You pick up the phone and dial the customer service number of the health insurance company, your intent is to verify benefits of a patient scheduled this week. The phone rings and a familiar voice answers the call, “All of our representatives are currently assisting other callers. Please remain on the line and the next available representative will assist you.” Relaxing piped-in music follows. This is the first of twenty-one calls you’re making today. You know it’s going to be a long day.
Actually, you already knew it would be a long day, as long hold times on the phone is something you’ve come to expect nowadays. Services that come after consumers have made their payment, like customer service, don’t quite make it to the top of the priority list. In a poll of more than 1,500 adults about customer service quality by 24/7 Wall St and Zogby Analytics, telecommunications and cable service providers make up 6 of the top 10 spots on the “worst customer service” list. It isn’t unusual to be on the phone for an hour or two to get some help with some of these companies. In fact, according to Woman’s World Magazine, the average consumer will spend about 1.2 years on hold in their lifetime (preferably not continuously).
This situation is also true for business-to-business customer service, like medical providers calling an insurance payor for inquiries. It isn’t unusual for a clinic employee to spend four hours on the phone every day and up to 45 minutes on a single phone call. It can cost a small clinic upward to $15 per call in terms of wages and benefits. Furthermore, there may be a domino effect because having a medical assistant on hold with a payor ties up staff and phone lines that may in turn put their own patients on hold.
Welcome to the new normal of long hold times. If you want to complain, they’ll transfer you to a supervisor. More relaxing piped-in music follows.
What caused this?
Among the causes are certainly budget considerations and the thrust to migrate customers to do-it-yourself online solutions. For providers, calls would typically be made for verification of benefits, pre-authorizations and billing related questions. There are alternatives like online webpage portals, automated voice options and automatic verification via interfaces with electronic medical record and billing systems.
The online systems, however, aren’t quite perfect yet. When you fill out an online form, if any of the required fields (boxes to be filled-in) are incomplete or incorrect, you hit a brick wall. There may be confusion on which information goes where (like having multiple NPI’s involved in a single procedure) or a lack of appreciation of the importance of some seemingly innocuous fields (i.e. that would result in outright approval or rejection). Furthermore, some outcomes require further advice (i.e. peer-to-peer). Even experienced staff, who are comfortable with navigating the alphabet soup of HMO’s, EPO’s, POS’, PPO’s, know that portals may not have all their specific procedures listed online anyway.
Interface systems, aren’t perfect either. If you have an interface between your electronic medical records system and the clearinghouse (often at a fee), you might receive multiple pages of benefit information that might overwhelm and require more sorting.
Given the above, the human voice that interrupts the crescendo of 25 minutes of piped-in music may still be the preferred approach for many medical facility employees.
Another likely reason for the long hold times is that the Affordable Care Act implementation increased the number of insured customers in a very short period of time. According to CMS.gov, about 12.7 million consumers were enrolled in the insurance marketplace by January of 2016. This surge in administrative load and new customers (although there are many renewals in that number as well) certainly puts payors in a catch up mode. Recall that providers and payors were still adjusting to the ICD-10-CM implementation in October of 2015.
So how do we manage the situation?
In the short term, Amy Bach of United Policyholders and J. Robert Hunter of Consumer Federation of America, offered these strategies for beating long hold times when you call your health insurer:
• Call first thing in the morning, or wait until Saturday if your insurance company has operators available then.
• Repeatedly hit the 0 (zero) or * (star) key on your phone. (That move may or may not help you reach a live customer service representative more quickly.)
• Search the insurer’s website to see if your questions might be answered there.
• If you must talk with someone and can’t get through to customer service, search for contact information for someone higher in the company that you could try to reach.
• Complain about excessive waits to your state insurance department or insurance commissioner.
Another strategy is outsourcing the service or hiring a virtual medical assistant. Outsourcing providers tend to be tasked-based; That is, they are contracted to accomplish very specifically defined tasks without supervision and are paid in terms of output. A virtual medical assistant (or “VMA”) is also an outsourcing service but gives a lot more flexibility in terms of task assignments and are time-based. They’re real people who will handle your tasks remotely without using your space, tying up your lines or breathing your air. These solutions can handle the administrative work which office-based staff would otherwise make so they can focus on patient interactions.
A longer term direction would be industry-wide improvements on automation that will decrease the need to make those calls. Cooperative approaches like the ACA (Affordable Care Act) marketplaces and CAQH (Council for Affordable Quality Healthcare), as well as standards like HL7 (Health Level Seven), are steps in the direction of cross company coordination and healthcare process simplification. If online processes can be simplified and standardized across multiple entities and platforms, there’ll be much less need to make that phone call. It is inconceivable to eliminate making calls altogether but at least less calls mean short hold times.
It will also help to take the time to fill out survey forms that can come after a customer service call. Perhaps even if there are limited direct financial incentives for companies to increase customer service resources, let’s hope survey metrics can influence individual behavior and organizational priorities.
Of course, these options are not mutually exclusive (although some would take a while). It is important to understand your processes, including how much time your team spends on the phone and the real benefits of freeing people up (or not hiring additional staff). Perhaps stat insurance verifications can go down and collections can increase; or avoid a situation where a medical assistant facing a three-day backlog, after waiting half hour for an agent, gets grumpy with a Yelp caller.
In the meantime, just listen to that relaxing music, wear a hands-free headset and multi-task. Those customer service agents at the other end of the line are just doing their jobs. Perhaps if they’re happier with their interactions, they’ll take the extra effort to at least make your wait worth your while. One call down, twenty more to go.