The salesman walked into the doctor’s office dressed in a rumpled overcoat, worn tan brogues, a hat too small for his head, and carrying a briefcase that looked more like a suitcase from the 1930’s.  I thought to myself, ‘well now Willy Lowman, are you auditioning for Death of a Salesman?’

In the waiting room, I occupied my time browsing the requisite magazines that were laying on the requisite coffee table.  People Magazine – 164 pages.  Time Magazine —56 pages – a Cliff Notes version of People.  Fifty-five pages slamming President Trump – aliens from Area 51 spearheaded the hacking of the U.S. election.  There was a one-page article about the decreasing price of gasoline.  The author of the article about gas prices was fired for not writing about real news.

`Inattention Deficit Disorder (IDD). Is IDD is a deliberate collaboration between providers and payers to not meet the customer service needs of patients, members, and consumers?  Its premise is simple—if we do not acknowledge that a problem exists, how then can we be expected to solve it?

Last week I was speaking with an executive vice president of a large payer. As a courtesy, he asked me not to mention his name because he was trying to protect the guilty party, namely his firm.

The situation is the following. His wife had been treated at a large health system. The names of the system, and the name of the payer, are not important. They are not important because you can substitute different providers and payers and it would not change the discussion.

She received a letter from her provider stating that her reimbursement claims for several thousand dollars had been denied. Two sentences. One dollar amount. Zero explanation. She started calling.

Dialing for dollars.

She called the provider. She called the payer. She asked for an itemization of the denied amount. Eleven total calls. “You have to request an itemized copy of your bill.”

“That is exactly what I am doing,” she told the person. (It does not matter whether she told a provider’s employee or a payer’s employee; knowing which it was would not affect the outcome.)

“I can’t give you that information. You must send us a letter; something with a stamp on it. And you have to prove you are you.”

“But, I am me. I am the person to whom you are speaking.  Why don’t you call me at this number?  Won’t that prove I’m me?”  “We’re not allowed to make calls,” she was told.

So, back to my conversation with the EVP about this flawed process. “Is there anything you’ve seen that can make this process better?” He asked.

“There are two possible solutions,” I said. “One of them requires that your wife enjoys singing.”

“She’s in the church choir,” he replied.

“Well then, since it looks like she will be spending way more time than she wants on hold as she tries to solve her problem, it can be helpful to find an activity that she enjoys occupying those extended periods of inactivity. If she likes musicals, I would recommend that she use all her time on hold to learn each of the roles of Les Misérables. That is what I do.” (In case you are interested, I will be presenting a one-man performance of Les Misérables this summer at the National Theater in Washington, D.C.)

The EVP did not sound too keen on my first idea. “Well,” I said. “There is another way to solve the problem, and this way works one hundred percent of the time. Tell her to stop calling. Tell her not to reply to any of their emails, and if she receives any letters from either firm, just tell her to throw them away.”

“But we probably owe them money,” he said.

“I’m not suggesting that you do not pay the bill. I am only suggesting that you quit working hard trying to figure out how to pay it and how much you owe. After a few months, she won’t have to call anymore. They will call her. And when they call, they will be very helpful. The whole idea is for you to put the monkey on their back. Get things to the point where their whole focus is on convincing you to send them money. You’ll be surprised by how helpful they will be when they initiate the call.  And before you send them a check, tell them to send you a letter with a stamp on it to prove who they are.”

Dialing for Dollars: Part Deux.

The CEO of a large health system calls to schedule an appointment at his own health system and fails.

Pshaw, you are thinking. (Apparently, pshaw is really a word.)

Many of you are probably thinking that his health system is an anomaly. Once again, my response is pshaw. When you finish reading, call your health system and pretend that you want to schedule an appointment. By the thirty-minute mark of your call, you will be screaming epitaphs into your phone—Sic (intentional error).

IDD—Inattention Deficit Disorder. It could also stand for Intentional Deficit Disorder.

If we do not know there is a problem, how can we be expected to fix it?

Well, now you know. Payers and providers make it very difficult for patients and members and consumers to meet their needs. Either they do not know that the problem exists. Or they know it exists, and they just don’t care.

Either way, it is a poor reason to have a call center.  If a patient calls the call center and nobody answers the call, did the patient make a noise?