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Vol.2 . No. 4
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September/October 2000 |
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Customer Service: Applying the Golden Rule
by Karen Cook
Have you read your automobile insurance policy? Me neither. I've tried from time to time, but I always end up calling to have someone answer my questions by telephone. And yet, when I work with health plan clients, I still get drawn into discussions about what we should expect members to read about their benefits. It's a great concept, but in the long run we're better served to focus on the Customer Service Department.
In the early days of managed care, health plans varied widely from one another. Everyone was feeling their way, trying to come up with the best benefit plan, the best provider network. We still try to find a better mousetrap. The difference is, when one health plan makes a change, the rest follow suit. It's imperative to offer the same benefit package and the same network in order to compete for business. And the tolerance of plan sponsors for a few dollars' difference in premium is almost non-existent.
How can we be different? Customer service. We who are in this industry know how complicated healthcare delivery can be. Imagine what it's like for people who don't know that the unseen pathologist generates a bill, or that an otolaryngologist and an ENT are the same thing. Just listen to your friends and neighbors as they describe their interactions with "the insurance company." And listen to calls in your customer service department. Listen to the tone of voice, the acronyms, the jargon people use. Make sure your grandmother could understand it.
Window of the Problem
Health plans frequently look for consulting assistance when they're having "problems in the customer service department." Most of the time, saying your customer service department has a problem is like saying your computer monitor has a problem when your hard drive gets corrupted. Focusing on the window through which you identify problems won't get them fixed. A colleague of mine referred to customer service as the "early warning system" for the plan. That's a very appropriate analogy — one worth listening to. Different health plans direct their calls in different ways. Some have separate lines for providers to call. Some offer a separate point of entry for brokers and employer group contacts. In the end, though, it still lands in customer service.
If claims are paid incorrectly, the member eventually becomes involved. If ID cards or enrollment information is faulty, customer service hears about it. If providers are inaccessible or the authorization process is onerous, |
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members will be calling. Your customer service department not only creates the first impression many of your members get, it's also the plan's emissary when something's gone wrong and people are unhappy.
Training and Education
Take a look at what you're telling your customer service representatives. Do they have equipment that's at least as current and operates as reliably as that of your senior management team? Does senior management ever get on the telephones next to the customer service reps and take some calls, or place a few outbound satisfaction survey calls? Do staff members and management in other departments recognize their accountability to customer service as the plan's front line? Most health plans, and many businesses in other industries for that matter, could benefit greatly from training for the entire staff on a customer service focus. Customer service is a tough job, and one of the few that almost everyone can contribute to with a little effort. In terms of basic customer service and telephone technique in your customer service department, there's no substitute for monitoring and recording calls. People need specific feedback on what they're saying and how they sound. They need coaching and role-playing to help them be most effective and sound most confident in answering calls. Nothing makes people want to call back for a second opinion like talking to someone who sounds uncertain of the information he/she is providing. And nothing makes a member more unhappy than receiving unfriendly responses from an organization already seen as a bureaucracy.
The Golden Rule
I recently had a theft, which meant I had to talk to my homeowner's insurance company. The representative I spoke to could just as easily have been taking a call about a death claim instead of a property claim. And she was just as sympathetic about my loss. At the end of the call I asked her if the representatives received any special customer service training. She said they just treat people like they'd like to be treated. What a concept.
About the author: Karen Cook is an SMG senior consultant with particular expertise in managed care provider network management and MCO operations. She manages a full spectrum of provider-related operations for SMG clients. |
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