworth Financial and their major claims processing center in Lynchburg, Virginia.  Lynchburg is 50 miles from my hometown, so the accents and grammatical nuances of the call center personnel are familiar.  Lynchburg, like my hometown, is not broadly a center of high literacy or education.  It does have Liberty University, but I repeat myself.  Putting their call center in a low wage part of the country, southside Virginia, may be a cost savings to Genworth but in the long run it may not be so efficient, as you will read.

Without going into too much detail, the issue was that payments under a policy for K were not being made, even though an elimination period was already satisfied.  Calls were made periodically over the last month to ask about this, and the answer was that they were still researching the claim.  Asked if they were receiving all of the information from the service provider that they always said "we are researching the claim".   When pressed as to what this meant the responses would be to say that it would be done by the end of the month, what month?, or to stay silent, or to repeat more loudly the same words "researching the claim".  When asked about a supervisor they would promise a call back within 24 hours which rarely came.  An especially annoying aspect of these calls was that they always ended with a scripted "is there anything else that I can help you with?"  The response here was generally something like "are you suggesting that you have helped with something?"

Finally,yesterday afternoon, there was a call back from a benefit analyst who was intelligent.  She knew exactly what was going on when I asked the right question as always.  Genworth was not receiving adequate information from the service provider.  They have now talked to the service provider, I have talked to the service provider, and soon all may be on the right track.

The is a disturbing reminder of those days when Dell moved the great majority of its customer service to India, and all call center reps had finely detailed scripts to follow.  The whole key with that was to wait until intelligent life finally showed up on a call.  That usually took about three hours.

The other time consuming calls here were a lengthy effort to arbitrate between a hospital and an insurance company.  Actually it was a lengthy effort not to arbitrate between an insurance company and a hospital.  Over and over again the insurance company rejected a claim, a claim so simple that the payment due was in large print on one page of the contract with them.  At one point earlier today the only way to settle it, according the insurance company, was for me to fax them the hospital bill, with a cover letter explaining the situation. That was a role that was not appropriate.  No way.

A second supervisor got on the line, and there was intelligent life, once again!  He understood the situation, got the appropriate information from me, called the hospital, and a solution is underway.

Both of these problems described were extremely simple.  The problem was, and is, that the call center reps and even some supervisors do not know how to listen or think.  That is a disturbing, word used again, commentary on the capabilities of many workers or the training that they are given, or not given.

From talking to others, there seems to an epidemic of this type of problem, especially in health care. Such useless agitation.


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