Communication with insurers: a pandemic problem the vaccine won’t fix

During COVID-19, I have developed a special dislike for jazz. The dreaded phone call hold—upbeat music paired with frequent interruptions by a robotic voice assuring me that someone will be with me shortly—has become an all-too-familiar sound. Though customer service lines have experienced increasing automation levels for several decades, their inefficiencies have been set against the backdrop of the COVID-19 pandemic in 2020. Following the pandemic’s beginning in the U.S. in mid-March, patients (and, by extension, their medical providers) have only had more reasons to call insurance companies. Their reasons have ranged from discussing fees in the unfamiliar landscape of telemedicine appointments to navigating long-time medication coverage under a new insurance plan post-job loss. Communication gaps have led to the fragmented quality of care for patients and frustration for doctors’ offices as they prioritize patients’ needs.

On a typical day, I see room after room of patients fighting to improve, or even stabilize their conditions without the most ideal medications for their treatment. At the end of these days, I turn my attention to a paperwork pile of phone calls to make and elaborate letters of medical necessity to send. It seems today that insurance plans, not providers, are tasked with determining a treatment plan for patients.

In contrast to the widespread economic consequences of COVID-19 for patients and small medical practices, health insurance companies have reported significant pandemic profits.  Some of the largest names in the industry, including Anthem, Humana, and UnitedHealth Group, reported “second-quarter earnings that are double of what they were a year ago.” Insurance companies may not necessarily hold onto these gains per the Affordable Care Act’s requirements to cap insurance profits. Nevertheless, such headlines call into question insurance companies’ interests to prioritize patient outcomes and employee safety. A Washington Post article notes that “strict regulations for industries such as banking and health care make fielding calls from outside the office impossible in certain situations.” As a result, a smaller subset of overburdened employees risks their health assisting patients and doctors’ offices with calls from anxious patients and frazzled medical staff. A Harvard Business Review study found that in two weeks, the average company saw the percentage of calls scored “difficult” double from 10 percent to 20 percent, including insurance disputes.

Together, these factors have produced the perfect storm of confused patients, frustrated providers, and understaffed insurers. Unsurprisingly, customers’ perception of insurance companies in the past year has been decidedly negative. From 2019 to 2020, the American Customer Satisfaction Index (ACSI) scores in two sectors, Finance & Insurance and Health Care & Social Assistance, dropped more than any other sector. Of note, Kaiser Permanente has consistently been in the upper bracket of individual health insurance company scores for the past five years. Kaiser Permanente offers a different model of coverage in which the company both treats the patient’s illness and sells the patient health insurance to pay for treatment. More time is needed to fully understand the possible merits of such a structure, but in theory, this model allows for a more streamlined channel of communication between providers and insurers.

Resolving this communication gap will clearly require an in-depth look at multiple aspects of the insurance-patient relationship: from providing representatives with training to de-escalate upset patients and studies that determine what patients really value in their interactions with insurance companies. With feelings of provider burnout and patient dissatisfaction on the rise, it is increasingly important that we draw attention to and brainstorm solutions for this issue. At its core, improving communication between insurers, patients, and providers optimizes human interactions to produce the most efficient and effective care. With this “call” to action in mind, perhaps jazz music will produce a less visceral reaction in the near future.

Anupama Balasubramanian is a premedical student.

Image credit: Shutterstock.com

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