Are you satisfied with your current
health care plan provider? When
your employees call for assistance, are they being well-served?
It is hoped that you answered yes.
However, if you’re having a lot of problems
— and your employees are constantly
complaining to human resources — it may
be time to consider other alternatives.
The first consideration for most employers is how much coverage they can get for
their money. But it’s equally as important to
factor in the level of customer service.
“Whether you are seeking a plan for the
first time or are thinking about changing
providers, keep in mind that you want your
employees to be able to get a knowledgeable, empathetic person on the line quickly
when they call for assistance,” says Joyce
Krajnovich, director of service, Member
Services at AvMed.
Smart Business asked Krajnovich about
customer service and other qualities
employers should look for in a health care
provider.
What is the first thing a company should consider when selecting a health plan?
To begin, the employer should consider
the overall needs of its entire population.
It’s important to review the limitations and
exclusions, as well as the formulary guidelines to identify any specific coverage
deficits. Make sure the plan works for you.
Are the services you need covered? At
what cost share? How is the customer service? What value-added benefits does it
offer? Does it have a solid network of
providers? Bigger isn’t always better. What
about longevity? How long has the company been in business? How long do its customers stay?
What should an employer look for in customer service?
The days of customer service representatives (CSRs) who just ordered ID cards are
long gone. Today’s CSRs need to be fully
capable of guiding members through the
process in order to obtain 100 percent of
the benefits to which they are entitled. Is the company local? If so, the CSRs will
have that fundamental commonality with
members. What about phone response?
Does the company offer 24-7 access to a
CSR, nurse, clinician? How long are the
hold times? Can the customer get through
to a live person quickly and painlessly?
Are the CSRs well-trained and knowledgeable? Do they work closely with the
clinical staff, placing member health as the
first priority? Do they work with primary
care physicians to find specialists when
need be? Do they exhibit the important
qualities of patience, integrity and empathy? If they cannot help the member, are
they able to quickly escalate the issue to a
supervisor?
What are some additional considerations
when evaluating a provider?
Based on my experience, employers
make decisions based on the broadest
level of benefits at the most cost-effective
price. That’s what draws them to a plan.
What keeps them with a plan is the level of
service received from the plan. Without
quality customer service, the company is
going to get constant complaints from
employees, administrative costs will rise,
and oftentimes, the HR staff will get caught up in the middle.
Changing plans takes a great deal of time
and resources in terms of the bid process,
enrollment, etc. So companies should do
everything they can upfront to ensure that
they’re going to be satisfied with the plan
they select.
What other value-added services might be
important to a company?
As I mentioned earlier, working with a
provider whose employees are local is a
benefit because those employees know the
area and understand the logistics when
working with the list of network providers.
They can also help members find other
local resources to assist with services that
may not be covered — or are only covered
to a partial extent — in their policy.
Another important consideration involves
the wellness component. Does the plan
cover annual wellness visits? Does it offer
special care management programs, for
example, for those with asthma, diabetes?
Does it cover flu shots and immunizations.
Does the plan offer value-added services,
such as weight loss and smoking cessation
programs?
With all the controversy about health insurance and HMOs, what is the most important
piece of information you want to share?
Customers need to know that plan
providers are closely regulated and monitored by both federal and state regulatory
agencies. They cannot make arbitrary decisions but must make coverage decisions
based on the members’ individual plan
benefits. There is oftentimes a misperception that providers want to withhold care,
rather than manage care. Providers should
help consumers manage their benefits and
their care, so they can get the most out of
what’s available in regard to both.
JOYCE KRAJNOVICH is director of service, Member Services,
AvMed. Reach her at (352) 337-8617 or
[email protected].
