ICAE Dallas Spring 1999 Exchange – Health Breakout Session
Customer service challenges facing the health industry include:
- Customer education, or the lack there of
- HMO/Managed Care Issues
- UCR question
- Internal communications
- Regulator & consumer frustration with lack of company action and or communication which causes the consumer to go to the regulator
- The regulators expressed their frustration with the lack of continuity of personnel that they can go to for assistance
- LTC has its own set of issues, the delay of continuous claim payments once the period of disability has been established
- The lack of understanding of the elimination periods & the grandfather status of the older plans
The top area of complaints:
- Authorization for servicer/precert problems
- UCR
- UtilReview Assoc
- Medical necessity
- Claim payment delays
- Medicare HMO pullouts
