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 firstname.lastname@example.org.