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
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