Las Vegas, Nevada

Disclaimer: While we are passionate about educating people on Medicare, Just Medicare Advisors is currently only licensed in the state of Nevada to assist with policy placement.

Why Do We Continue To Accept Mediocre?

In a recent Kaiser Family Foundation Survey – 6 out of 10 people surveyed indicated that if they had a problem with their health insurance coverage, it had not been resolved or handled to their satisfaction.  Why?  Why is it that in one of the industries that has the most money funneled to it through insurance premiums, government subsidies and the like – is the customer service aspect so abysmal?  And why do we put up with it?

When something is wrong with our car, we take the car to the dealer and expect, no demand, that they solve the problem.  When we receive a bill that is in error from our electric service, we work with the customer service rep to correct the mistake and then they send an updated bill.  With most consumer services, these companies typically resolve the problem within a reasonable time frame.  Why does it take healthcare over 1 year sometimes?

A personal story – I had a surgical procedure in July of 2022.  Last week, I got a bill from the anesthesia group for over $1000.  I had met my deductible AND out of pocket last year.  Based on my plan, the bill should have been covered in full with no additional money needed from me.  They were an in network provider.  

Come to find out that they had submitted this bill 5 times incorrectly to my insurance carrier.  The difference they were billing me for is the provider discount that they negotiated with Anthem Blue Cross.  They cannot bill me for the discount that they agreed to!  It looks like perhaps this is their normal process even though it is illegal.  Do you know how many people just pay these bills because they want them to go away or not be put into collections?  

What I find intolerable is the wrong information that is given to people from provider offices.  People use their doctors as the front-line for information.  That is not a good strategy.  First, the receptionists in the doctor’s offices may be very “nice” but typically they are the youngest, least educated and don’t possess the skill set to problem solve on the spot. That position also has the highest turnover for staffing.   I have actually caught them “making stuff up”.  Not really calling an insurance carrier for accurate info – basing a response on what they heard someone else saying to another person.  

It is important that people have advocates – people that they can call – that are knowledgeable in how insurance programs should work.  Carriers want insureds to call member services but the response time is typically slow and often they are just reading off of a script without a basic knowledge or understanding of what they are even talking about.  In order to sell insurance in all states, a person must be licensed.  That is not the case with member services.  Many do not even understand the ins and outs of how providers interact with the insurance carriers.  So to call them when there is a provider issue – well, that can take a very long time.  

I suggest that people use a broker or insurance agent that has access to a customer service call center.  These people are typically from the industry and have been involved in the industry for a while.  There are aligned incentives to make sure that people get their issues resolved.  People that call in for help are not just a “number”.  Your broker or agent wants you to feel as good as possible about the insurance policy that they have sold.  Get them involved to help with the bumps in the road – they would love for you to refer them to others that you might know.


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