Misinformation Kills: Conflicting Information Between Insurance and Medical Suppliers can Harm More Than Profits

Receiving opposite answers from two customer service reps left me wondering whether my health insurance claim would be approved or denied.

When I called Cologuard recently before sending my mail-in specimen to add new health insurance information to my doctor’s order for a routine screening for colorectal cancer, the process seemed easy enough.

“Most health insurance covers Cologuard so you shouldn’t have a problem,” the Cologuard agent told me. “But we always call to make sure first. I’ll call you back this afternoon if it’s not covered.”

I went about my work that day without worry — that is, until my phone rang and “Cologuard” popped up on my caller ID. Turns out my new health insurance provider would not cover the test, the Cologuard agent told me.

“That’s strange, since colorectal cancer screening is considered preventative care, she told me, adding that she even told the customer service rep that Cologuard was covered under the list of preventive services that most health insurance providers must provide to people 45 to 75 at no cost.

The insurance rep agreed with her. But then she contended that I’d have to pay 50 percent of the cost anyway.

Since both the Cologuard customer service agent and I were baffled by the information the health insurance rep conveyed, the Cologuard agent recommended that I call my health insurance provider directly the next day and ask again.

If you’ve ever called your health insurance company for information about your policy and documents, you already know it’s often a stressful experience, with many numbers punched before you finally get to a real person who then transfers you to the “right” department.

By this time, I’d already taken time from my workday to make one call to Cologuard. Now I faced two more calls — one to my health insurer and another call to Cologuard with a reference number if the health insurance customer rep told me the test was covered.

After a seven-minute hold, I finally got a health insurance customer rep.

“That procedure is covered 100 percent, so there’s no cost to you,” the agent told me.

“Are you sure? Another agent said it wasn’t covered,” I replied.

“That’s odd,” the agent told me. “We definitely cover that test.”

I made sure to get a reference number in case there was a problem with my claim later. But there remained nagging doubt that the insurer would actually approve the claim, since the first employee provided incorrect information to at least one provider and customer seeking approval for necessary health care.

I’m already dreading potential future issues with this claim that could force me to make even more calls to customer service due to misinformed or poorly trained employees. Getting conflicting information from two different agents at the same call center number put a serious dent in my trust and confidence in my new, well-known health insurance provider.

Were these customer experiences typical of this insurance provider? I’d like to think no.

However, actions speak louder than customer experience strategies when it comes to customer service reps doling out inaccurate information that could cost customers hundreds of dollars they shouldn’t have to pay or cause them to choose a self-pay option to “save” money.

The need for ongoing customer experience training

I’m guessing that the first health insurance customer rep was either poorly trained or unwilling to explore why the information she provided conflicted with federal healthcare laws.

Either way, the problem she presents for that health insurance company could be corrected with ongoing training and/or call monitoring and coaching from customer experience management at this company.

Will that happen? Maybe. Or maybe not, considering that among all the customer survey requests I received that week, there wasn’t one from this well-known insurer.

We’ll see what happens with my claim. But even if it’s approved, a poorly trained customer service rep has already sown a seed of distrust with my health insurance company that could blossom into more discontent, more easily, later on should other issues arise.