Fifty shades of customer service
Itās hard to say one industry or company typifies terrible customer service, in a world where Comcast, Sallie M--um, oops, I mean Navient, and AT&T are all still in business. But I think you can be pretty confident in assuming whatever run-ins you have with medical billing departments are not going to be great.
Iāll omit the name of the hospital system thatās ensnared me in billing purgatory for the past eight months because I donāt want them coming after me or something. Suffice to say itās in eastern Massachusetts, theyāve got locations all over Metrowest, and their acronym is invoked in this ad campaign. This situation has been so characteristic of an utter failure at service design, though; I canāt resist sharing it.
In May, after a long winter of walking around in ill-fitting boots, I went to see a podiatrist about the pain in my right foot. While I was there, an x-ray of the foot and ankle was taken to rule out possible fractures. The x-ray came backĀ āclean,ā I was diagnosed with plantar fasciitis, and I went off to buy a new pair of sneakers and some arch-friendly insoles.
About a month later, I got a bill for the x-ray for over $300. I was shocked, unsure of why my insurance wouldnāt cover this when Iād only had the usual co-pays for seeing my PCP and the podiatrist. I looked into it and found that the claim had been denied as the diagnosis listed was āroutine foot care,ā a very vague term my insurance memberās handbook deemed uncoverable.
Long story short, I made about fifty phone calls between late June and November, alternating between billing department, insurance company, and eventually the podiatrist himself.
The billing department kept insisting that my insurance company āwasnāt able to view the whole claimā because people in member services ācan only pull up a little bit of it on their screens.ā (What?)
The insurance company kept telling me that the billing department needed to adjust the diagnosis codes and resubmit the bill. (Seems simple enough.)
But the billing department wouldnāt just do this. Instead, they continued making bizarre excuses to me, like saying the hospital would have to pay (something? someone? who??) twice if they were forced to resubmit the bill to my insurance. (As if, even if this were true, I am somehow responsible for or related to the practice in question.)
Finally, I thought Iād made some headway about a week before Thanksgiving - the podiatrist told me heād directly spoken to the billing department directly, asking them to change the diagnosis codes so they could resubmit the bill to my insurance in a way that wouldnāt trigger this āroutine foot careā business. I checked with him about a week later to see if anything had developed, but he told me to be patient; sometimes these things can take 45 or 60 days. So, I figured, OK, Iāll be patient - Iāve got better things to do than worry about whatās going on with a months-old medical bill.
Then, in a letter dated December 18th (which I only received two days ago, because it was sent via certified mail and I am pretty universally not around my house to sign things between 9-5 on weekdays), I see the following:
Account #: xxxxxxxxxx
Date of Service: 5/11/2015
Amount: $1,575.00
Pursuant to [insert appropriate regulation number here], this certified letter is being sent to inform you your account is seriously overdue, and you are going to be handed over to a collections agency if we do not hear from you within 20 days.
To give credit where creditās due, I suppose, this is a great way to get a visceral reaction out of a person (especially the bottom part of this bill, where this number is writ large in fire engine red).
Keep in mind the original amount of this bill was around $300, and also that Iāve been paying for all the other medical services Iāve received through the same hospital system (with yes, the same billing department) throughout the past eight months. It's not as if I'm some delinquent medical dine-and-dasher. There was no itemization on the new bill, just a figure that had somehow increased fivefold.
It was around 5pm by the time I opened this letter, an hour past closing time for the billing department. In the meantime, I called my insurance company to see if they could give me any insight. They had no explanation of the $1,575 charge and let me know that theyād never received an adjusted bill for my x-ray. (Iiiiinnteresting.)
I couldnāt talk to the billing department that day, and helpfully they have absolutely no billing-related information or FAQs on their website, so although Iād pretty clearly unearthed the root of the problem here, I couldnāt do anything about it until the following morning.
Bright and early the next day, I got through to the billing department. Cheerfully, the woman I spoke to told me that the $1,575 amount and the threat of a collections agency getting involved was all ājust verbiageā and that I should disregard it all.
Seriously.
She noted that my podiatrist had in fact asked her department to adjust the diagnosis codes in my bill and that theyād more or less just let it slip, but would do it now that Iād called.
So, they didnāt do their job, they sent me a farcical threat, and they wasted dozens of hours of my time. Nice work!
At the end of the phone call, I asked when I could expect this to be resolved.
ā45 to 60 days,ā the rep told me. (The magic numbers, apparently.) āBut we wonāt call you and tell you. Whatāll happen is, you may get another bill at the end of that time period. If itās the same amount, you can just disregard that and call us again. All that means is that no progress has been made.ā
All that means is, Iāll probably get to spend another set of hours attempting to resolve this, possibly also wasting the time of the doctor and my insurance company in the process. My cup runneth over!
I know thereās any number of systemic reasons why this situation exists, chief among them the overall inadequacy, cost-ineffectiveness, and deliberate inefficiency of the U.S. medical industry. But a service experience this abysmal does not have to continue. This hospital system could:
ā¹ Put a billing FAQ on their website, if only to placate people who are having panic attacks about ~$1,600 bills at dinnertime. Making customers feel helpless makes them hate you. (I think of the MBTAās woes during Snowpocalypse last year - how much ill will they couldāve spared themselves if theyād been more communicative and transparent.) Put more knowledge in the world, y'all.
ā¹ Stop threatening people with imaginary numbers and collections agencies.
ā¹ Proactively call people who are attempting to resolve billing troubles, or even just briefly email them through the hospitalās robust internal messaging system.
ā¹ Use some kind of CRM-type system to track customer issues in a knowledge base of sorts, so people donāt have to repeatedly explain their situation and/or hope for a rep whoās knowledgeable enough about similar cases to be able to meaningfully help.
ā¹ Just be more observant. If youāve got a customer whoās paid 9 of 10 bills, and has all kinds of notes in her record tacked on that 10th one, itās a little extreme to threaten her with a paycheck-sized charge and debt collection.
