How not to run a business…
As I’ve mentioned in past blogs, one of the great joys of running your own business is getting to choose how to treat your customers. When I was working at BlueCross BlueShield running an operations team, we intentionally made the decision to uncomplicate a really complicated product/service so that our customers didn’t get caught in the middle. At Hofmeister Family Dentistry, we attempt to authentically welcome our patients into our family by treating them with respect and dignity (with a little humor sprinkled in).
Running a business isn’t all that complex. Your customers pay you to provide a service. You spend a certain amount of money to provide that service (e.g., paying employees, rent, buying materials, licensing software, and so on). And if you do it right, the amount of money coming in is more than the amount of money going out. Win win! The harder part is expressing your personal values while running the business. I think Jamie and I are effectively threading that needle (and every Google review get validates that take).
While it’s incredibly gratifying to project yourself out into the business world with empathy and kindness, it’s even more frustrating to interact with businesses that don’t share your values (or don’t event to attempt to hold themselves accountable to any semblance of a mission statement). I’d like to share a recent experience I had with an insurance company through whom one of our patients has a policy…
Back in June, a new patient called us to set up an exam/cleaning and to discuss treatment options for some work in which she was interested. She let me know up front that she had insurance through Careington Corporation and she wasn’t sure if we were in-network with them. I told her that’s no problem and that I’d be happy to speak with Careington to understand the extent to which they would or would not reimburse the patient’s upcoming visit with us. So that’s what I did. I spoke to Careington in late June (the week prior to the patient’s appointment). They quoted me out-of-network benefits and faxed me the details so I could have them on record should I need to do further benefit review. I relayed those benefits to the patient, that the visit would cost ~$450, and that Careington should pay between $250 - $350. The patient was fine with those prices and we scheduled the visit. At the appointment, the patient discussed future treatment options with Dr. Jamie and we told her we’d follow up in a couple weeks once Careington processed the claim. Two weeks later, I received a notice from Careington. They denied the claim for lack of eligibility! That meant that in Careington’s eyes, Lynn didn’t have an active insurance policy for the date of service. How could that be? I just spoke to a representative at Careington the week prior to the patient’s appointment. They quoted me benefits. They sent me an official document summarizing those benefits. It had the employees name on it and the date on which they sent it to me. I thought there must have been a mistake (an easily rectified mistake as sometimes this type of thing happens accidentally). So in mid-July, I called Careington. I explained what happened. I showed them the benefit documents I received from a Careington employee indicating that the patient would be reimbursed for her cleaning/exam she had at our office. They were just as confused as I was and they said they would review the case and get back to me. At the end of July, a supervisor with Careington called letting me know they weren’t going to pay anything for the patient’s exam/cleaning. They said they agreed that their employee made a mistake in quoting me the wrong benefits but the patient should have known that she didn’t have an active insurance policy with Careington and that she would have been responsible for payment (caveat emptor - blah blah blah). I expressed my disappointment to the supervisor and asked to speak to his manager. Three weeks went by and I didn’t get any response (despite repeated attempts to speak to the supervisor with whom I had discussed the case). Finally, yesterday, I got a call from a Quality Assurance Director at Careington who reiterated position that they would not be paying anything for the patient’s cleaning/exam and that the patient should have known that she did not have an active insurance plan. I reiterated my disappointment to the QA Director. I submitted a complaint to the Illinois Department of Insurance. And I wrote off the debt so the patient wouldn’t have to pay for Careington’s mistake.
I shouldn’t be surprised. The Better Business Bureau gave Careington 1 out of 5 stars. At BlueCross BlueShield, any time something out of the ordinary happened that negatively impacted our members or providers, we ran it through what we called the “Wall Street Journal Test”. We used this test to calibrate our response and to keep us oriented relative to our commitment to stand with our members in sickness and in health. In this test, we asked ourselves what would happen if a reporter wrote an article about what we were about to do. What would that article say? How would that article make the reader feel? How would we feel about ourselves and our business reading that article? Careington failed the Wall Street Journal test. I know how easy it is to do the right thing. You just have to do it. You have to hold yourself accountable to your stated values. I’m proud that Jamie and I get to do that. But I’m disappointed when I have to interact with other businesses that don’t hold up their end of the bargain.